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COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
Continuing to prove consistently effective, CHLOROMYCETIN
(chloramphenicol, Parke-Davis) has retained its effectiveness against
most strains of Escherichia coli 1-3 and other gram-negative organ-
isms.2'6 Altemeier reports: “At present, approximately 80 per cent
of the gram-negative organisms isolated in our laboratories are
sensitive to Chloromycetin.”2
A truly wide-spectrum antibiotic, CHLOROMYCETIN is also effec-
tive against gram-positive pathogens,3’4,7'11 even the troublesome
staphylococci.3’4,7'11
CHLOROMYCETIN is a potent therapeutic agent and, because certain blood
dyscrasias have been associated with its administration, it should not be used
indiscriminately or for minor infections. Furthermore, as with certain other
drugs, adequate blood studies should be made when the patient requires pro-
longed or intermittent therapy.
REFERENCES:
(1) Metzger, W. I., & Jenkins, C. J., Jr.: Pediatrics 18:929, 1956. (2) Altemeier, W. A.:
Postgrad. Med. 20:319, 1956. (3) Cohen, S.: Postgrad. Med. 20:483, 1956. (4) Rantz,
L. A., & Rantz, H. H.: Arch. Int. Med. 97:694, 1956. (5) Bennett, I. L., Jr.: West
Virginia M. ]. 53:55, 1957. (6) Hughes, J. G., & Carroll, D. S.: Pediatrics 19:184, 1957.
(7) Kempe, C. II.: California Med. 84:242, 1956. (8) Spink, W. W.: Ann. New York
Acad. Sc. 65:175, 1956. (9) Yow, E. M.: GP 15:102, 1957. (10) Wise, R. I.; Cranny, C.,
& Spink, W. W.: Am. J. Med. 20:176, 1956. (11) Royer, A.: Scientific Exhibit, 89th
Ann. Conv. Canad. M. A., Quebec City, Quebec, June 11-15, 1956.
PARKE, DAVIS & COMPANY * DETROIT 32, MICHIGAN
L I P P A P Y
JflN -9 1359
321340
NEW YORK ACAjEMY
Cr' .AEuiCiNE
V
FFECTIYE
fCETIN
SENSITIVITY OF 3 SEROTYPES OF E. COLI TO CHLOROMYCETIN
AND THREE OTHER MAJOR BROAD-SPECTRUM ANTIBIOTICS*
CHLOROMYCETIN 89%
*This graph is adapted from Metzger & Jenkins.1
Inhibitory concentrations were 12.5 meg. or less.
\
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
VOLUME XLIV, No. 1 ♦ July. 1957
CONTENT S :
Convention Events
Presidential Address, Francis H. Langley, M.D. 19
National Socioeconomic Issues Confronting Medicine, Ernest B. Howard, M.D. 24
Dependents’ Medical Care Program, Lt. Col. E. G. Rivas, MSC 27
Proceedings of Eighty-Third Annual Meeting 31
General Session 31
First House of Delegates 33
Second House of Delegates 37
Scientific Assemblies 69
Registration at Annual Meeting 70
Annual Reports
Annual Joint Report of Secretary-Treasurer, Samuel M. Day, M.D.,
and Managing Director, Ernest R. Gibson 73
Report of Editor of The Journal, Shaler Richardson, M.D. 79
Abstracts
Drs. Wm. H. Turnley, H. J. Roberts, Alvan G. Foraker, Bernard M. Barrett,
J. Ernest Ayre, David J. Lehman Jr. 28
Editorials and Commentaries
William Carmel Roberts, M.D., President 81
1957 Annual Meeting in Review 82
Ophthalmologists Awarded Citations by Florida Council for the Blind 86
Postgraduate Obstetric-Pediatric Seminar 86
Florida Medical Association Golf Tournament 86
Ford Foundation 1956 Report 87
Genera! Features
Others Are Saying 88
New Members 90
State News Items 92
Component Society Notes 98
Medical Officers Returned 100
Births and Deaths 100
Classified 102
Obituaries 102
Books Received 106
Schedule of Meetings 113
Florida Medical Association Officers and Committees 114
County Medical Societies of Florida 118
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price $5.00 a year: single numbers, 50 cents. Address Journal of Florida
Medical Association. P.O. Box 2411, 735 Riverside Ave., Jacksonville 3, Fla. Telephone EL 6-1571. Accepted for mail-
ing at special rate of postage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16.
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville,
Florida, October 23, 1924.
J. Florida, M.A.
July, 1957
s
YOUR PATIENT NEEDS AN ORGANOME RCURIAL
Practicing physicians know that many years of clinical and laboratory experience
with any medication are the only real test of its efficacy and safety.
Among available, effective diuretics, the organomercurials have behind them over
three decades of successful clinical use. Their clinical background and thousands of
reports in the literature testify to the value of the organomercurial diuretics.
TABLET
NEOHYDRIN
BRAND OF CHLORMERODRIN (is * mg. of 3*chloromercuri-2-methoxy-propvlurea
EQUIVALENT TO IO MG. OF NON-IONIC MERCURY IN EACH TABLET)
a standard for initial control of severe failure
M ERCUH YDRI N ® SODIUM
BRAND OF MERALLURIDE INJECTION
OIIM
6
Volume XLIV
Number 1
FOR ALL COMMON FORMS OF DIARRHEA
/j/ew^'OCHUf cJiecfc^. - .
POMALIN [liquid
DEMULCENT, A N T I - I N F E C T I V E A N T I D I A R R H E A L
. . . effective against both specific and nonspecific diarrheas
. . . palatable oral suspension . . . well tolerated
Each 15 cc. (tablespoonful) contains:
Sulfaguanidine
2 Gm.
Pectin
225 mg.
Kaolin
3 Gm.
Opium tincture
0.08 cc.
(equivalent to 2 cc.
paregoric)
DOSAGE: Adults: Initially 1 or 2 tablespoonfuls from 4 to 6 times daily,
or 1 or 2 teaspoonfuls after each loose bowel movement; reduce
dosage as diarrhea subsides.
Children: Vi teaspoonful (=2.5 cc.) per 15 lb. of body weight
every 4 hours day and night until 5 stools daily, then every
8 hours for 3 days.
Bottles of 16 fl. oz.
EXEMPT NARCOTIC. AVAILABLE ON PRESCRIPTION ONLY.
J. Florida, M.A.
July, 1957
7
Youngsters really go for the taste-true orange flavor of
Achromycin V Syrup. But this new syrup offers more than
“lip-service” to your junior patients. It provides the new
benefits of rapid-acting, phosphate-buffered Achromycin V —
a faster-
acting
oral
form
« accelerated absorption in the gastrointestinal tract
• earlier, higher peaks of concentration in body tissue and fluid
• quicker control of a wide variety of infections
• unsurpassed true broad-spectrum action
• minimal side effects
• well-tolerated by patients of all ages
ACHROMYCIN V SYRUP: aqueous, ready-to-use, freely
miscible. 125 mg. tetracycline per 5 cc. teaspoonful
phosphate-buffered.
DOSAGE: 6-7 mg. per lb. of body weight per day.
*Reg. U. S. Pat. Off.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
Volume XLIV
Number 1
A new
therapeutic approach
with inherent safety
in PRURITUS ANI
HYDRO LAM I NS®
TOPICAL AMINO ACID THERAPY
Unique physiologic barrier — topical amino acids —
brings rapid relief ( 98%‘ ) and complete healing (88%‘)
. .the objectives of therapy in pruritus ani can be listed
under 3 headings:
(1) relieve itching: [Hydrolamins produced immediate relief
of intractable itching in 98% of patients. The anti-
pruritic effect of one application lasts about twenty-four
hours.1]
(2) accelerate healing, [Hydrolamins rapidly and com-
pletely healed reddened, fissured, macerated and ridged
perianal lesions in 88% of cases.1]
(3) allow natural healing without trauma due to physical,
chemical, allergic, or microbiologic agents.”2 [The
amino acids of Hydrolamins promote safe, natural heal-
ing while the ointment protects the perianal area from
irritation.1]
Due to the rapidity of action of Hydrolamins, it is believed that protein-precipitating
irritants, responsible for the pruritus, are neutralized. Hydrolamins also forms a
biochemical barrier against further irritation.
SUPPLIED: In 1 oz. and 2.5 oz. tubes.
Pharmaceutical Company , Chicago 14, Illinois
1. Bodkin, L.G., and Ferguson, E.A., Jr.: Successful Ointment Therapy tor Pruritus Am, Am. J Digest. Dis
18:59 (Feb.) 1951.
2. Fromer, J.L Dermatologic Concepts and Management ot Pruritus Ani, Am. J. Surg 90 805 (Nov.) 1955.
J. Florida, M.A.
July, 1957
9
optimal dosages for atarax,
based on thousands of case histories:
( t.i.d .)
i".
■ t < i ■ i .
//;■// i'l l,
TENSION SENILE ANXIETY MENOPAUSAL SYNDROME ANXIETY PREMENSTRUAL TENSION
PHOBIA HYPOCHONDRIASIS TICS FUNCTIONAL G. I. DISORDERS PRE-OPERATIVE ANXIETY
HYSTERIA PRENATAL ANXIETY • AND ADJUNCTIVELY IN CEREBRAL ARTERIOSCLEROSIS
PEPTIC ULCER HYPERTENSION COLITIS NEUROSES DYSPNEA INSOMNIA
PRURITIS ASTHMA ALCOHOLISM DERMATITIS PARKINSONISM PSORIASIS
perhaps the safest ataraxic known
PEACE OF MIND ATARAX
(BRAND or HYOROXYZINC) nn 1 1 . O
Lablets-byrup
Consider these 3 atarax advantages:
• 9 of every 10 patients get release from tension,
without mental fogging
CHICAGO 11. ILLINOIS
• extremely safe— no major toxicity is reported
• flexible medication, with tablet and syrup form
Supplied:
In tiny 10 mg. (orange) and 25 mg. (green)
tablets, bottles of 100.
atarax Syrup. 10 mg. per tsp., in pint bottles.
Prescription only.
10
Volume XLIV
Number 1
kids really like.
SQUIBB IRON, B COMPLEX AND Bu VITAMINS ELIXIR
■ to correct many common anemias
■ to correct mild B complex deficiency states
■ to aid in promotion of growth and stimulation of appetite in poorly nourished children
Squibb
Squibb Quality —
the Priceless Ingredient
Each teaspoonful (5 cc.) supplies:
Elemental Iron 38 mg.
(as ferric ammonium citrate and colloidal iron)
(equivalent to 130 mg. ferrous sulfate exsiccated)
Vitamin Bis activity concentrate 4 meg.
Thiamine mononitrate 1.0 mg.
Riboflavin 1.0 mg.
Niacinamide 5 mg.
Pantothenic acid (Panthenol) 1.5 mg.
Pyridoxine hydrochloride 0.5 mg.
Alcohol content : 12 per cent
Dosage: 1 or 2 teaspoonfuls t.i.d.
Supply: Bottles of 8 ounces and 1 pint.
«iBi*AT0N,d> IS A SQUIBB TRADEMARK
J. Florida, M.A.
July, 1957
11
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or V2 teaspoonful
contains:
Pentylenetetrazol . .100 mg.
Nicotinic Acid 50 mg.
1. Levy, S„ JAMA., 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J.. 15:596, 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM I, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
Volume XLIV
Number 1
Meat . . .
and Protection
Against Hypochromic Anemia
Hypochromic anemia, the most common nutritional deficiency in
children in the United States, occurs most frequently in the second
six months after birth.1 A major cause of anemia in early infancy
may arise from insufficient transfer of iron from the mother to
the fetus,2 since anemia is not uncommon in pregnant women.
A first step, then, toward prevention of hypochromic anemia in
the infant is the provision of a prenatal diet rich in available iron
and in high quality protein. A second and most important step is
the addition of foods high in utilizable iron (egg yolk, sieved meat
and vegetables) to the infant’s daily diet as early as possible
(usually 3 months after birth).1
Meat contributes valuable amounts of anabolically effective pro-
tein, B vitamins, readily available iron, and other minerals to the
nutrition of the pregnant and lactating woman. The feeding of
sieved meat to infants after the third month provides well-utilized
iron and aids in the prevention of hypochromic anemia.
1. Jackson, P. L.: Iron Deficiency Anemia in Infants, Editorial, J.A.M.A. 160: 976
(Mar. 17) 1956.
2. Martin, E. A.: Roberts’ Nutrition Work with Children, Chicago, The Uni-
versity of Chicago Press, 1954, p. 211.
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nu-
trition of the American Medical Association and found
consistent with current authoritative medical opinion.
American Meat Institute
Main Office, Chicago. ..Members Throughout the United States
J. Florida, M.A.
July, 1957
13
(dihydroxy aluminum aminoacetate with belladonna alkaloids and phenobarbltal)
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs!
BCL.LADONNA ALKALOIDS
ALONE
LD 90%*
*15 mg. dose
of spasmolytic
proved lethal
in 90% of
test animals
BELLADONNA ALKALOIDS
WITH
ALUMINUM HYDROXIDE
BHIII Bfll fl IJUI
m
m
H
mammm
AI(OH)j
w/spasmolytic
substantially
reduces spasmolytic
drug effect
belladonna alkaloids with
DIHYDROXY ALUMINUM AMINOACETATE
(alolyn®, brayten)
LD 83%
Malglyn Compound
provides maximal
spasmolytic effect
Alglyn
Sty,
t Hr 1 i*4&
OJ Q fKQIOlQy
IS MO. ALKALOIDS
300 MO. AL (OH),
IB MO. ALKALOIDS
300 MOL ALOLYN
each tablet contains
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked at/sorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
dihydroxy
aluminum
aminoacetate.
N.N.R.
belladonna
alkaloids
(as sulfates)
phenobarbital
o.a aw.
o iea mo.
i«.a mo.
For both rapid and prolonged antacid effect, with consistently
effective spasmolytic and sedative action, rely upon Malglyn
for treatment of peptic ulcer and epigastric distress.
Also supplied: ALGLYN* (dltiydro«y alumi-
num aminoacetate, N N B. 0.5 Gm par tablet).
8ELGLYN* (dibydroiy aluminum aminoacatat*.
N.N.R.. 0.5 Gm. and belladonna alkaloids. 0.162 m|.
par tablet).
Specialities for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA ». TENNESSEE
14
Number 1
Volume XLIV
among nonhormonal antiarthritics . . .
unexcelled in
therapeutic potency
GEIGY Vm
Ardsley, New York
In the nonhormonal treatment of arthriti
and allied disorders no agent surpasse:
Butazolidin in potency of action.
Its well-established advantages
include remarkably prompt action,
broad scope of usefulness,
and no tendency to development
of drug tolerance. Being
nonhormonal, Butazolidin
causes no upset of normal
endocrine balance.
Butazolidin relieves pain,
improves function,
resolves inflammation in:
Gouty Arthritis
Rheumatoid Arthritis
Rheumatoid Spondylitis
Painful Shoulder Syndrome
Butazolidin® (phenylbutazone
Geigy). Red coated tablets of 100 mg.
Butazolidin being a potent therapeutic
agent, physicians unfamiliar with its
use are urged to send for detailed
literature before instituting therapy.
BUTAZOLIDIN
(piieriy 1 hutuz
AO/'
Signemycin V—the new name
for multi-spectrum Sigmamycin
—now buffered for higher
antibiotic serum levels.
capsules
OLEANDOMYCIN TETRACYCLIN E - PHOSPHATE BUFFERED
advance in potentiated multi-spectrum therapy-
higher, faster levels of antibiotic activity
New added certainty in antibiotic therapy
— particularly for that 90% of the patient
population treated at home or office where
susceptibility testing may not be practical.
Signemycin V Capsules provide the unsur-
passed antimicrobial spectrum of tetracy-
cline extended and potentiated to include
even those strains of staphylococci and
certain other pathogens resistant to other
antibiotics. The addition of the buffering
agent affords higher, faster antibiotic blood
levels following oral administration.
Supplied: Capsules containing 250 mg. (oleando-
mycin 83 mg., tetracycline 167 mg.), phosphate
buffered. Bottles of 16 and 100. ‘Trademark
World leader in antibiotic development and production
izer) Pfizer Laboratories, Brooklyn 6, N.Y.
— - — ^ Division, Chas. Pfizer & Co., Inc.
Volume XLIV
Number 1
The Best Tasting Aspirin you can prescribe.
The Flavor Remains Stable down to the last tablet.
25 p Bottle of 48 tablets (IK grs. each).
We will be pleased to send samples on request.
THE BAYER COMPANY DIVISION
of Sterl ing Drug I nc.
1450 Broadway, New York 18, N. Y.
METRETON
METI-STEROID — ANTIHISTAMINE COMPOUND
TABLETS NASAL SPRAY
with stress supportive prompt nasal comfort
vitamin C without jitters or rebound
ESPECIALLY FOR RESISTANT AND YEAR-ROUND ALLERGIES
Because edema is unlikely with the tablets and sympathomimetic
effects are absent with the spray, Metreton Tablets and Nasal Spray
afford enhanced antiallergic protection in vasomotor rhinitis
and all hard-to-treat allergic disorders — even in the presence of
cardiorenal and hepatic insufficiency.
COMPOSITION AND PACKAGING
Each Metreton Tablet contains 2.5 mg. prednisone, 2 mg.
chlorprophenpyridamine maleate and 75 mg.
ascorbic acid. Bottles of 30 and 100.
Each cc. of Metreton Nasal Spray contains 2 mg. (0.2%)
prednisolone acetate and 3 mg. (0.3%) chlorprophenpyridamine
gluconate in a nonirritating isotonic vehicle.
Plastic squeeze bottle of 15 cc.
Meti-steroid benefits are potentiated in
• • •
*
'T.M. KT i ll?
18
Volume XLIV
Number 1
from allergic effects of pollen
CO-PYRONIL
(Pyrrobutamine Compound, Lilly)
— with minimal side-effects
Each Pulvule ‘ Co-Pyronil’
provides:
‘Pyronil’ 15 mg.
( Pyrrobutamine , Lilly)
‘Histadyl’ 25 mg.
( Thenylpyramine , Lilly)
‘Clopane
Hydrochloride’ 12.5 mg.
( Cyclopentamine
Hydrochloride , Lilly)
This is the season when we all yearn for escape from every-
day life, to “commune with nature.” But, to the one allergic
to pollen, this craving is usually easier to endure than the
penalty of exposure to pollen.
Such a patient is grateful for the relief and protection
provided by ‘Co-Pyronil.’ Frequently, only two or three
pulvules daily afford maximal beneficial effects.
‘Co-Pyronil’ combines the complementary actions of a
rapid-acting antihistaminic, a long-acting antihistaminic,
and a sympathomimetic.
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.
758021
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, July, 1957 No. 1
Presidential Address
Francis H. Langley, M.D.
ST. PETERSBURG
This is not New Year’s Eve by the calendar,
but it is in a very real sense to our Association.
Our year is drawing to a close, and it is well to
look back and think of the good things and the
bad, the glories and the disappointments.
Two years ago I was entrusted with a great
responsibility. It carried with it one of the great-
est honors that could come to anyone — the trust
and faith of his fellows. I had a year in which
to train myself before the cares and duties of
office really descended on me. With eagerness I
followed the work of my predecessor, and con-
stantly feared my own inadequacy; but as I
watched the loyal support and strong backing
of a united organization, my confidence grew.
With such help, no one could fail.
A year ago John Milton passed the gavel to
me. I received it humbly but with a burning
determination to carry it honorably, and pass it
on, having done my best.
As I look back through the years to my pred-
ecessors in the presidency, it seems that each in
turn might join with the poet celebrating the torch
bearers of knowledge, of integrity and of dedica-
tion to medicine and humanity.
Whispering, take this deathless torch of
truth,
Take thou the splendor, carry it out of
sight
Into the great new age I must not know,
Into the great new realm I must not tread.
Officers and Board of Governors
The Officers of the Association and the Board
of Governors come first in this discussion. The
dedication of these men deserves praise beyond
my poor powers of expression. They have given
careful consideration and wise counsel regarding
the numerous problems which have arisen, and.
I believe they have arrived at sound solutions of
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 5, 1957.
those problems. In doing so, they have sacrificed
in time and money, and have done so cheerfully
and gladly. Our Secretary-Treasurer, Dr. Samuel
M. Day, has been most helpful, for many things
are cleared through his office which would other-
wise cause serious delay, and his continuing term
of office gives him a profound knowledge of the
working of the organization.
This year we have tried the use of an Execu-
tive Committee of the Board of Governors. The
possibilities are still being explored, but it has
served well in regard to long range planning.
Several of the items which I shall discuss origi-
nated in this Committee, and many things are
planned for the future.
Council
The Councilors under the leadership of Dr.
Herschel G. Cole have done an exceptional job.
The district meetings in the fall were well at-
tended, and such was the care that went into
their planning that I feel that any who did not
attend were deprived of a fine experience. A
new county society, Collier, has been established
during the year. It is a small group but a most
enthusiastic one. I am sure that the members
will give us excellent support in all activities in
their county.
Committee of Seventeen
At the request of Blue Shield, a committee
of seventeen members was appointed as an ad-
visory group to that organization. Two members
from each councilor district were appointed with
one member at large. Dr. Henry J. Babers Jr.
has been chairman, and under his capable leader-
ship great strides have been made in promoting
better understanding between Blue Shield and
our membership. Since we are Blue Shield, and
this House of Delegates constitutes its governing
body, it seems strange that such understanding is
necessary. Problems, however, have arisen, though
already many of them are being eliminated.
20
PRESIDENTIAL ADDRESS
Volume XLIV
Number 1
Scientific Work
Our Committee on Scientific Work, under the
chairmanship of Dr. George T. Harrell Jr., has
arranged a program which is varied and excellent.
Our guest speakers are outstanding, and this meet-
ing is an opportunity to learn much scientifically,
as well as to acquaint ourselves with the activities
of the Florida Medical Association.
Medical Postgraduate Course
As usual, the Committee on Medical Post-
graduate Course is to be commended for the excel-
lent program which it has provided. Not only
was the Short Course well attended, but many
took advantage of the five seminars throughout
the year. These covered such varied subjects as
cardiovascular diseases, gastroenterology, diabetes
mellitus, cancer, and opthalmology and otolaryn-
gology. I sincerely thank Dr. Turner Z. Cason
and his co-workers.
Medical Education and Hospitals
The Committee on Medical Education and
Hospitals has assumed new importance with the
assignment by the House of Delegates a year ago
of the duty of studying the relationship of Med-
ical School Faculties and the Physicians of the
Community. The actions of this Committee are
detailed in its report, and they should be care-
fully studied as this is a matter of great impor-
tance, and one which has caused much antago-
nism in other parts of the country. Among other
things, it recommended a Liaison Committee con-
sisting of a member from each medical school, a
physician from the county where each school is
located, one from each medical district where
there is no school, and a member at large. Dr.
Walter E. Murphree, Chairman of the Committee
on Medical Education and Hospitals, was ap-
pointed from Alafhua County and made Chair-
man of the new committee also, in order better to
integrate the two committees. I feel that they
have done everything possible to avert future
ill feeling and friction.
Medical Economics
The Committee on Medical Economics has
continued work on malpractice insurance. Now
that the state has allowed a 100 per cent increase
in premiums, there is more interest in getting our
business. The disability policy for our members
has been written for many individuals. We are
far short, however, of the percentage which
would permit all members to participate regard-
less of physical condition. I hope that you will all
think seriously of this coverage as it is excellent.
Legislation and Public Policy
The Committee on Legislation and Public
Policy under Dr. H. Phillip Hampton has been
working steadily throughout the year. Its task is
never ending as new problems arise faster than
the old ones can be disposed of. Yet, the thought
and care which the members of this Committee
expend deserve from every member of the Asso-
ciation the support which we alone can give, in
contacting our legislators and other people in
position to help us.
To all chairmen and committee members I
wish to express my heartfelt thanks. Time does
not permit my dwelling on each committee by
name, but they have all done well. I urge you
to read each of the reports in detail as they cover
the year’s work for the Association. Such study
will help you to evaluate the wwk of the Asso-
ciation and give you some idea of the immense
amount of effort expended by our membership.
Medicare Program
I shall pass quickly over the Medicare Pro-
gram as it will be reported by Dr. Milton. In
June 1956. the Congress passed legislation requir-
ing the care of all military dependents, either at
military installations or by private physicians.
Six months were allowed to implement the pro-
gram. This was an almost impossibly short inter-
val, but the American Medical Association and
the Department of the Army went to work with
representatives of the state associations. As you
recall, we had a called meeting in November when
there was much dissatisfaction expressed. Yet
we had no recourse, and our representatives were
empowered to bargain in our behalf. We may be
proud that our schedule is reported as the best
of any state. For this I am glad to express my
thanks to Dr. Milton. He carried the burden of
the negotiations, though he had the assistance
of a fine committee on his original work. Blue
Shield was set up as our fiscal agent. So far,
the situation has not developed too many prob-
lems.
In anticipation of renegotiation of our con-
tract, you instructed me to set up a Fee Schedule
Committee of fifteen men in five categories to
work out a more carefully balanced fee schedule.
This has been done, and they have entered into
the work with enthusiasm. T understand, how-
ever, that the time for renegotiation has been
J. Florida, M.A.
July, 1957
PRESIDENTIAL ADDRESS
21
changed from June 1957 to early 1958, as it was
thought that necessary data would not be avail-
able. To avoid misunderstandings, an arbitration
committee has been arranged to try to smooth
out situations not completely covered in the es-
tablished rate schedule.
Budget
Our budget has been worked out for the com-
ing year, and just as in the past year, there should
be a definite margin of savings. Our expenses
rise, but so does our income, and at present we
are on sound ground. The report of the annual
audit will be published in the July Journal.
Public Relations
Dr. Edward Jelks continues as Liaison for
the Board of Governors with our Public Relations
organization. To this important work he brings
a remarkable experience in the practice of medi-
cine. One has the conviction that in time of
stress, here is a man who can always be relied
upon for understanding and sound advice. The
quality of his work is a goal we should all strive
to emulate.
The Association had a very attractive exhibit
at the Florida State Fair in Tampa under the
supervision of Mr. Eugene L. Nixon. I watched
it for a time, and real interest was displayed in
it by the public.
At the State Science Fair in Gainesville, our
Association offered prizes in the junior and senior
divisions for exhibits in fields allied to medicine.
The exhibits came from local fairs all over the
state and they were wonderful. Our judges be-
came very enthusiastic, and I am confident that
this activity can well be maintained, and even
enlarged.
New Association Building
On the fifteenth of September 1956, the new
Home of the Association was dedicated. We all
had anticipated this for over a year, but the
reality far surpassed our hopes. The building is
beautiful and practical. Our staff can now work
to advantage, and it is surprising how much more
use is made of the building by various committees
than we had expected. Our thanks are due to the
committee who carried this project through, Drs.
Edward Jelks, Robert B. Mclver and Samuel M.
Day. You will be happy to learn that it was
possible to complete and furnish the building
without going in debt. In fact, we had a small
surplus.
Executive Staff
As the Association grows, there is an increas-
ing load placed on the staff of our Executive Of-
fice. The major problems and the minutiae of
detail alike keep them under constant pressure.
At all times our Managing Director, Mr. Ernest
R. Gibson, has his finger on the pulse of our
work. His quiet efficient management makes ev-
erything so smooth that one has to remember
that such service does not just happen.
Mr. W. Harold Parham is Assistant to Mr.
Gibson and Supervisor of the Bureau of Public
Relations. He is intimately acquainted with the
work of the Association and particularly as it ap-
plies to our relationships with others. A diplomat
of the first order, he is a power to be reckoned
with in all his activities.
Mr. Nixon is building a fine place for himself
in the organization. More and more, important
duties are being entrusted to him, and he per-
forms them well.
Our thanks are due for the devoted work of
Mr. Thomas R. Jarvis, Director of Publications;
Mrs. Zoe Pack, Office Manager; Mrs. Mae W.
Mason, Secretary to the Board, and the remain-
der of our hard-working staff.
Thirty-Five Year Certificates
We have considered for some time at the
Board meetings the desirability of some recog-
nition for long service in the practice of medicine
in Florida. The question of honoring our fifty
year members was given up as being too long
a span for most of us to attain. We have life
membership for those who have been active mem-
bers for thirty-five years. This is fine, but it
was thought that further recognition in the shape
of a certificate to be presented to each member
at the convention following his attaining life
membership would be in order. The Board ap-
proved the idea and the certificates have been
prepared and will be presented during this meet-
ing. On the ninth of April, I was privileged to
present the first certificate to Dr. Joseph Halton,
of Sarasota, at a meeting of the Sarasota County
Medical Society, given over to recognition of his
fifty years of active practice in Sarasota. He
brings to six the number of our fifty year mem-
bers.
Convention Schedule
As you have noted, there has been a reorgan-
ization of the convention schedule. Various rea-
22
PRESIDENTIAL ADDRESS
Volume XLIV
Number 1
sons have necessitated this. One of the most im-
portant was the need to provide more time for our
all important reference committees. So much
business has to be transacted that it must be care-
fully considered, with an opportunity for all in-
terested parties to be heard, by such small groups.
Their careful recommendations are then heard by
the House and usually are accepted. Such trust
required that their deliberations must not be
hurried.
Also, this House is the Governing Body for
Blue Shield and adequate time had to be found
for the Annual Meeting. Now the newly seated
group of delegates will hold the meeting rather
than the outgoing one. I believe that this change
will unite us more closely behind Blue Shield and
trust each delegate will be at the meeting tomor-
row.
Auxiliary
As we have come to expect, our Auxiliary has
done a magnificent job this year. My sincere con-
gratulations to the President. Mrs. Scottie J.
Wilson, and her able group of officers and com-
mittee women. I believe that I should also com-
mend Mrs. Richard F. Stover for her work in get-
ting the Charter, Constitution, and By-Laws in
order. To all the ladies, I extend my sincere
thanks for their constant help, and to Mrs. Perry
D. Melvin my best wishes for a successful year
to come.
A. M. A. Delegates
We have in our midst a group of men who
are working hard, not just this year, but through
the years in behalf of our own State Organization
and for the Profession as a whole. I refer to our
Delegates to the American Medical Association.
Drs. Louis M. Orr, Reuben B. Chrisman Jr. and
Francis T. Holland. Their work is outstanding as
is that of Dr. Homer L. Pearson Jr., who is
Chairman of the Judical Council of the A. M. A.
Florida Medical Foundation
The establishment of the Florida Medical
Foundation was authorized by the House of Dele-
gates a year ago. The organization has now been
completed. Our Charter has been issued and
Constitution and By-Laws adopted. The govern-
ing body is the Board of Governors of the Flor-
ida Medical Association, and the officers are Dr.
Edward Jelks, President; Dr. John D. Milton,
Vice President; and Dr. Clyde O. Anderson, Sec-
retary-Treasurer. Although the organization has
recently been completed, there is already a small
sum of money in the treasury. I hope that very
soon this will be multiplied to the point that work
on varying lines may be started.
Constitution and By-Laws
It has become increasingly evident that the
Association’s Constitution and By-Laws are long
overdue for a thorough revision. Continuous
amending over the years has permitted discrep-
ancies and even contradictions to creep in. I
recommend that the President be instructed to ap-
point a subcommittee to the Board of Governors,
to study and rewrite the Constitution and By-
Laws, and present them to the House of Dele-
gates at the next annual meeting for consider-
ation.
Sound and effective revision will be no easy
task. Many phases of Association activities will
require extensive study to determine what changes
are required now, and for the years ahead. The
Journal, for example, has grown and prospered
splendidly and has kept pace with progress, but
it has done so under increasing handicaps. The
time has come to give its organization, procedures
and policies careful scrutiny to determine how it
can best serve the Association.
This problem has been discussed with the
Editor. Dr. Shaler Richardson, who is in full ac-
cord with my recommendation that the President
be instructed to appoint a committee of not more
than five members to consult with the Editor in
a study of all phases of The Journal and to report
its findings and recommendations at the next an-
nual meeting of the House of Delegates. These
could then be incorporated in the Constitution
and By-Laws, thus relieving the other committee
of this particular topic.
When we think of such a wonderful publica-
tion as our Journal, I am sure that everyone will
wish to do all possible to make things easier for
the Editor, Dr. Richardson, and his Professional
Staff. At the same time, we can show our com-
mendation of Mr. Jarvis and Mrs. Edith B. Hill,
who have worked so enthusiastically for The Jour-
nal, by simplifying some of their problems.
I believe that this covers the major happen-
ings of the year. Considering the number of peo-
ple working, I could spend hours detailing the
many fine accomplishments of our individual com-
mittees, county societies, county officers, indeed
all who unselfishly give of their time and labor for
the good of all.
J. Florida, M.A.
Julv, 1957
PRESIDENTIAL ADDRESS
23
Dr. Francis H. Langley delivering Presidential Address.
Union and Solidarity
A year ago, Dr. Milton spoke of the dangers
of the corporate practice of medicine. This is a
constant threat to American Medicine and is
rapidly increasing as a threat here in Florida.
New industries are pouring into the state, and
the unions are demanding more and more conces-
sions. Much thought and careful planning must
be expended if we are to meet this challenge to
the private practice of medicine. The keystone
of private practice is the physician-patient rela-
tionship. This calls for the free choice of physi-
cian by patient, as well as the right of the physi-
cian to decline the care of a patient whom he does
not wish to treat.
The closed panel is the device of those who
wish to subordinate the physician to some out-
side group. Their motto is “Divide and Con-
quer,” and this is a method which has been used
disastrously throughout all recorded history by
tyrants and dictators. The United States of
America early recognized the dangers inherent in
this approach and set up a tightly knit union in-
stead of a loose federation of states. Do you have
a coin in your pocket? If so, you will find on it
two rules for guidance of a nation such as ours,
or an association such as ours. The first is “In
God We Trust.” No one will gainsay this noble
rule by which we all try to live. On the other
side of the coin we find in Latin “E Pluribus
Unum.” “One from many.” Here is the critical
point. We must present a united front. A saying
learned in childhood “United We Stand, Divided
We Fall” was never more true than now.
It has been with great anxiety that I have
observed a tendency on the part of a few to be
ready to disrupt the unity of the profession. It is
manifest in threats to carry to the newspapers
stories of dissension and disagreement, and in
willingness to sign on closed panel insurance lists
in the hope of personal advantages, not recogniz-
ing that by so doing, one gives power to those
who would debase and degrade the practice of
medicine.
1 quote from an address by G. Westbrook
Murphy, M.D., of Asheville, N. C.: “We live in a
society which is largely controlled by tightly or-
ganized groups, and 1 submit to you the hypothe-
sis that in it only an organized group can survive.
In the eyes of the public we are a union. We
bear the excoriation and censure which is often
heaped upon unions, but we have not had the
advantages which come from union organization.
1 do not suggest that now or ever in the future
we refuse to give our best professional services to
24
SOCIOECONOMIC ISSUES CONFRONTING MEDICINE
Volume XLIV
Number 1
all the sick who need us. 1 do suggest that we
use the power of this organization to control the
social and economic circumstances under which
our services are rendered when a third party
intervenes between physician and patient.”
George Washington once said: ‘‘If to please
the people, we offer what we ourselves disapprove,
how can we afterward defend our work? Let’s
raise our standard to which the wise and honest
can repair — the event is in the hand of God.”
Dr. Samuel Z. Freedman, President of the
New York County Medical Society, makes the
suggestion that physicians do their negotiating
with labor unions, management, insurance com-
panies and hospitals through their medical so-
ciety. I quote: “The practitioner of medicine as
an individual is at the mercy of any group which
decides to provide medical care through a closed
panel system, a clinic, or any other plan in which
the physician becomes a hired hand.”
Now a final quotation from that great Ameri-
can whose knowledge and understanding of peo-
ple have probably never been equaled, Benjamin
Franklin: “They that can give up essential liber-
ty to obtain a little temporary safety deserve
neither liberty nor safety.”
Before I close, I wish to thank my wife Sarah,
who has been a constant help and inspiration to
me. I know that I have tried her patience on
many occasions, but it could not be avoided.
Her company on some trips made them vastly
pleasant, and I hope she enjoyed them as much
as I. To my children, I am sorry that I disrupted
many of their plans. I promise to do better in
the future.
I spoke of the torch bearers at the opening
of this address — the men who have been Presi-
dents of this great Association. Before me I see
succeeding Presidents, though I know not which
ones they are; and still beyond them are others
still in school, even as yet unborn. So I must
return to the poet and say:
Come then, swift footed, let me see you
stand
Waiting before me, crowned with youth
and joy;
This is the turning. Take it from my hand.
For I am ready, ready now, to fall.
National Socioeconomic Issues
Confronting Medicine
Ernest B. Howard, M.D.
CHICAGO
Political-Legislative Situation
At the moment the Washington legislative
situation can be characterized as moving in a
sidewise direction. Many health bills have been
introduced, but little significant action has oc-
curred because of the preoccupation of the Con-
gress with the subject of government economy.
If the economy drive succeeds in bringing about
a significant reduction in the budget, many
health bills that might have received favorable
attention will die in committee.
It is our hope that substantial reductions will
be made in government appropriations. Such
reductions would make unlikely the adoption of
health measures opposed by American medicine.
The Eisenhower administration, notwithstand-
ing its relatively liberal proposals in certain
directions, is not supporting any important health
legislation in this Congress to which the Ameri-
can Medical Association objects. It is significant
that for the first time in many years no special
Assistant Secretary, American Medical Association.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 6, 1957.
health message was delivered to the Congress.
The absence of a health message reflected the at-
titude that no health crisis exists.
Only two health proposals are receiving seri-
ous administration consideration: (1) federal
support on a one time basis of reconstruction and
renovation of the physical plant of medical
schools, and (2) legislation to permit pooling of
insurance funds for the purpose of selling sub-
standard or high risk health insurance without
violation of the antitrust provisions of the Sher-
man Act. The AMA has repeatedly endorsed the
Hill-Burton type of program for renovation and
reconstruction of medical schools proposed by the
administration. No stand has been taken relative
to the pooling of insurance funds by the health
insurance industry, and it is unlikely that the
Association will adopt any position on this issue.
Social Security
The administration’s attitude toward the dis-
ability amendments to the Social Security Act
adopted in 1956 has not, so far as we know,
changed. This amendment, providing cash bene-
J. Florida, M.A.
July, 1957
SOCIOECONOMIC ISSUES CONFRONTING MEDICINE
25
fits at age 50 to Social Security enrolees who
are disabled as defined in the bill, was strongly
opposed by Secretary Folsom of the Department
of Health, Education, and Welfare on behalf
of the Eisenhower administration, at the Senate
Finance Committee hearings in 1956. Notwith-
standing the opposition of the AMA, the U. S.
Chamber of Commerce, the Farm Bureau Feder-
ation, the health insurance industry, and the ad-
ministration, the bill was adopted 47 to 45. It
was a bitter defeat, and it set the stage for an
expanding role of the federal government in med-
ical care. Already bills have been introduced to
liberalize the disability definition, reduce the age
at which benefits can be received, add “free”
hospitalization to Social Security beneficiaries over
the age of 65 and increase the taxable income
limit from $4,200 to $6,000. Through this dis-
ability provision the drive for compulsory health
insurance has been facilitated.
Specific Legislation
VA Medicine. — Certain bills have been in-
troduced in the field of veterans’ medical care
that provide a ray of hope in that they tighten
the requirements for eligility for such care. On
the other hand, pressure continues for liberalizing
governmental benefits to veterans and their de-
pendents. Of all AMA legislative programs none
requires more vigilance and patience, for the
veterans’ medical care program has been in oper-
ation for a long time. Every medical society and
physician should support Dr. Louis Orr, Chair-
man of the AMA Committee on Federal Medical
Services, in his statesman-like efforts to contain
this program and eventually bring about changes
in the basic legislation that will establish it on a
sound basis.
Social Security Coverage of Physicians. —
Coverage under the Social Security Act still ex-
cludes physicians. There is at the present time no
strong pressure in the Congress for their inclusion.
I would be less than candid, however, if I did not
admit that there appears to be a growing percent-
age of physicians who desire compulsory coverage
and who have been increasing their pressure with-
in the organization for a change in our fundamen-
tal policy. The information that we have indicates
that physicians in general are still overwhelmingly
opposed to compulsory coverage, but the percent-
age of such opposition has declined.
A vigorous program is being pushed to pro-
mote passage of the Jenkins-Keogh bills. These
bills will permit physicians and other self-em-
ployed persons to set aside from current income
a maximum of $5,000 or 10 per cent, whichever is
lower, into an individual retirement trust fund.
The fund could be established through insurance
companies or banks. Taxes on the current con-
tributions would be deferred until the money
was withdrawn at the age of 65 from the fund.
I'he American Bar Association and many other
organizations, including the AMA, have com-
bined their resources in the American Thrift As-
sembly, which is conducting a vigorous campaign
of information and education on this issue. Un-
fortunately, other groups are seeking special
benefits which may make the Keogh-Jenkins
proposals more difficult to achieve. The railway
employees are seeking tax deductibility for their
contributions to their government-controlled pen-
sion fund, and there is pressure for the granting
of tax deductibility for the contributions of Social
Security taxpayers. The Keogh-Jenkins principle,
therefore, which is equitable for the self-employed,
is being exploited by other groups in such a way
as to endanger the success of the entire program.
Medicare. — The Medicare program which has
now been in operation for some time has obvious-
ly become a serious issue at this meeting of the
Florida Medical Association. The central issue
is the degree of control, if any, that should be
exercised by the federal government over the fees
charged by physicians for the treatment of de-
pendents of service men. In the negotiations con-
ducted by the AMA with the Department of De-
fense, it was held by the Department of Defense
Task Force that the intent of the Congress was
that a full service program be set up. The Task
Force further insisted that a schedule of allow-
ances, constituting full payment, must be a part
of such a program.
Whatever the interpretation of the Depart-
ment of Defense, and the U. S. Army office that
acts as its agent, the law itself does not require
any schedule of allowances.
Contract Practice
Contract practice, in which physicians are
hired by third parties for the purpose of provid-
ing medical services on a prepayment basis or on
fee-for-service received by the third party, has
always caused deep concern among medical so-
cieties. It is obvious that when medical services
are provided by a third party, particularly of a
corporate nature, the opportunity exists for ex-
26
SOCIOECONOMIC ISSUES CONFRONTING MEDICINE
Volume XU V
Number 1
ploitation of the physician and the public by the
sale of medical services primarily for profit. The
abridgment of the right of the patient to select
the physician of his choice that characterizes
many medical care plans of the contract or cor-
porate type is what most disturbs the medical
profession. This basic principle of “free choice’’
is the essence of capitalism. It is the case of
antisocialist philosophy. In this sense, therefore,
it applies to all free, competitive enterprise as
well as to the provision of medical care.
The second basic free enterprise principle
that applies to medicine, as well as to other pro-
fessions, commerce and industry, is the right to
seek a fair price for service rendered. Interfer-
ence with this right is common in contract or
corporate practice. The medical profession prop-
erly looks with a jaundiced eye on the loss of this
privilege.
The corporate practice of medicine by hospi-
tals, medical schools, lay-sponsored plans and
other agencies continues in a state of flux, ex-
panding in some areas, receding in others. The
Larson Commission on Medical Care Plans of the
AMA is conducting an exhaustive study of many
of the problems incident to this type of medical
care. Undoubtedly it will report conclusions of
far reaching importance in the near future to the
AMA House of Delegates.
Labor
The future shape of medical practice will
depend to a considerable degree on what the
AFL-CIO finally decides to do in the field of
health. Unlike its attitude on pensions, the AFL-
CIO has not yet crystallized its position on medi-
cal care. Bargaining for health benefits, therefore,
is characterized by diversity rather than by uni-
formity. If the AFL-CIO continues its support
of compulsory health insurance and the promotion
of medical care plans characterized by full serv-
ice, fixed fees, closed panels, no income limit,
medicine’s troubles will be compounded — for the
political and economic power of labor must not
be underestimated.
In this connection, the current McClellan
committee investigation of racketeering and cor-
ruption in labor is a salutary event. It will un-
doubtedly have a profound effect upon the activi-
ties of labor. It is unlikely, however, that it will
neutralize the effect of labor on the practice of
medicine. Under the circumstances, it is urgently
necessary that medicine use all of its resources to
inform labor leaders about the practice of medi-
cine and the nature of the physician-patient rela-
tionship. It is possible — although unlikely — that
we can persuade labor to withdraw from its posi-
tion of supporting compulsory health insurance.
Collaboration with Other National Organizations
Medicine cannot win its battle alone. It is
vital that American medicine collaborate as
closely as possible with other national conserva-
tive organizations. Nationally, we have succeeded
in the last few years in establishing constructive
relations with the U. S. Chamber of Commerce,
the National Association of Manufacturers, the
American Farm Bureau Federation, the National
Retailers Federation, the American Bar Associa-
tion and many other professional and business
groups. These relationships have been fruitful
both for medicine and for the nonmedical leaders
with whom we have consulted. I urge you to ex-
pand this liaison so that it exists in the states and
counties wherever appropriate liaison can be
established.
Conclusion
It is just as difficult to prognosticate socio-
economic events as it is in difficult medical cases.
Obviously, a serious struggle is now in process
between the conservative and liberal wings of
both major parties. The present economy wave,
if it is brought to a successful conclusion, will be
a strong force for conservatism. The spontaneity
and widely diffused nature of the public’s reac-
tion to high taxes and government spending are
enormously encouraging. Other factors, such as
the increasing percentage of home ownership, the
movement of families from crowded urban areas
into the suburbs, the recent strong antisocialist
comments of the father of “cradle to the grave”
security, Lord Beveridge, and many other isolated
events, suggest a possible renaissance of con-
servative thought and action. Certainly it can
be said without fear of contradiction that a spirit
of defeatism will lead to nothing but defeat. A
reasonable degree of hope and optimism is essen-
tial if we are to stem the tide of government con-
trol. One of the most effective tactics used for
years by socialist propagandists has been the pro-
motion of the idea that socialism is inevitable.
We must as a countertactic oppose this false idea
at every opportunity, and press every advantage
we have — for tomorrow’s history will be written
by leaders with courage and conviction, not by
those who have already yielded.
535 North Dearborn Street 10.
J. Florida, M.A.
July, 1957
27
Dependents Medical Care Program
Lt. Col. E. G. Rivas, MSC
WASHINGTON, D. C.
It is an honor and a privilege to speak to you
today concerning the Dependents’ Medical Care
Program. Before I discuss the program, however,
I want you to know how very much we appreciate
the wonderful manner in which you have co-
operated with us in its implementation and execu-
tion. We think that everyone has done a magnif-
icent job. Before coming here, I carefully looked
over our files concerning the operation of the pro-
gram in Florida. I found no correspondence which
indicated that any serious problem existed in the
administration of the program in this state. On
the contrary, it seems to be operating in a highly
efficient manner.
Florida ranks third in the nation in the num-
ber of cases of dependents cared for under the
Dependents’ Medical Care Program. Perhaps
you have guessed that your record is topped only
by your age-old rivals, California and Texas. Ap-
proximately 4.8 per cent of all claims received
have come from the state of Florida.
Program Experience
To date, we have received approximately
88,000 hospital and physicians’ claims amounting
to about $7,000,000. Some 37,000 of these claims
are from hospitals while about 51,000 have been
received from physicians. The average cost per
claim for physicians amounts to approximately
$68 while the average cost for a hospital claim
is around $96. These figures do not include ad-
ministrative costs connected with the handling of
claims.
You might be interested in knowing that 41
per cent of all claims received were for care ren-
dered to Air Force dependents; 31 per cent for
Navy; 26 per cent for Army; and 2 per cent for
public health service. I am not sure that these
statistics prove anything. It is noteworthy, how-
ever, that dependents of Air Force personnel
lead the list of those eligible dependents benefit-
ing from care authorized from civilian sources.
Another interesting point is that 42 per cent of
all claims received involve the care of dependents
Director. Liaison and Special Activities, Office for Depend-
ents’ Medical Care, Office of the Surgeon General, Department
of the Army.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 5, 1957.
who reside away from their sponsors, that is,
those who in the past have received care from
civilian sources at their expense.
Analysis of Statistics Concerning the Program
Although it is a little early in the program
to present statistical data connected with the
program, or to attempt to evaluate collected sta-
tistics, we have made an analysis of claims so far
submitted, which I should like to offer to you
for your information.
Principal Procedures and Operations From
5,000 Physicians’ Claims
Operation or Procedure Per Cent
Physician’s Visits 23.4
Hospital visits 18.1
Home or office visit 5.3
Surgery 73.0
Maternity 37.9
Delivery 28.8
Miscarriages and abortions 3.7
Circumcisions 2.7
Cesarean 1.8
Others 0.9
Female genital system 8.0
Curettage of uterus 3.1
Hysterectomy 1.7
Salpingectomy 0.7
Oophorectomy 0.6
Others 1.9
Eye, ear, nose, throat 18.0
Tonsillectomy 17.4
Eye 0.2
Ear 0.2
Nose 0.2
Abdominal operations 4.6
Appendectomy 1.8
Herniorrhaphy 1.4
Hemorrhoidectomy . 0.4
Cholecystectomy 0.4
Others 0.6
Integumentary system 2.2
Musculoskeletal system 0.9
Other operations 1.4
Other Procedures 3.6
Pathological examinations 2.5
X-rays, diagnostic 1.1
Total 100.0
Source: ODMC claims from physicians.
Date: March 1957.
Identification of Dependents (Eligibility Card)
The dead line date for which dependents must
have in their possession an identification card en-
titling them to care under the program has been
extended to Dec. 31, 1957. This extension was
necessitated by difficulty in preparing a suitable
card to be used in connection with the program.
28
ABSTRACTS
Volume XLIV
Number 1
I am happy to say that this card has now been
decided upon and is being printed. It should
be available in the field in the immediate future.*
A card will be required in the case of all depen-
dents 10 years of age and over. A picture of the
dependent will be required. While, as I mentioned
before, the dead line has been extended to Dec.
31, 1957, it is hoped that every eligible dependent
will make an effort to obtain an identification
card as soon as possible.
Comment on Questionnaires
Our office sent out a number of questionnaires
to dependents who availed themselves of care from
civilian sources under our program. Without ex-
ception, all stated they were entirely satisfied
with the care they received. Many were most
complimentary in their replies concerning care
which they received from civilian sources. This is
certainly a tribute to the practice of medicine in
this country.
*DD Form — 1173 is now being issued.
Summary
In summary, 1 should like to say that the
program is operating in a highly commendable
manner. We have received extremely few com-
plaints of any nature, and those we have received
have not been concerned with the quality of care,
but rather with the lack of coverage provided by
the program, particularly in the area of outpatient
care. I do not know of one single instance in
which a physician has denied an eligible depen-
dent care under the program.
Again, I wish to thank all of you for con-
tributing so much to the operation of the pro-
gram— -the physicians for their participation in
caring for our dependents; the Florida Medical
Association for its invaluable assistance in the
implementation and continuing operation of the
program in Florida; and the fiscal agent, Blue
Shield of Florida, Inc., for handling so efficiently
the payment of physicians in this state.
ABSTRACTS
Hemicrania — or One-Sided Sphenopala-
tine Ethmoid Headache. By Wm. H. Turnley,
M.D. Laryngoscope 66:582-591 (May) 1956.
Hemicrania, a term first adopted by Galen
and eventually corrupted to migraine, designates
a one-sided headache which seems to have its
origin in the sphenopalatine ganglion region of the
nose, between the posterior ethmoid cells and the
nasal septum. The syndrome may radiate from
this spot to the entire side of the body in extreme
cases, simulating the whole gamut of headaches
from tic to epilepsy. The author here relates his
experience in treating this type of headache, dis-
cussing the anatomic considerations, symptoms,
signs and therapy. He comments on the much
greater frequency with which he has encountered
this syndrome in central Florida than in a
metropolitan area in the North. His clinical
results have convinced him that the treatment
“par excellence” is relieving the pressure and
allowing ventilation and drainage in the spheno-
palatine ethmoid area by a careful and thorough
submucous resection of the nasal septal carti-
lage, especially posteriorly and superiorly, al-
though even this is not a panacea.
Postdiphtheritic Polyneuritis and Pseudo-
diphtheritic Polyneuritis: Report of Two
Cases Treated with Cortisone and Cortico-
tropin. By H. J. Roberts, M.D. A. M. A. Arch.
Int. Med. 97:618-626 (May) 1956.
Two cases are reported in which cortisone and
corticotropin were employed in the treatment of
diphtheritic and pseudodiphtheritic polyneuritis,
primarily because of the progressively deteriorat-
ing state of the patients. In one patient with
atypical diphtheritic polyneuritis these hormones
neither reversed nor retarded the neuritis and
cardiac complications. The treatment, however,
had been delayed by one month following the
initial pharyngitis. The other patient, manifest-
ing a progressive neuritis, exhibited a dramatic
and complete remission when cortisone was begun,
approximately three weeks after the faucial in-
flammation and two weeks after she had ingested
apiol. The diphtheria organism was not cultured,
although penicillin and antitoxin therapy had al-
ready been administered. The differential diag-
nosis of this case is discussed. The available lit-
erature relating to the use of cortisone and corti-
cotropin in diphtheria and polyneuritis is reviewed,
J. Florida, M.A.
June, 1957
KILLINGER: DOCTOR GOES TO COURT
1197
“Opinion evidence, as a whole, is not looked
on with great favor by the law. It is probable
that juries are more prone to distrust the testi-
mony of the medical expert witness than the
testimony of any other witness. Laymen find it
difficult to understand how honest physicians may
express contradictory opinions. Jurors do not at
times seem to attach any higher credibility to the
testimony of physicians of high standing than to
that given by the ‘professional’ expert witness. . . .
“Although medicine is not an exact science
and although it is the opinion of the expert wit-
ness that is generally of primary importance, it
is believed that in most instances a panel of im-
partial medical experts would be able to find
basic agreement and that their conclusions would
reflect the truth that the court and the jury
seek.”6
Appointment by the court of medical experts,
whose services are paid for usually by the defense
in the first instance, is still another way to secure
unbiased expert medical advice. This method is
now widely used.
Need for a New Order
On May 22, 1956, Dr. Walter C. Alvarez,7
through his syndicated column “How to Live,”
made astute observations on “The Need for Im-
partial Medical Expert Testimony.” He declared
that for 45 years he had seen the need for a new
order and warmly endorsed “Impartial Medical
Testimony,”8 a book just published by The Mac-
millan Company. This book is recommended
reading for every physician, lawyer and jurist in
America. The New York Medical Expert Testi-
mony Project described in the book has been in
operation since 1952 in New York City, with the
New York Academy of Medicine and the New
York County Medical Society designating the
medical talent, and has been “adopted as a regu-
lar part of the operations of the Supreme Court
of the State of New York in the First Depart-
ment.” The basic idea of the Project revolves
around panels of “neutral outstanding physicians
in various specialized branches of medicine.”
Available at the call of the court, these experts
make medical examinations of plaintiffs in per-
sonal injury cases, report their findings, and, if
necessary, testify in those cases in which medical
aspects are controversial and substantial. These
unquestionably expert members of the medical
profession, Dr. Alvarez noted, do not have to
depend for their remuneration on either the pros-
ecution or the defense. Their fees are charged
against Project funds. Such panels, he observed,
make trials much more dignified with less hysteria
and more good sense. In addition, trials have
thereby been shortened, a result that is particu-
larly gratifying since approximately 80 per cent
of the cases in trial courts of the country are
personal injury cases, involving the taking of
medical testimony, and courts are often years
behind in their work.
As the title of the book indicates, the new
order seeks the antithesis of partisan medical tes-
timony as now too frequently practiced by a con-
siderable group of lawyers and doctors who do not
conform to the highest traditions of their calling.
An impartial expert gives confidence to judge
and jury in understanding the technical aspects of
a problem. Although the legal and medical profes-
sions have made efforts to curb abuses in the pre-
sentation of medical proof, “this Project repre-
sents the first major effort in the personal injury
field to cope with the problem by arming the
judge with facilities as well as power to appoint
neutral, competent medical experts.”
Interestingly enough, Professor Delmar Karlen
of the Institute of Judicial Administration of the
New York University Law Center, as research
director, and Dr. Irving S. Wright, Professor of
Clinical Medicine at the Cornell Medical College,
as medical consultant for the Project, reached
substantially the same conclusions, the one from
the legal and the other from the medical view-
point, in their independently written reports.
They and the other members of the Committee
on the Medical Expert Testimony Project, re-
porting after a highly successful two year trial
of this pilot project, cited the following accom-
plishments:
“1. The Project has improved the process of
finding medical facts in litigated cases.
“2. It has helped to relieve court congestion.
“3. It has had a wholesome prophylactic ef-
fect upon the formulation and presentation of
medical testimony in court.
“4. It has proved that the modest expendi-
ture involved effects a large saving and economy
in court operations.
“5. It has pointed the way to better diag-
nosis in the field of traumatic medicine. Unlike
the others listed above, this accomplishment is
an unexpected dividend, which was not in con-
templation when the Project was initiated.”
1198
LAWRENCE: DETERMINING IMMUNITY IN A COUNTY
Volume XI.III
Number 12
Conclusions
The great majority of cases in trial courts are
personal injury cases, requiring the taking of
medical testimony.
The average doctor is inadequately prepared
for and dislikes to appear in court.
The time is propitious for both the medical
and the legal professions to clear themselves of
any suspicion of bias and prejudice in the mind of
the public and to renew efforts to secure only the
truth.
To obtain unbiased nonprejudicial medical
expert testimony in personal injury cases, a sys-
tem based on the New York Medical Expert Tes-
timony Project described in “Impartial Medical
Testimony” is recommended.
Such medicolegal collaboration offers the best
remedy yet proposed for the deficiencies and
abuses prevailing in the presentation of medical
proof in judicial proceedings by enlisting the serv-
ices of independent and impartial medical experts
to aid the court in the better and quicker disposi-
tion of those cases which are most voluminous in
the courts of this country.
An outstanding example of successful inter-
professional cooperation, the Project charts the
way toward a new order which offers a solution
to the universal problem of securing better medi-
cal testimony, not alone in personal injury cases
but also in other types of litigation in which the
physical or mental condition of a litigant may be
involved. This approach improves the admin-
istration of justice, upholds the best traditions
of the medical and the legal professions and pro-
motes favorable public relations.
Appreciation is expressed to the many members of The
Jacksonville Bar Association who gave helpful guidance in the
preparation of this paper.
References
1. Gilbert, W. I. Jr.: Advice to the Medical Witness, J. A.
M. A. 156:1311-1313 (Dec. 4) 1954.
2. Spalding, E. D. : A Physician’s Obligation to the Courts,
The Technique of Being a Good Medical Expert Witness,
J. Michigan M. Soc. 53:1 60-1 6 1 (Feb.) 1954.
3. Miles, V. H.: Must I Testify in Court? J. M. Soc. New
Jersey 52:88-89 (Feb.) 1955.
4. Trostler, I. S. : The Physician as a Witness, Illinois M. J.
104:189-193 (Sept.) 1953.
5. Steinberg, R.: Expert Medical Testimony, Am. J. Clin.
Path. 24:1149-1153 (Oct.) 1954.
6. Medical Expert Testimony, J. A. M. A. 156:1332 (Dec. 4)
1954.
7. Alvarez, W. C. : The Need for Impartial Medical Expert
Testimony, in “How to Live,” Jacksonville Journal, Jack-
sonville, Fla., May 22, 1956.
8. Impartial Medical Testimony, A Report by a Special Com-
mittee of The Association of the Bar of the City of New
York on the Medical Expert Testimony Project, New York,
The Macmillan Company, 1956.
225 West Ashley Street.
Determining Immunity Level in a County
Joseph W. Lawrence, M.D.
ARCADIA
In November and December of 1955, there
was a mild epidemic of diphtheria in DeSoto
County. In a total of 12 cases, all of the patients
were white, and fortunately, all but one recovered
without any apparent sequelae; in the one case
the disease was fulminating in type, and the pa-
tient died. Because of the public alarm at that
time, the staff of the DeSoto County Health
Center gave a markedly increased number of im-
munizations for the months of November and
December. In November, we gave 288 diphtheria
inoculations, 143 being given to children five
years of age or older. In December, we gave 370
diphtheria inoculations, 329 being given to chil-
dren five years of age or older. During these two
months only eight smallpox vaccinations were
given. For the entire year of 1955, there were 863
diphtheria inoculations given in the DeSoto Coun-
ty Health Center, and 658, or 76 per cent, of
Director of the DeSoto-Hardec-Cliarlotte Health Unit.
Read before the Florida Health Officers’ Society, Eleventh
Annual Meeting, Miami Beach, May 13, 1956.
these were given during November and December.
Needless to say, as soon as the public lost its fear,
the rate of inoculations immediately dropped
drastically; in January 1956 there were 88 and
in February only 28. These figures are from the
records of the Health Department only and in-
clude no inoculations given by the practicing phy-
sicians of this county. They fairly well reflect the
immunity in the community, however, as we give
about two thirds of the inoculations in the county.
Because of this epidemic and the resultant
mass inoculations, Dr. L. L. Parks, Director of
the Bureau of Special Health Services, thought
that it might be interesting to attempt to deter-
mine the immunity level in the county. It is true
that “fools walk in where angels fear to tread,”
as I aptly demonstrated by deciding to make a
survey in all three of my counties, comprising the
DeSoto-Hardee-Charlotte Health Unit, rather than
in just one county. Had I realized the amount
of work involved, I assuredly would not have
J. Florida, M.A.
July, 1957
ABSTRACTS
29
and it is suggested that serious consideration be
given to the employment of these agents in pa-
tients with progressive polyneuritis, particularly
when bulbar symptoms are present and the etiol-
ogy is obscure. It is stressed that the definitive
place of hormonal therapy instituted early in
diphtheritic polyneuritis has yet to be evaluated.
Histochemieal Studies in Squamous Car-
cinoma. By Alvan G. Foraker, M.D. Cancer
9:367-373 (March-April) 1956.
In the study reported here 38 examples of
primary squamous carcinoma of the skin or
mucosa or of metastatic squamous carcinoma
were subjected to a battery of histochemieal tech-
nics, including localization of dehydrogenase, al-
kaline phosphatase, phosphamidase, protein-bound
sulfhydryl and disulfide groups, and glycogen.
Comparisons were made with epidermis and squa-
mous mucosa. In general, squamous carcinoma
showed a reaction pattern similar to that of deep-
er layers of epidermis or mucosa, including evi-
dence of dehydrogenase and phosphamidase ac-
tivity. Keratinizing squamous cells from neoplas-
tic and non-neoplastic epithelium contained di-
sulfide groups. Squamous cells in superficial layers
of epidermis and mucosa and well differentiated
squamous carcinoma cells contained glycogen. No
histochemieal reaction pattern peculiar to car-
cinoma was found.
Vascular and Allergic Headaches; A Pan-
el Discussion. By French K. Hansel, M.D.,
Raymond L. Hilsinger, M.D,, Bernard M. Bar-
rett, M.D. Tr. Am. Acad. Ophth. 60:459-464
(May-June) 1956.
In this panel discussion, Dr. Hansel describes
vascular headache, and Dr. Hilsinger discusses the
treatment of this type of headache. Dr. Barrett
discusses the resistant headache patterns which
persist regardless of etiologic evaluation and
proper therapy. He reports a series of cases clas-
. sified on the basis of vascularity in which reser-
pine therapy was used as an adjunct in the treat-
ment of the various resistant headache patterns
which had not responded to any other form of
treatment. Included were cases of migraine, “his-
taminic cephalalgia” and those classified as of the
carotid type or atypical as well as those due to
vascular tension. He concluded that reserpine
merits consideration in the treatment of these
resistant cases.
A New Rapid Detection Method for Gas-
tric Cancer: The Rotating Gastric Brush.
By J. Ernest Ayre, M.D. Acta Union Interna-
tionale Contre le Cancer 12:13-19, 1956.
The rotating gastric brush is described as a
new rapid method for diagnosis of gastric cancer.
The method is a simple, relatively painless pro-
cedure, suitable for use in the physician’s office,
and it, therefore, lends itself well to mass use.
Extensive trials have included tests on several
hundred patients, and the present report includes
the follow-up on a consecutive series of 339 of
these. The accuracy of the brush procedure ap-
pears to compare most favorably with other
diagnostic methods. It is particularly significant
that false negative errors have been rare; in all
cases of proved cancer except two, positive or
suspicious cells were recognized. In no case was
there evidence of hemorrhage in this series, which
included normal persons, patients with gastric
ulcer and patients with malignant lesions.
Massive Hemorrhage into an Adrenal
Pheochromocytoma, Report of a Case with
Sudden Death. By David J. Lehman, Jr., M.D.,
and Jack Rosof, Ph.D., M.D. New England J.
Med. 254:474-476 (March 8) 1956.
Irreversible shock and sudden death due to
massive unilateral adrenal hemorrhage without
sepsis is a unique, often unrecognized syndrome,
death usually being ascribed to some other ca-
tastrophic illness. The case reported here illus-
trates the diagnostic difficulties that may be en-
countered. In this case it was established at
autopsy that there was a hemorrhage into a pre-
viously unsuspected pheochromocytoma. It is
concluded that a high index of suspicion is neces-
sary for the correct diagnosis of a case of acute
collapse and pulmonary edema occurring with
unilateral adrenal apoplexy. This type of case is
regarded as a definite clinical syndrome that may
prove to be remediable if early diagnosis is made
and treatment instituted.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
J. Florida, M.A.
July, 1957
31
Proceedings
Eighty-Third Annual Meeting
Florida Medical Association
Hollywood. May 5-8, 1957
GENERAL SESSION
The Eighty-Third Annual Meeting of the
Florida Medical Association was called to order
at 9:30 a.m., Monday, May 6, in the Pageant
Room of the Hollywood Beach Hotel, Hollywood,
Florida, by President Francis H. Langley.
Invocation was pronounced by The Reverend
S. Harry Russell, of the West Hollywood Metho-
dist Church, Hollywood.
Dr. Langley introduced Dr. Walter J. Glenn
Jr., of Fort Lauderdale, President of the Broward
County Medical Association.
Dr. Glenn: “Mr. President, Members of the
Florida Medical Association:
“It is a distinct privilege and pleasure to
speak for the Broward County Medical Associa-
tion in welcoming the Florida Medical Association
for its Eighty-Third Annual Convention. We,
as individuals and as a group, have attempted to
make available facilities which will be adequate
to insure success. Individual members of our
county association will be glad to assist their fel-
low members of the Florida Medical Association,
or you may contact the members of the commit-
tees listed in the program for assistance in find-
ing any diversions you may wish. Feel free to
approach any of our members whenever you de-
sire assistance. We hope that you enjoy your
stay here and that the experience will prove
rewarding in direct proportion to the efforts of
many to make this convention possible.”
Dr. Langley: “Are there any fraternal dele-
gates from other states?”
Dr. Charles E. Merkert from Minneapolis.
Minnesota, was welcomed to the meeting.
Dr. Langley: “We are delighted to have with
us today Dr. Ernest B. Howard, Assistant Secre-
tary of the American Medical Association. Dr.
Howard received his M.D. degree from Boston
University Medical School and Master of Public
Health degree from the Harvard School of Public
Health. He served with the Massachusetts De-
partment of Public Health from 1940 to 1942
and as assistant director of the Army’s V. D.
Control program from 1942 to 1945. He was
chosen as chief of the U. S. Department of State’s
health mission to Peru in 1946. He joined the
A. M.A. as Assistant Secretary in April, 1948. Dr.
Howard will speak to us on ‘National Socio-
Economic Issues Confronting Medicine.’ ”
(Dr. Howard’s address appears in this issue
of The Journal on page 24.)
Dr. Langley: “It is with great pride that I
introduce my guest speaker Dr. Lemuel W. Diggs,
Director of the Department of Medical Labora-
tories for the University of Tennessee and City
of Memphis Hospitals.
Highlights of the Eighty-Third Annual Meeting
(1) A portion of the 2,108 persons registers for the Annual Meeting. (2) l)r. Lemuel W. Diggs, of
Memphis, the President’s guest speaker, delivers his address on “Management of Hemorrhagic Diseases." (3)
The Conference of County Medical Society Presidents and Secretaries planned by Dr. William C. Roberts, Pres-
ident-Elect, is held at breakfast in the main dining room of the Hollywood Beach Hotel. (4) The Pageant
Room is filled for the closed circuit television program moderated by Dr. Robert J. Needles, of St. Petersburg,
and sponsored by Smith, Kline & French Laboratories. (5) The Patio Party is held in the Southwest Gardens
of the Hollywood Beach Hotel. (6) President-Elect Roberts is escorted to the rostrum for the installation cere-
monies by Dr. Herbert L. Bryans, of Pensacola, and Dr. David R. Murphey )r., of Tampa. (7) The engraved
gavel is presented by retiring president, Dr. Francis H. Langley, to Dr. Roberts. (8) A group of physicians
who have been members of the Association for 33 years or more assemble following presentation of certificates
by Dr. Samuel M. Day, Secretary-Treasurer. (9) Dr. Jere W. Annis, of Lakeland, is escorted to the rostrum by
Drs. Marion W. Hester and Charles Larsen Jr., also of Lakeland, following his election as President-Elect.
32
GENERAL SESSION
Volume XLIV
Number 1
“Dr. Diggs is a Virginian by birth and a Ten-
nessean by adoption, having been a Memphian
for a quarter of a century. Born in Hampton,
Va., in 1900, Dr. Diggs spent his early years in
his native state and also received his academic
training there. He was awarded the degrees of
Bachelor of Science and Master of Arts by Ran-
dolph Macon College. For his medical training
he chose the Johns Hopkins University School of
Medicine, where he received the degree of Doctor
of Medicine in 1926.
“After spending three years in postgraduate
work in medicine at the University of Rochester’s
Strong Memorial Hospital in Rochester, N. Y.,
Dr. Diggs joined the staff of the University of
Tennessee College of Medicine as a pathologist.
Later he transferred to the Division of Medicine
as a Professor of Medicine and Director of the
Department of Medical Laboratories for the lTni-
versity of Tennessee and city of Memphis Hos-
pitals. For two years he was the clinical patho-
logist for the Cleveland Clinic Foundation in
Cleveland, Ohio. He is now a consultant to the
Tennessee Valley Authority and to the Armed
Forces Institute of Pathology in Washington,
D. C.
“Locally, Dr. Diggs takes an interest in com-
munity activities. His principal hobby is farm-
ing.
“A member and a former vice president of the
American Society of Clinical Pathologists, he
is also a member of the College of American
Pathologists and the International Society of
Hematology. At present, he is chairman of the
Council on Hematology of the American Society
of Clinical Pathologists. He also holds member-
ship in the American Medical Association and the
Southern Medical Association.
“The principal research in which Dr. Diggs
has engaged has been in the fields of clinical
pathology and hematology. He has written many
articles on sickle cell anemia, his chief interest.
He is the author of a new text entitled ‘Mor-
phology of Human Blood Cells.’ His laboratory
manual, bearing the title ‘Laboratory Procedures
Used at the John Gaston Hospital,’ is widely used
throughout the South. For the last three editions
of Miller’s ‘Textbook of Clinical Pathology’ he
has served as the co-author. In addition, he has
contributed to ‘Current Therapy’ and ‘Gould’s
Medical Dictionary.’
“Dr. Diggs will speak on ‘Management of
Hemorrhagic Diseases.’ ”
(Dr. Diggs’ address will appear in the August
issue.)
After a short recess to visit exhibits, the gen-
eral session was continued with Dr. George T.
Harrell Jr., Chairman, Scientific Work Commit-
tee, presiding.
Dr. Harrell: “It is a pleasure to bring to
you Dr. J. R. Heller, Director, National Cancer
Institute, Bethesda, Maryland. Dr. Heller was
born in South Carolina and received his M.D.
degree from Emory University in 1929. He was
with the U. S. Public Health Service for many
years, is on the faculty of George Washington
University, and was made Director of the Na-
tional Cancer Institute in 1948.”
Dr. Heller spoke on “Progress in Cancer Con-
trol,” which will appear in a subsequent issue of
The Journal.
Dr. Harrell: “Our next speaker is Dr. Thomas
Findley, Research Professor of Medicine for
Cardiovascular Diseases, Medical College of
Georgia, Augusta.
“Dr. Findley received his M.D. degree from
Rush Medical College in 1928. He has been In-
structor in Internal Medicine at Michigan Uni-
versity, Chief of the Medical Section of Ochsner
Clinic, Professor of Clinical Medicine at Tulane,
and came to the University of Georgia in 1954
as Research Professor of Medicine for Cardio-
vascular Diseases.”
Dr. Findley spoke on “Diuresis and Anti-
diuresis,” which will appear in a subsequent issue
of the Journal.
The general session was adjourned at 12:30
p.m.
J. Florida, M.A.
July, 1957
33
FIRST HOUSE OF DELEGATES
The House of Delegates convened at 2:30
p.m., Sunday, May 5, 1957, in the Pageant Room
of the Hollywood Beach Hotel, Hollywood, Flor-
ida, with Dr. Francis H. Langley, President, in
the Chair.
Dr. Langley: ‘‘During past years, there has
been some confusion as to the function of the
Chair and the Parliamentarian. The sole function
of the Parliamentarian is to advise me on moot
points of parliamentary procedure when I con-
sider it necessary. This I shall do privately. The
Chair is under no obligation to accept his deci-
sion. Ultimate decisions will be made by me.
All remarks and parliamentary inquiries will be
addressed to the Chair, and not to the Parliamen-
tarian.
' “Dr. George F. Schmitt Jr., who is a registered
parliamentarian, will be glad to consult with any
member of the House of Delegates concerning
parliamentary matters. This, however, must not
be done during the formal sessions. In an effort
to aid the delegates, some literature has been
distributed.”
Dr. Louis M. Orr, Chairman of the Creden-
tials Committee, announced that a quorum was
present, 112 delegates being registered. (Sub-
sequent report of the Credentials Committee
showed that 154 delegates were registered.)
Dr. David R. Murphey Jr., of Hillsborough,
moved that the delegates be seated.
Seconded by Dr. Herbert L. Bryans.
Motion carried.
Delegates
DUVAL — Frederick H. Bowen, Hugh A. Carithers, Tur-
ner Z. Cason, Frank L. Fort, A. Judson Graves, Karl
B. Hanson, Gordon H. Ira, Edward Jelks, Raymond
H. King, Joseph J. Lowenthal, Charles F. McCrory,
Richard G. Skinner Jr., John T. Stage, Sidney Still-
man, Leo M. Wachtel, Ashbel C. Williams
ESCAMBIA — Paul F. Baranco, Herbert L. Bryans, Jo-
seph W. Douglas, Alpheus T. Kennedy (Absent —
Walter C. Payne Sr.)
FRANKLIN-GULF — John W. Hendrix
HILLSBOROUGH — Samuel H. Adams, Efrain C. Azmi-
tia, Leffie M. Carlton Jr., C. Frank Chunn, Herschel
G. Cole, H. Phillip Hampton, David R. Murphey Jr.,
James N. Patterson, Madison R. Pope, William M.
Rowlett, Weslev W. Wilson
INDIAN RIVER— William L. Fitts 3rd
JACKSON-CALHOUN— James T. Cook Jr.
LAKE — George E. Engelhard
LEE-CHARLOTTE-HENDRY— William H. Grace, John
S. Stewart
LEON - GADSDEN - LIBERTY - WAKULLA - JEF-
FERSON— Francis T. Holland, George H. Massey,
Robert H. Mickler
MADISON — Wilmer J. Coggins
MANATEE — Richard V. Meaney
MARION — Henry L. Harrell, Eugene G. Peek Jr.
MONROE — Ralph Herz
NASSAU — (Absent — Benjamin F. Dickens)
ORANGE — Frank C. Bone, Chas. J. Collins, Norman F.
Coulter, Harry H. Ferran, Walter B. Johnston, Fred
Mathers, Louis M. Orr, Charles R. Sias, W. Dean
Steward, Robert L. Tolle
PALM BEACH — Willard F. Ande, Edwin W. Brown,
V. Marklin Johnson, Walter R. Newbern, Raymond
S. Roy, W. Lawson Shackelford, A. Scott Turk,
Edward W. Wood
PASCO-HERNANDO-CITRUS — S. Carnes Harvard
PINELLAS — Clyde O. Anderson, M. Eldridge Black,
Harry R. Cushman, William D. Futch, N. Worth
Gable, Percy H. Guinand, Norval M. Marr Sr., Joseph
W. Pilkington, George H. Schoetker, James E. Thomp-
son, Walter H. Winchester, Rowland E. Wood
POLK — Jere W. Annis, James R. Boulware Jr., Samuel
J. Clark, Marion W. Hester, Charles Larsen Jr.
PUTNAM — (Absent — Lawrence G. Hebei)
ST. JOHNS— Herbert E. White
ST. LUCIE-OKEECHOBEE-MARTIN — Richard F.
Sinnott
SARASOTA — John M. Butcher, Melvin M. Simmons
(Absent — Hugh G. Reaves)
ALACHUA — Henry J. Babers Jr., F. Emory Bell, Walter
E. Murphree
BAY — Harold E. Wager
BREVARD — Thomas C. Kenaston, Arthur C. Tedford
BROWARD — Norris M. Beasley, Julius F. Boettner,
Burns A. Dobbins Jr., Anthony C. Galluccio, John H.
Mickley, Richard A. Mills, Paul G. Shell
COLLIER — Daniel B. Langley
COLUMBIA — Louis G. Landrum
DADE — James L. Anderson, Edward R. Annis, Morris
H. Blau, Reuben B. Chrisman Jr., Jack Q. Cleveland,
Francis N. Cooke, Vincent P. Corso, Edward W. Cul-
lipher, Robert F. Dickey, L. Washington Dowlen,
Franklin J. Evans, M. Jay Flipse, Milton S. Gold-
man, Maurice M. Greenfield, W. Tracy Haverfield,
James W. Holmes, R. Spencer Howell, Ralph W.
Jack, Joseph T. Jana Jr., Walter C. Jones, David
Kirsh, Alfred G. Levin, Donald F. Marion, John D.
Milton, Warren W. Quillian, Hunter B. Rogers, Walter
W. Sackett Jr., T. D. Sandberg, Ralph S. Sappenfield,
George F. Schmitt Jr., Donald W. Smith, Joseph S.
Stewart, William M. Straight, Oliver P. Winslow Jr.,
Jack L. Wright, Corren P. Youmans, Nelson Zivitz
DeSOTO-HARDEE-HIGHLANDS-GLADES — Carl J.
Larsen
SEMINOLE— Daniel H. Mathers
SUWANNEE— Edward G. Haskell Jr.
TAYLOR— John H. Parker Jr.
VOLUSIA — C. Robert DeArmas, William R. Hutchinson,
Alphonsus M. McCarthy, Arthur Schwartz
WALTON-OKALOOSA— Frederic E. Caldwell
WASHINGTON-HOLMES— Walter H. Shehee
STATE OFFICERS — Francis H. Langley, William C.
Roberts, Meredith Mallory, Kenneth A. Morris, Cecil
M. Peek, Samuel M. Day, Shaler Richardson
Dr. Langley declared the Eighty-Third Annual
Session duly opened.
On motion by Dr. Ralph Herz. seconded by
Dr. Walter C. Jones, and carried, the proceedings
of the Eighty-Second Annual Meeting as pub-
lished in the July 1956 Journal were approved.
On motion by Dr. Shaler Richardson, second-
ed by Dr. S. Carnes Harvard, and carried, the
proceedings of the Called Meeting of November 4,
34
FIRST HOUSE OF DELEGATES
Volume XLIV
Number 1
1956 as published in the February 1957 Journal
were approved.
President Langley relinquished the Chair to
Dr. Meredith Mallory, First Vice President.
Dr. Mallory: “Since the election of a year ago
this is the first opportunity that a Vice President
has had to function. It is probably only right
that 1 make proper use of it whether or not it
proves a burden to you. How well do I know that
you did not come here to see me or to hear me,
but 1 have you at a distinct disadvantage. Ac-
cording to the program this is my time and the
parade cannot go on until I have finished. How-
ever, I do not intend to usurp the time and I
know you will be surprised to learn whom I am
supposed to introduce, and furthermore, you may
or may not have even heard of him.
“Our next speaker comes from the Buckeye
State, having been born in Cumberland, Ohio,
on the 23rd of October, 1899 and he arrived in
Florida in October 1909. He graduated at Ohio
Wesleyan with a B. A. degree and in the year
1926 received his Doctor of Medicine from Johns
Hopkins. His immediate hospital training was at
the Hospital for Women in Maryland where he
was an intern, assistant resident and resident,
finishing in 1929. He also holds a Honorary Doc-
tor of Science from Ohio Wesleyan University
received in 1956.
“He is a Fellow of the American College of
Surgeons, Fellow of Southeastern Surgical Con-
gress, Member of Florida Council of American
College of Surgeons and former Chairman of First
Congressional District, Florida Medical Commit-
tee for Better Government.
“He has served the Florida Medical Associa-
tion well, having been First Vice President in
1952, member of the Board of Governors 1950-55,
and Chairman of the Council in 1954.
“He belongs to the Lions Club, the American
Legion, St. Peterbsurg Chamber of Commerce,
the St. Petersburg Yacht Club and Sunset Coun-
try Club. He is a 32nd degree Mason and a
Shriner belonging to Egypt Temple.
“His army service followed closely his activi-
ties in civilian life. He was Chief of Surgery of
an evacuation hospital in E.T.O., was decorated
with five Battle Stars, the Bronze Star and the
Victory Medal. He was Chief of Surgery at Sta-
tion Hospital at Camp Croft, and held the rank of
Lt. Colonel.
“His church affiliation is the Methodist
Church and he has been a trustee of Christ
Methodist Church since 1931.
“His fraternities are Phi Delta Theta, Phi
Beta Kappa, and Alpha Kappa Kappa.
“On October 26, 1929 he married Miss Sarah
Graham Hall of Charlotte, N. C. and they have
four children, Ann Carter, James Nelson, Peter
and Elizabeth Hall.
“He is Chief of Surgery at Mound Park Hos-
pital and former Chief of Staff of St. Anthony
Hospital.
“It has been my opportunity to have been
associated with him on various committees and
I can assure you that the Florida Medical Asso-
ciation has been fortunate to have had his advice
and counsel during the past few years.
“It is indeed not only a privilege but also a
pleasure to present to you your President — Dr.
Francis H. Langley, of St. Petersburg.”
Dr. Langley delivered his presidential address.
(The complete text may be found in this issue
of The Journal on page 19.)
Dr. Mallory: “Mr. President, we all enjoyed
your talk very much. I want to congratulate you
on your accomplishments, and it is with a great
deal of pleasure that I return the gavel to you.”
Dr. Langley: “It is my honor and privilege to
recognize a distinguished visitor from another pro-
fession which we all respect and to which we
owe very much. I refer to Mr. Baya M. Harrison
Jr., of St. Petersburg, who last night assumed
office as President of The Florida Bar. He has
been a member of the Board of Governors of that
organization since 1952. He graduated in law
from the University of Florida in 1935. During
World War II, he served for four years and ended
as a Colonel in the Artillery. He and his wife are
with us and it is my pleasure to invite Mr. Harri-
son to the rostrum.”
Mr. Harrison: “President Langley, Dr. Mal-
lory. Members of the House of Delegates of the
Florida Medical Association. Ladies and Gentle-
men:
“I am privileged on behalf of the 7,000 law-
yers and judges of Florida to extend the warm
and cordial greetings of The Florida Bar.
“I am also personally grateful for the oppor-
tunity to be present because as a lawyer and as
a citizen I have an abiding regard for the medi-
cal profession and for those of your members
who address to their important task the full meas-
ure of their learning and sympathy.
“To those of you who are not fully aware of
the organized bar of Florida, it has imposed up-
on it by a ruling of the Supreme Court of this
state, the important responsibility of assuring the
J. Florida, M.A.
July, 1957
FIRST HOUSE OF DELEGATES
35
competence and integrity of the Bar and the pub-
lic service of its members. It is not a voluntary
group and all practicing lawyers and judges which
the provisions of the law require to be lawyers
are members. Overriding those responsibilities
is the larger one, which has been our responsibil-
ity since the world began, and that is to improve
the administration of justice. It is in that im-
portant respect that the Florida Bar has welcomed
the cooperative efforts of the Florida Medical
Association in assisting in the administration of
justice. In the past 15 or 20 years it became more
apparent that doctors are so important to the
proper administration of justice that we of the
Florida Bar are very glad that there has come
about a Guide for Cooperation Between Lawyers
and Doctors of Florida, with the idea of improv-
ing the administration of justice. We are aware
of the important part the doctor has in cases in
which you appear as witnesses before the court.
“It is a great pleasure to be here and I thank
you for including my wife in your invitation.’’
Dr. Langley: “Thank you very much, Mr.
Harrison.”
“It is now my pleasure to recognize the mem-
bers of the Woman’s Auxiliary.”
Mrs. Perry D. Melvin: “As President-elect, I
am here to represent the Auxiliary. Our Presi-
dent and our distinguished guests are in our
Board meeting.”
Dr. Langley: “Early this year the Dade Coun-
ty Medical Association, the Miami Herald, the
Dade County Health Department and the Dade
County Chapter of the National Foundation for
Infantile Paralysis sponsored a very successful
poliomyelitis immunization drive. The major part
of this drive preceded the current campaign, end-
ing June 30, in which the Florida Medical Asso-
ciation, through its component county medical
societies, is encouraging the increased use of
poliomyelitis vaccine in all age groups. During
the nine-week drive over 247,000 cc. of vaccine
were distributed in the Miami area, of which
some 70% was administered by private physi-
cians. This is a considerably larger amount of
vaccine than the total amount distributed in Dade
County during the entire time prior to the drive.
“Although all of the news media in the area
provided excellent support during the campaign,
one of the primary factors contributing to the
tremendous success of the drive was the human
interest news reporting done by Mr. Lawrence R.
Thompson, of the Miami Herald.
“In recognition of Mr. Thompson and the
Miami Herald for this outstanding journalistic
effort on behalf of public health, the Florida Med-
ical Association is privileged to present an official
citation. If Mr. Thompson is present, will he
please come forward to receive the citation at
this time?”
Mr. Thompson came to the rostrum.
Dr. Langley: “I should like to read the cita-
tion: ‘The Florida Medical Association is priv-
ileged to present this citation to Lawrence R.
Thompson, of the Miami Herald, in recognition
of exemplary and unselfish service in the interest
of public health during the poliomyelitis immu-
nization drive, January-March, 1957, Miami,
Florida. Presented, May 1957.’ ”
The Chair recognized Dr. Louis M. Orr,
Chairman of the Credentials Committee.
Dr. Orr: “I am very pleased to announce, on
behalf of the Credentials Committee, that 154
delegates and officers out of a total of 158 are
now seated.”
Dr. Langley introduced Dr. Homer L. Pear-
son Jr., Secretary, State Board of Medical Ex
aminers, who gave his annual report, which was
referred to Reference Committee No. 1.
Dr. Langley: “We are very fortunate to have
with us Lt. Col. E. G. Rivas, MSC, Director,
Inquiries and Liaison, Office for Dependents’
Medical Care, Washington, D. C.”
(Col. Rivas’ address appears in this issue on
page 27.)
Dr. John D. Milton reported briefly on the
progress of the Medicare program.
Dr. Donald F. Marion, General Chairman of
the Medicare Fee Schedule Committee, presented
a report, which was referred to Reference Com-
mittee No. 3.
President Langley called for the election of
one delegate and one alternate to the House of
Delegates of the American Medical Association,
for two-year terms beginning January 1, 1958.
The Chair recognized Dr. W. Tracy Haver-
field, of Dade.
Dr. Haverfield: “President Langley, Members
of the House of Delegates: I have the honor and
privilege to place in nomination as your dele-
gate to the American Medical Association, the
name of a man to succeed himself, a man who
has served you vigorously and well for a number
of years in that capacity, a man who is at present
Vice Speaker of the House of Delegates of the
A.M.A., a man who, if every indication is correct,
36
FIRST HOUSE OF DELEGATES
Volume XLIV
Number 1
will probably become President-Elect of the
A.M.A. in 1958, thereby bringing honor not only
to himself but to the State of Florida. Gentle-
men, 1 give you Dr. Louis Orr, of Orlando.”
Dr. Robert L. Tolle: “It is my personal pleas-
ure and I have been instructed to second this
nomination in behalf of the Orange County
delegation.”
Dr. Ralph Herz: “I move that the nomina-
tions be closed and the secretary be instructed
to cast a unanimous ballot for Dr. Orr.”
Seconded by Dr. H. Phillip Hampton.
Motion carried.
Dr. David R. Murphey Jr.: “As our alternate
delegate, I wish to nominate Dr. Richard A.
Mills.”
Dr. John D. Milton moved that nominations
be closed.
Seconded by Dr. Walter W. Sackett Jr.
Motion carried.
Dr. Langley read the personnel of the four
reference committees as follows:
1 HEALTH AND EDUCATION
Leo M. Wachtel, Chairman
C. Frank Chunn
V. Marklin Johnson
Charles R. Sias
Paul F. Baranco
2. PUBLIC POLICY
Chas. J. Collins, Chairman
S. Carnes Harvard
Burns A. Dobbins Jr.
James T. Cook Jr.
Leffie M. Carlton Jr.
3. FINANCE AND ADMINISTRATION
Norval M. Marr Sr., Chairman
Donald W. Smith
Sidney Stillman
James R. Boulware Jr.
Francis T. Holland
4. LEGISLATION AND MISCELLANEOUS
L. Washington Dowlen, Chairman
Raymond H. King
Melvin M. Simmons
Alpheus T. Kennedy
Jack Q. Cleveland
The following committee reports and resolu-
tions were referred as published in the Handbook,
together with supplemental reports and additional
resolutions as presented:
(To Reference Committee No. 1)
Scientific Work, George T. Harrell Jr.
Medical Postgraduate Course, Turner Z. Cason
Cancer Control, Ashbel C. Williams
Venereal Disease Control, C. W. Shackelford
Tuberculosis and Public Health, Phillip W. Horn
Maternal Welfare, E. Frank McCall
Child Health, Warren W. Quillian
State Board of Medical Examiners, Homer L. Pear-
son Jr., Secretary
(To Reference Committee No. 2)
Conservation of Vision, Charles C. Grace
*Medical Education and Hospitals, Walter E. Mur-
phree
Medical Economics, Robert E. Zellner
Representatives to Industrial Council, Chas. L. Far-
rington
Grievance, David R. Murphey Jr.
Nursing, Jere W. Annis
Blood, Louis E. Pohlman
♦Supplemental report presented and referred.
(To Reference Committee No. 3)
Address of President, F'rancis H. Langley
♦Board of Governors, Francis H. Langley
♦Necrology, Alvin L. Stebbins
Advisory to Woman’s Auxiliary, John P. Ferrell
♦Councilor Districts and Council, Herschel G. Cole
♦Advisory to Selective Service for Physicians and
Allied Specialists, J. Rocher Chappell
Emergency Medical Service, Rowland E. Wood
Blue Shield Liaison, Henry J. Babers Jr.
Resolution: Blue Shield Service Category, Hillsborough
County Medical Association
Resolution: Blue Shield Fee Schedule, Escambia County
Medical Society
Reports: Medicare Program, John D. Milton
Medicare Fee Schedule, Donald F. Marion
♦Supplemental reports presented and referred.
(To Reference Committee No. 4)
♦Legislation and Public Policy, H. Phillip Hampton
Mental Health, Sullivan G. Bedel!
State Controlled Medical Institutions, William D.
Rogers
Poliomyelitis Medical Advisory, Richard G. Skinner Jr.
Resolution: Changes in State Welfare Law, Escambia
County Medical Society
Resolution: Workmen’s Compensation Fee Schedule,
Escambia County Medical Society
♦Supplemental report presented and referred.
The Chair called for resolutions from the floor.
Dr. Herbert L. Bryans, of the Escambia Coun-
ty Medical Society presented three resolutions
as follows: a resolution on replacement of blood
by Medicare patients which was referred to Com-
mittee No. 3; a resolution on the Annual Dinner,
referred to Committee No. 4, and a resolution on
non-cancellable health and accident insurance
policies, referred to Committee No. 2.
Dr. Frank C. Bone, of the Orange County
Medical Society, presented a resolution on indi-
gent service, which was referred to Committee
No. 4.
Dr. Walter E. Murphree, Chairman. Medical
Schools Liaison Committee, presented the report
of this special committee, which was referred to
Committee No. 2.
Dr. Walter H. Winchester, of the Pinellas
County Medical Society, presented a resolution
on minimum standards for motor vehicle licens-
ing. which was referred to Committee No. 4.
Dr. Burns A. Dobbins Jr., of the Broward
County Medical Association, presented two resolu-
tions: a resolution on increased Blue Cross-Blue
Shield benefits, and a resolution on Medicare.
Both of these were referred to Committee No. 3.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
37
Dr. Samuel M. Day, Secretary-Treasurer,
read a letter from the Orange County Medical
Society, regarding a bill S. 727 on scholarships
for children of veterans, which was referred to
Committee No. 4.
The Secretary also read a resolution from the
Orange County Medical Society on Abolition of
Tuberculosis Board, which was referred to Com-
mittee No. 4.
As Dr. Alvin L. Stebbins, Chairman of the
Committee on Necrology, was not present, Dr.
Day read the supplemental report of the Commit-
tee on Necrology. Two names were added from
the floor. Dr. Ralph S. Torbett, of Tampa, and
Dr. Gordon F. Henry, of West Palm Beach.
Dr. Langley recognized Dr. Edward Jelks,
President, Florida Medical Foundation.
Dr. Jelks: “I wish to present to you the finest
opportunity the doctors of this state have ever
had to accomplish a great deal for our Association
and to provide better medical care for the people
of Florida.
“In his address, our President has given you
the history of the Foundation. The next thing,
is money. I am here to ask you to participate in
this Foundation, which is your Foundation. This
morning at breakfast, one doctor said, ‘I will give
you $100 if you will send $25 to my medical
school.’ You can earmark the money to go any-
where for any purpose that is covered by our
charter. If you will read this charter, you will
find that the Foundation can send your contri-
bution to almost any good cause in the United
States.
“We are anxious to get as many doctors’
names as possible on our list of contributors be-
cause this will encourage others to give to the
Foundation. In this way, we hope to get sizeable
contributions. This is not our idea — it is the idea
of people who handle trusts — and they have
passed it on to us. They told us that we will not
be able to interest others until the doctors them-
selves contribute.
“Let’s take this seriously. We will send your
contributions wherever you want them to go. If
you have any questions, Dr. Milton, Dr. Ander-
son. Mr. Parham or I will give you more infor-
mation while you are here. This gives us a won-
derful opportunity to render a great service.”
Several of the members rose and stated their
intentions to contribute.
Dr. Langley announced that an emergency
hospital unit had been erected outside the hotel
by Civil Defense, and that all doctors were in-
vited to inspect it.
Dr. Walter C. Jones announced that the
Southern Medical Association was planning a
headquarters building and would welcome con-
tributions from the doctors.
There being no further business, the House
of Delegates recessed at 5:10 p.m. to reconvene
at 9:30 a.m. on Wednesday, May 8, 1957.
SECOND HOUSE OF DELEGATES
The House of Delegates reconvened at 9:30
a.m. on Wednesday, May 8, 1957, in the Pageant
Room of the Hollywood Beach Hotel, Hollywood,
President Francis H. Langley in the Chair.
Dr. Louis M. Orr, Chairman of the Creden-
tials Committee, was recognized and reported
that a quorum was present. (Subsequent report
of the Credentials Committee showed 146 dele-
gates registered.)
Delegates
ALACHUA— Henry J. Babers Jr, F. Emory Bell, Walter
E. Murphree
BAY — (Absent — Harold E. Wager)
BREVARD — Thomas C. Kenaston, Arthur C. Tedford
BROWARD — Norris M. Beasley, Julius F. Boettner,
Burns A. Dobbins Jr, Anthony C. Galluccio, John H.
Mickley, Richard A. Mills, Paul G. Shell
COLLIER— Daniel B. Langley
COLUMBIA — Louis G. Landrum
DADE — James L. Anderson, Edward R. Annis, Morris
H. Blau, Reuben B. Chrisman Jr, Jack Q. Cleveland,
Francis N. Cooke, Vincent P. Corso, Edward W.
Cullipher, Robert F. Dickey, L. Washington Dowlen,
Franklin J. Evans, M. Jay Flipse, Milton S. Gold-
man, Maurice M. Greenfield, W. Tracy Haverfield,
James W. Holmes, R. Spencer Howell, Ralph W. Jack,
Joseph T. Jana Jr, Walter C. Jones, Alfred G. Levin,
Donald F. Marion, John D. Milton, Warren W.
Quillian, Hunter B. Rogers, Walter W. Sackett Jr,
T. D. Sandberg, Ralph S. Sappenfield, George F.
Schmitt Jr, Donald W. Smith, Joseph S. Stewart,
William M. Straight, Jack L. Wright, Corren P.
Youmans (Absent — David Kirsh, Oliver P. Winslow
Jr., Nelson Zivitz)
DeSOTO-HARDEE-HIGHLANDS-GLADES (Absent
— Carl J. Larsen)
DUVAL — Frederick H. Bowen, Hugh A. Carithers, Tur-
ner Z. Cason, Frank L. Fort, A. Judson Graves, Karl
B. Hanson, Gordon H. Ira, Edward Jelks, Raymond
H. King, Joseph J. Lowenthal, Charles F. McCrory,
Richard G. Skinner Jr, Sidney Stillman, Leo M.
Wachtel, Ashbel C. Williams (Absent — John T. Stage)
38
SECOND HOUSE OF DELEGATES
Volume XT. IV
Number 1
ESCAMBIA — Paul F. Baranco, Herbert L. Bryans, Jo-
seph W. Douglas, Alpheus T. Kennedy, Clyde E.
Miller Jr.
FRANKLIN-GULF— John W. Hendrix
HILLSBOROUGH — Samuel H. Adams, Efrain C. Azmi-
tia, Leffie M. Carlton Jr., Herschel G. Cole, H. Phillip
Hampton, David R. Murphey Jr., James N. Patterson,
Madison R. Pope, William M. Rowlett, Wesley W.
Wilson (Absent — C. Frank Chunn)
INDIAN RIVER— William L. Fitts 3rd
JACKSON-CALHOUN— James T. Cook Jr.
LAKE — George E. Engelhard
LEE-CHARLOTTE-HENDRY— William H. Grace, John
S. Stewart
LEON - GADSDEN - LIBERTY - WAKULLA - JEF-
FERSON— Francis T. Holland, George H. Massey,
Robert H. Mickler
MADISON — (Absent — Wilmer J. Coggins)
MANATEE — Richard V. Meaney
MARION — Henry L. Harrell, Eugene G. Peek Jr.
MONROE — (Absent — Ralph Herz)
NASSAU — Cecil B. Brewton
ORANGE — Frank C. Bone, Chas. J. Collins, Norman F.
Coulter, Harry H. Ferran, Walter B. Johnston, Fred
Mathers, Louis M. Orr, Charles R. Sias, W. Dean
Steward, Robert L. Tolle
PALM BEACH — Willard F. Ande, Edwin W. Brown, V.
Marklin Johnson, Walter R. Newbern, Raymond S.
Roy, W. Lawson Shackelford, A. Scott Turk, Edward
W. Wood
PASCO-HERNANDO-CITRUS— S. Carnes Harvard
PINELLAS — Clyde O. Anderson, M. Eldridge Black,
Harry R. Cushman, William D. Futch, Percy H.
Guinand, Norval M. Marr Sr., Joseph W. Pilkington,
George H. Schoetker, James E. Thompson, Walter
H. Winchester, Rowland E. Wood (Absent — N. Worth
Gable)
POLK — Jere W. Annis, James R. Boulware Jr., Samuel J.
Clark, Marion W. Hester, Charles Larsen Jr.
PUTNAM — (Absent — Lawrence G. Hebei)
ST. JOHNS— Herbert E. White
ST. LUCIE-OKEECHOBEE-MARTIN — Richard F.
Sinnott
SARASOTA — John M. Butcher, Melvin M. Simmons
(Absent — Hugh G. Reaves)
SEMINOLE — Daniel H. Mathers
SUWANNEE — Edward G. Haskell Jr.
TAYLOR— John H. Parker Jr.
VOLUSIA — C. Robert DeArmas, William R. Hutchinson,
Alphonsus M. McCarthv, Arthur Schwartz
WALTON-OKALOOSA— Frederic E. Caldwell
WASHINGTON-HOLMES— Walter H. Shehee
STATE OFFICERS — Francis H. Langley, William C.
Roberts, Meredith Mallory, Kenneth A. Morris, Cecil
M. Peek, Samuel M. Day, Shaler Richardson
Dr. Langley: “I have taken the liberty of
changing the order of business slightly this morn-
ing and instead of following the program exactly,
we will now hear from the representative of the
University of Florida to the Student American
Medical Association Convention. I would like to
introduce two medical students from the Univer-
sity of Florida, Mr. Marvin I. Baker and Mr.
Bill R. Blakey.”
“Mr. Baker will give us the report on the
Student A.M.A. Convention.”
Report on National Convention of the Student
American Medical Association
It is the purpose of this report to acquaint the mem-
bers of the Florida Medical Association with the aims and
ideals of the Student American Medical Association, as
well as to inform them of the proceedings of the national
convention held in Philadelphia on May 3, 4, and 5. It is
hoped that the first expressed purpose will be accom-
plished through the summary of the convention proceed-
ings. Because of the large number of items considered at
the convention, it is necessary to restrict this report to
those items which are judged to be of more direct interest
to the members of the Florida Medical Association.
Several items concerning medical education were con-
sidered and acted upon. For several years, Student Amer-
ican Medical Association chapters have been sending in-
ternship evaluation forms to their recent graduates for the
purpose of establishing files on as many hospitals as pos-
sible. The returned questionnaires enable currently en-
rolled students considering internships to learn of the edu-
cational opportunities and economic aid provided by a
given hospital. Legislation to provide for a central file on
each hospital to contain percentage tabulations of answers
to each question of a standard evaluation form was en-
acted. Funds are not available for this operation as yet;
but since such a file would be of considerable value to the
prospective intern, it is expected that this difficulty will
be overcome in the near future.
The economic plight of most married interns is well
known in medical circles. The Student American Medical
Association conducted a survey of medical students and
found that 54 per cent of students entering their senior
year are married and that 46 per cent of students enter-
ing their junior year are married. It was further deter-
mined that at the time that maintenance — room, board,
laundry, and stipend — was instituted for the intern, the
married intern was somewhat of a rarity. Provision for
the economic maintenance of the married intern and his
family is far from adequate. The national organization is
now undertaking a survey for the purpose of publishing
a comparison of the index of the cost of living with the
index of economic maintenance by hospitals. Since cost
of living indices vary widely over the nation, this infor-
mation will be by geographic area. The statistics pro-
vided by the survey will be made available to all hos-
pitals; and since it is generally those hospitals which offer
the finest educational opportunities that have the small-
est provision for the economic welfare of the intern, it
will be pointed out that when more graduates can afford
these internships, the increased number of applicants will
very likely provide these hospitals with a better class
of interns.
The increasing occurrence of malpractice suits brought
against interns and residents was pointed out at a pre-
convention meeting of the advisory committee of the local
chapter with the chapter officers. At the national con-
vention, a resolution stating the problem and designed
to institute a survey to determine the extent of such suits
and the best possible method of resolving the situation
was introduced and passed. It is understood that to an
intern or resident, the cost of malpractice insurance is
prohibitive.
As many physicians realize, there is a great need among
many medical students for financial aid. The ideal way
to meet and continue meeting this need would be to estab-
lish a loan fund which would operate on a no interest,
postgraduate payment plan. Under this plan, loans should
be available to any student judged to be likely to com-
plete his academic work and deemed to be in need of
financial aid. Such a plan, in freeing the needy student
of a heavy financial burden, would permit him to func-
tion more efficiently in school and would serve to encour-
age application to medical school by those who are inter-
ested in medicine as a career but choose another field be-
cause of the financial difficulties involved in medical train-
ing.
The Student American Medical Association for sev-
eral years has attempted to institute a loan plan similar
to the one outlined above. Donations have been solicited
from various professional organizations and individuals,
but the amount received is not yet sufficient to begin
operation of the plan. However, a Board of Trustees has
been established for the administration of the funds.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
39
The author of this report has no information con-
cerning the amount of money needed on a national scale,
but feels capable of making an estimate of the local need.
Approximately one third of the members of the freshman
class of the University of Florida College of Medicine, or
15 students, are in need of financial aid. A reasonable
estimate would be $500 for each of four years, or a total
of $2,000 per student. Since full-scale operation of the
school must be considered, the need, with four classes, will
be $30,000 per year, or $180,000 for the first six year
period. Since repayment of loans will be extensive by the
end of six years, the amount needed each year after that
would progressively diminish. It might be added that the
full amount received as donations to this fund would be
paid out as loans, since the College of Medicine will pro-
vide for administration of the funds at its own expense.
Curriculum evaluation programs are being conducted
by individual chapters, and recommendations are made
by the national organization for improvement of educa-
tion standards and methods in medical schools. These
recommendations arc published in the monthly journal
of the Student American Medical Association, now known
as New Physician.
The national organization urged its individual chapters
to continue to improve their premedical student counsel-
ing programs. These are designed to improve the quality
of applicants to medical schools by stimulating interest
among the more superior students.
There is also a survey of high school students to deter-
mine their scientific interests. It is hoped that this survey
will indicate better ways to stimulate interest in medicine
as a career among scientifically inclined students and pro-
vide educators with more knowledge of deficiencies in
scientific education in the public schools.
Several constitutional amendments designed to expand
the range of the Student American Medical Association
and to provide membership in a medical organization for
those who are in postgraduate training were approved.
Now a medical student can have membership through
medical school, internship, and residency by payment of
the $4 membership fee in his freshman year. This fee is
paid only once and covers membership (including the
monthly publication) for the duration of this training.
Another amendment involves the creation of geo-
graphical regions, each to elect its own regional vice
president. The purpose of this arrangement is to facilitate
exchange of ideas among chapters ; and since each regional
vice president is a member of the executive council, indi-
vidual chapters will more closely determine national
policy.
As sidelights to the convention, there were some very
interesting programs, such as presentations of scientific pa-
pers by students, a panel discussion by nationally promi-
nent physicians concerning specialty and general practice,
and technical exhibits by drug and equipment companies.
The Florida Student Medical Association has received
valuable aid and guidance from Dr. Carl Herbert, repre-
senting the Florida Medical Association, and Dr. Thomas
Brill, representing the Alachua County Medical Society,
and would like to express its appreciation to them and
to their respective societies for providing these represen-
tatives to the advisory committee of the Florida Student
Medical Association.
The author of this report, representing the Florida
Student Medical Association chapter at the University of
Florida College of Medicine, feels that the Student Amer-
ican Medical Association is a living organization which
is taking great strides toward fulfillment of its purpose to
help improve medical standards over the nation and to
better educational opportunities. The Florida Student
Medical Association stands to gain much from its mem-
bership in the Student American Medical Association and
would like to express its appreciation to the Florida Med-
ical Association for providing it with the opportunity to
be represented at the national convention and for per-
mitting this report to be presented before the House of
Delegates of the Florida Medical Association.
Respectfully submitted,
Marvin I. Baker, Delegate
Dr. Langley: ‘‘We now go to something that
is different. We have arranged to present certi-
ficates to our Life Members. To those that are
not in attendance, the certificate will be mailed
later. In subsequent years, it is intended that
Life Members will receive their certificates each
year at the convention. I now turn this pleasant
duty over to our Secretary, Dr. Sam Day.”
Dr. Day: “It has been said that the feeling of
having done a job well is rewarding; the feeling
of having done it perfectly is fatal. Certainly, we
men of medicine are not too often bothered with
the feeling of having done it perfectly, but it is
rewarding to have done the job well. Our Life
Members deserve some distinction. They have
done the job well and we want to show our appre-
ciation for it. For the first time, we have pre-
pared a certificate. As Dr. Langley mentioned in
his address, the first one was awarded to Dr. Jo-
seph Halton of Sarasota on his fiftieth anniver-
sary. We are now going to present certificates to
those who have been in the Association for 35
years and hereafter they will be presented each
year at the Convention.”
Dr. Day called the roll of Life Members and
presented certificates to those in attendance.
Dr. Langley: “We will now take up the recom-
mendations of the Reference Committees. We
will hear first from Dr. Leo M. Wachtel, Chair-
man, Committee No. 1, Health and Education.”
Report of Reference Committee No. 1
Dr. Wachtel: “Mr. President and Members
of the House of Delegates:
“Your reference committee gave careful con-
sideration to items referred to it and makes the
following report:
“The Report of the Committee on Scientific
work, Dr. George T. Harrell Jr., Chairman, is
approved as printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. James N. Patterson.
Motion carried.
Report of Committee on Scientific Work
George T. Harrell Jr., Chairman
In an effort better to organize the work of the Asso-
ciation during the Annual Meeting, the Committee on
Scientific Work planned a different program than in re-
cent years. The scientific papers have been grouped in two
sessions in a single day so that the House of Delegates
and Reference Committees might meet without conflict
with other activities. A new feature of the program has
40
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
been the inclusion of a closed-circuit television program in
conjunction with other state societies meeting concurrent-
ly-
The scientific exhibit has been increased in variety. It
is recommended that more flexibility in size of space for
individual exhibits be provided in the future if possible.
An expanded program of scientific movies has been ar-
ranged along with kinescopes of nationally televised medi-
cal programs. This feature might warrant further emphasis
in future years.
The Committee met on December 1, 1956 in Gaines-
ville to select the papers, exhibits, movies, moderators of
the panels, and the other details of the selection of the
program. The number of applications for a place on the
program was gratifying, but the lateness of many inquiries
made the work of the Committee unduly heavy. Greater
emphasis should be placed on early submission of titles
and abstracts so that the complete program can be selected
by the middle of January and printed in The Journal on
time. If the number of titles submitted continues to in-
crease, the Committee might be enlarged and divided into
separate sub-committees which could be responsible for the
selection of scientific exhibits, movies, papers, and dis-
cussants.
The Committee recommends the continuation of the
appropriation of $250 per year, first granted in 1954, to
permit the invitation of out-of-state distinguished guests
for participation on panels, symposia, and the general ses-
sion program.
“The Report of the Committee on Medical
1’ostgraduate Course, by Dr. Turner Z. Cason.
Chairman, is approved as printed in the Hand-
book.
“The reference committee took note of the un-
selfish and untiring work of the chairman. Dr.
Turner Z. Cason, who is retiring from this posi-
tion after 26 years of service to the physicians
of Florida.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. W. Dean Steward.
Motion carried.
Report of Committee on Medical
Postgraduate Course
Turner Z. Cason, Chairman
The only meeting of the Medical Postgraduate Course
Committee during the year 1956 was held at 10:30 A M.
Sunday, October 28, at the Medical Science Building, Col-
lege of Medicine, University of Florida, in Gainesville.
The appointment of Dr. William C. Thomas Jr., of
Gainesville as Director of the Division of Postgraduate
Education, College of Medicine, University of Florida, was
made at the time of his introduction to the group. Dr.
Thomas will assume the duties of this office on July 1,
1957.
Dr. George T. Harrell Jr., Dean of the College of
Medicine, together with Dr. Thomas expressed a wish for
the continued close cooperation of the Florida Medical
Association, the Florida State Board of Health, and the
College of Medicine in the presentation of postgraduate
medical education in the state.
The Committee approved continued efforts to elicit
cooperation among all sources presenting postgraduate
medical education to clear dates and to list their seminars
with the office of the Florida Medical Association thereby
eliminating, as far as possible, overlapping and conflicts of
dates as well as duplication of seminars.
An exhibit stressing postgraduate medical education at
the annual meeting of the Florida Medical Association was
suggested to the Committee. Space was secured and vari-
ous organizations throughout the state contacted for as-
sistance in planning such an exhibit.
A ruling allowing medical postgraduate education to
be deducted from the income tax made further action by
the Committee in this regard unnecessary.
Plans for a Special Course in Hematology beginning
on June 20, 1957 and for the 25th Annual Short Course,
June 24-28, have been formulated. In compliance with the
recommendation of the previous Committee, these courses
will be held at the College of Medicine, University of
Florida. Plans also are underway, at the request of the
Florida Diabetes Association, for the presentation of a
Seminar on Diabetes Mellitus during the Fifth Annual
Meeting of this group scheduled for the fall at the College
of Medicine.
The following courses were held during the year 1956:
Seminar on Cardiovascular Diseases, February 23-
25, Jacksonville, with 120 in attendance.
Seminar on Gastroenterology, June 21-23, Jack-
sonville, with 44 attending.
24th Annual Short Course, June 25-28, Jackson-
ville, with 136 attending.
Seminar on Diabetes Mellitus, October 18-19,
Jacksonville, with 74 registering.
Southeastern States Cancer Seminar, November
7-9, Jacksonville, with 85 registering for
credit out of the 410 attending.
11th Annual Midwinter Seminar on Ophthalmolo-
gy and Otolaryngology, January 14-19, 1957,
with 370 attending.
“The report of the Committee on Cancer Con-
trol. Dr. Ashbel C. Williams, Chairman, is ap-
proved as printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. James R. Boulware Jr.
Motion carried.
Report of Committee on Cancer Control
Ashbel C. Williams, Chairman
The Committee on Cancer Control of the Florida
Medical Association met jointly with the Florida Cancer
Council, January 25, 1957, at Tampa, Florida.
It was the consensus that the chest X-ray remains
the most accurate means for the early detection of lung
cancer but that it is most effective when there is a direct
patient-doctor relationship and where there is a patient
selection on the basis of age and sex. Mass chest X-ray
programs for early detection of lung cancer are not en-
couraged by this committee since they have proved im-
practical elsewhere in the country.
It was recommended that the hospitalization of in-
digent cancer patients be incorporated in the Plan for the
Hospital Service for the Indigent provided that adequate
funds be made available by the Florida State Board of
Health for the continuation of other aspects of the cancer
program including the support of tumor clinics, cancer
seminars, cancer registries and other such projects as may
develop in the future.
A subcommittee was appointed to study the distribu-
tion of tumor clinics in Florida and determine the need
for, and location of, any additional clinics.
It was recommended that the Cross Roads Seminar
be held again in the fall of 1958 and that this latter
seminar be offered the Hillsborough County Medical As-
sociation for staging in Tampa. It was reported to the
Committee that the Southeastern States Cancer Seminar
held in Jacksonville in November, 1956, had a faculty of
19 outstanding cancer authorities and that the registered
attendence was 425 physicians.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
41
It was recommended that the American Cancer So-
ciety provide funds for and set up a program to aid and
encourage the pathologists of Florida to take additional
postgraduate training in exfoliative cytology. Also, it was
recommended that a similar program be set up for the
training of technician screeners in exfoliative cytology.
The Committee feels that the above measures will greatly
broaden and improve the quality of the cytodiagnostic
facilities in Florida which is deemed a most important
objective in cancer control.
The Committee recommended approval of a brochure
prepared by the Florida Society of Pathologists at the
request of the Florida Cancer Council. The brochure out-
lines information relative to the indications for obtaining
and preparation of cytological smears. It also explains the
clinical significance of the various types of pathological
reports. It is for distribution to the physicians of the
Florida Medical Association.
The Committee recommended approval of the princi-
ple of pilot cytological screening programs for cervical
cancer and recommended the setting up of such a program
in a Florida community.
‘'The report of the Committee on Venereal
Disease Control, Dr. C. W. Shackelford. Chair-
man, is approved as printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. Jere W. Annis.
Motion carried.
Report of Committee on Venereal
Disease Control
C. W. Shackelford, Chairman
Venereal diseases in the state appear to be under rel-
atively good control. During the current year, there have
been no sustained fluctuations in the trend which would
indicate a rise or a greater than average decrease in the
incidence of the five venereal diseases. About 1945, it was
stated that there were more cases of venereal disease in
Florida than any other state, and more cases in Bay
County than any county in the state.
Through my office in 1956, a General Practitioner, 366
Kahns were made through the State Health Department,
only fourteen positives were found; one primary, two
early latent, eleven late latent and no congenital. Two
proved to be spinal.
The first six months of 1956 there were 144 cases of
primary and secondary syphilis reported by clinic and
private physicians. The second six months there were 58
cases reported. The reduction in the cases for the second
six month period may be due to reporting. However, in-
fectious cases of most of the venereal diseases have shown
a general decrease since 1950.
Gonorrhea is still the problem in venereal disease con-
trol. It is generally assumed that a large percent of gonor-
rhea is not being seen by private physicians, therefore, the
cases are never reported. This can be explained by saying
that many druggist are seeing and treating gonorrhea, not
only by oral penicillin and sulfonamides, but also by dis-
posable syringe penicillin. The State Health Department
should investigate this, if legal. Reports from the Venereal
Disease Control Committee state that they see about three
cases a year.
Figures as reported by the State
Board of
Health
follow:
1950
1956
Primary and Secondary Syphilis
1510
202
Acute Gonorrhea
14185
10766
Chancroid
248
268
Lymphogranuloma Venereum .
34
54
Granuloma Inguinale
446
72
Eleven counties have conducted selective intensive
blood testing surveys during 1956. Simular programs are
planned for eighteen other counties by June 30, 1957, re-
maining counties will have the same blood testing surveys.
In 1956, the state laboratories performed 190 TPI
tests for private physicians. More should take advantage
of this essential service. There is still a long way to go
before most of the venereal diseases reach a control level
or can be dismissed as a public health problem.
‘‘The report of the Committee on Tuberculosis
and Public Health. Dr. Phillip W. Horn, Chair-
man, is approved as printed in the Handbook.
‘'I move the adoption of this portion of the
report.”
Seconded by Dr. Madison R. Pope.
Motion carried.
Report of the Committee on Tuberculosis
and Public Health
Phillip W. Horn, Chairman
During the year there were no outstanding prob-
lems nor questions presented to the committee requiring
a formal meeting of the group.
Mr. W. T. Edwards of the State Tuberculosis Board
requested an opinion as to the advisability of the con-
tinued “early discharges” of patients from the State
Tuberculosis Hospitals. It was the belief that each pa-
tient should be individualized, and if facilities were avail-
able in his home community for follow-up and treatment,
and if he was non-infectious, then this policy would be
acceptable. In communities where the County Health
Officer might seek consultation, then these services might
be provided by the State Board of Health or the ad-
jacent sanatarium staff.
In December 1956, The Florida Tuberculosis and
Health Association initiated a state-wide coordinating
Council on Tuberculosis to aid the official and voluntary
groups interested in the care of the tuberculous patient
to bring into common action a program that would bene-
fit these persons. The various members of the health or-
ganizations, the medical association, the vocational service
and the state Tuberculosis Board presented the problem.
Definite recommendations are to be presented at the next
meeting in the summer.
The “Shared Dietician” program was not brought
up for discussion ; apparently the number of dieticians
interested in this type position is too small and also
the hospitals are too widely distributed for this type of
service to prove practical. The plan is excellent as it
would provide smaller hospitals with well trained per-
sonnel both for supervision and training. It is felt that
if there is sufficient demand the Florida Medical Associa-
tion should approve the plan.
“The report of the Committee on Maternal
Welfare. Dr. E. Frank McCall, Chairman, is ap-
proved as printed in the Handbook.
“I move the adoption of this portion of
report.”
Seconded by Dr. Chas. J. Collins.
Motion carried.
Report of Committee on Maternal Welfare
E. Frank McCall, Chairman
The Maternal Welfare Committee has had three
planned meetings for discussion; two in Miami during
the Florida Medical Association meeting and one in
Daytona Beach. One of our members, Dr. Richard
42
SECOND HOUSE OF DELEGATES
Volume XI.IV
Number 1
Stover, has met in a joint meeting with the American
Committee on Maternal Welfare in Hollywood. The
Maternal Welfare Committee sponsored by the State
Boards of Health of Florida, Georgia, and South Caro-
lina, held an Obstetric and Pediatric Seminar at Daytona
Beach September 10, 11, and 12. This meeting is show-
ing a progressive yearly increase in attendance. Total
registration was 323. The faculty for this meeting was
as follows:
Dr. Fred Adair, Maitland, Florida;
Dr. William J. Dieckmann, The Chicago Lying-In
Hospital ;
Dr. John Parks, The George Washington Univ.
School of Medicine;
Dr. Charles H. Hendricks, University Hospitals of
Cleveland ;
Dr. Milton L. McCall, Louisiana State University
School of Medicine;
Dr. Georganna Jones and Dr. Howard Jones, Johns
Hopkins Hospital;
Dr. Frederick H. Falls (Visitor) Chicago, Illinois;
Dr. Sydney S. Gellis, Childrens’ Hospital, Boston ;
Dr. James G. Hughes, University of Tennessee;
Dr. Edith L. Potter, The Chicago Lying-In Hos-
pital ;
Dr. Robert Lawson, University of Miami.
Plans are now in progress to again hold this meeting
in Daytona Beach in 1957.
The State Board of Health has not compiled their
final figures for the maternal deaths in Florida up to
this date, but with the figur*s we have at hand, we know
that there has been an increase in the total number of
deliveries, and that the maternal mortality for the state
will be approximately the same as 1956. That is, 5.5 per
10,000, which is below the national average.
We are again deeply grateful for the help we have
received from our sponsors. I would like to thank each
member of the committee for their complete cooperation
during this past year, and also our President, Dr. Francis
H. Langley, for his cooperation during the entire year.
‘‘The report of the Committee on Child
Health, Dr. Warren W. Quillian. Chairman, is
approved as printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. James R. Boulware Jr.
Motion carried.
Report of Committee on Child Health
Warren W. Quillian, Chairman
The Committee on Child Health has served during
the past year as an advisory group with the Florida Pe-
diatric Society and the Florida Chapter of the American
Academy of Pediatrics. Efforts have been largely in the
promotion of organized programs throughout the state for
poisoning control among children, and in a coordinated
effort to facilitate the availability and distribution of
poliomyelitis vaccine. Considerable effort has been ex-
pended in this connection in collaboration with the Flor-
ida State Board of Health, under the able leadership of
Dr. Wilson T. Sowder.
In an attempt to reduce accidental poisoning among
the children of this state, the Florida Pediatric Society has
established Centers at fifteen strategic locations through-
out Florida. These are serving as emergency stations for
diagnosis and therapy under the supervision of local phy-
sicians. By means of an educational program, these Cen-
ters are designed to become sources of factual information
concerning industrial and agricultural hazards which may
be potential sources of poisoning in children.
We were represented in January, 1957, at a meeting
of the Committee on Maternal and Child Care of the
Council on Medical Service of the American Medical As-
sociation at Hollywood Beach. It is the general consensus
that improvement of morbidity and mortality rates during
neonatal life depends now upon better technics and skills
during the prenatal as well as the postnatal periods. A
guide for maternal death studies, now being prepared for
distribution by the American Medical Association, should
be helpful in the attack on problems related to this field
of child care. Better cooperative effort among general
practitioners, obstetricians and pediatricians will inevita-
bly result in the reduction of perinatal mortality.
Programs for continuing health supervision of chil-
dren from birth through the school years were discussed.
It is hoped that these programs can be accomplished
through effective contact with the child’s own medical ad-
viser, his personal physician. Most of the problems of
child health are best managed at the local level, with the
aid and support of physicians through their local medical
society. Much of our work has been initiated by others.
We are glad to provide guidance and supervision when re-
quested. Our chief purpose as a Committee is to promote
activities designed for improvement of the health and
care of Florida’s infants and children. These activities are
sponsored by and through existing agencies since no funds
have been allocated for a state-wide organized effort by
our Committee. Needless reduplication of effort is thus
avoided. Committee personnel is selected from each medi-
cal district.
“The report of the activities of the State
Board of Medical Examiners, Dr. Homer L. Pear-
son Jr., Secretary, is approved as read.
“Mr. President, I move the adoption of this
portion of the report.
Seconded by Dr. James N. Patterson.
Motion carried.
Report To: Florida Medical Association,
House of Delegates
From; Florida State Board of Medical
Examiners
Submitted by; E. B. Hardee, M.D., President,
Homer L. Pearson Jr., M.D.,
Secretary
We are happy to again make a short report of the
activities of the Board of Medical Examiners.
During the past year we examined 723 applicants, 544
of whom were issued certificates of licensure. There was
a mortality rate of 24.6%. We revoked 1 license and
suspended 2. It may be of interest to you to know that
only the Board can suspend or revoke a license; how-
ever, we have no authority to reinstate a revoked license.
To regain a license one must re-apply and pass the ex-
aminations again— if accepted for examination. We can
find no fault with that procedure.
There are certain of the specialty groups who feel
that the examinations are not quite fair to them, since
they must pass examinations prepared primarily for the
general practitioner and many times there are no ques-
tions pertaining to their particular specialty, which if
asked would give the applicant an opportunity to bring
his general average up. The Board has considered this
complaint and will try to have a few questions covering
the entire field of medicine, surgery, and we may add
psychiatry.
The president and secretary of the Board have been
attending regularly the meetings of the Federation of
State Medical Boards of the United States where prob-
lems common to all boards are studied. We would like
to call your attention to one or two of these problems
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
43
1. Are examinations by the several state boards any
longer justified? Much can be said pro and con on this
subject, but it contains much food for thought. There
are now no unaccredited medical schools in the United
States. All graduates of these schools are declared fit
by the schools to be doctors. Each one will be granted
license in one or more states. Most examining boards
follow a similar pattern in examining and grading. If a
man will not make a fit doctor he should never be per-
mitted to graduate. If he is a fit doctor then he should
be permitted to practice anywhere he wishes, say some.
A man is actually not a fit doctor when he graduates
but needs hospital or other training before he is, so the
board examinations should cover an area above that
covered by school examinations and below that covered
by the specialty boards, or should be aimed at those who
have had at least one year internship, say others. Yet,
Florida has no internship requirement. There are some
who believe our principle function now is to regulate the
distribution of doctors. However, it is easy to see the
difficulty in so far as the state itself is concerned. Once
a license is granted we have no control over where in the
state one may locate. There can be too many doctors in
Fort Lauderdale and too few in Okeechobee but just try
to get somebody to move from Fort Lauderdale to Okee-
chobee ! Then too, it is very difficult to convince the
mother who cannot get a doctor to see her baby in the
middle of the night, or people living in a county that has
no doctor, that there is not a shortage of doctors in
Florida.
2. Another frequently discussed question is that of
national endorsement as opposed to reciprocity or no
reciprocity. We believe that all states except Florida
now have some degree of endorsement. We have used
the age old excuse that if we became more liberal and
granted license other than by examination we would
be flooded by doctors. That statement has been ques-
tioned by some. The examinations certainly create a
stumbling block for many. Endorsement does not mean
the indiscriminate acceptance of all who hold licenses in
other states but that under certain conditions he may be
accepted for license without examination. California
will accept certain ones without examination if they have
passed the endorsed state board examinations in the past
five years. Of course, the question of whether we should
grant license through any form of endorsement is one
which the doctors of this state should decide.
3. Another of the pressing questions has been about
what to do with foreign graduates. For a number of
years the Council on Medical Education and Hospitals
of the American Medical Association has published a list
of the acceptable foreign medical schools. We feel that
some on this list should not be and many which are not
there should be, yet, the American Medical Association
could not inspect all foreign medical schools. Especially
if they have not been invited to do so. From now on a
different approach is to be made to the problem. A
committee has been set up representing the American
Medical Association, American Hospital Association, Fed-
eration of State Medical Boards of the United States,
and others, called the “Educational Council for Foreign
Medical Graduates.” The purpose of this group is to
screen every foreign graduate who comes to the United
States and if his education comes up to standard for the
United States he is recommended to the state boards.
There is no obligation of the part of the board to accept
him but he has a clean bill of health as far as his medi-
cal education is concerned. The American Medical As-
sociation will then no longer accredit or discredit any
foreign school.
Finally, since the Florida Medical Association, of
which each member of the Board of Medical Examiners
is a part, has as one of its aims the improvement of
medical care for our people. We are of the opinion that
the Board of Governors of the Florida Medical Associa-
tion should act as an advisory committee to the Board
of Medical Examiners. We feel that in this way our
Board can be in closer touch with the general member-
ship of the Florida Medical Association and that any
recommendation for changes in the medical practice act
and in the conduct of the affairs of the Board would
more definitely come from the medical profession of this
state as a whole.
“Mr. President, I move the adoption of the
report as a whole.
Seconded by Dr. Meredith Mallory.
Motion carried.
Other members of this committee were Drs.
C. Frank Chunn. of Hillsborough. V. Marklin
Johnson, of Palm Beach. Charles R. Sias, of Or-
ange. and Paul F. Baranco, of Escambia.
Report of Reference Committee No. 2
The Chair called for the Report of Reference
Committee No. 2, Public Policy, by Dr. Chas. J.
Collins, Chairman.
Dr. Collins: “Mr. President and Members of
the House of Delegates:
“Your reference committee gave careful con-
sideration to items referred to it and makes the
following report:
“The report of the Committee on Conserva-
tion of Vision, Dr. Charles C. Grace, Chairman,
is approved as printed in the Handbook.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Walter C. Jones.
Motion carried.
Report of Committee on Conservation of Vision
Charles C. Grace, Chairman
The Committee on Conservation of Vision in co-
operation with the Florida Council for the Blind is in
the process of making a survey of the educational facili-
ties offered throughout the state for the blind and partial-
seeing children.
This information will be correlated and printed in
pamphlet form. It will be available to all state resi-
dents who desire and who write to the Florida Council
for the Blind.
“The Committee carefully considered the re-
port of the Committee on Medical Education
and Hospitals together with the supplemental
report and the additional report of the Medical
Schools Liaison Committee. The Committee rec-
ommends that point 6 of the original Committee
report read as follows: ‘That a Liaison Commit-
tee be established as a sub-committee of the Com-
mittee on Medical Education and Hospitals. This
committee shall be appointed by the President of
the Florida Medical Association and shall consist
of seven members to be selected as follows:
a. One member from the medical faculty
of the University of Miami School of
Medicine and one member from the
44
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
medical faculty of the University of
Florida College of Medicine.
b. One member of the Dade County Med-
ical Association and one member of
the Alachua County Medical Society.
c. One member from each of the other two
medical districts of the Florida Medi-
cal Association other than where the
medical schools are located, and one
member from the Florida Medical As-
sociation at large.’ ”
“The Committee recommends that the last
sentence of the supplemental report, which reads
‘Therefore, this committee again recommends to
the House of Delegates that serious consideration,
and action, be given to the idea of each member
of FMA donating $10 each year to the AMEF’
be changed to ‘This committee recommends to
the House of Delegates that each member of the
FMA be encouraged to donate $10 or more to the
Florida Medical Foundation to be used for what-
ever purpose he designates as defined in the Char-
ter.’ ”
“The Committee recommends that paragraph
5 of the Report of Medical Schools Liaison Com-
mittee be deleted.
“Mr. President, I move that these portions of
the report be adopted as amended with commend-
ation to Dr. Walter E. Murphree and his commit-
tee for their fine work."
Motion seconded.
Dr. James L. Anderson: “I would like to say
something in favor of Dr. Murphree’s original
report. I feel he has a better idea than has been
suggested. There are several reasons; one of
which is that the county medical society, with all
due respect to our president, is more likely to ap-
point a man to represent the county who could
successfully iron out differences between the med-
ical school and the local medical profession than
could a man who was appointed by the president
of the association, who might be someone resid-
ing in another locality who was not familiar with
the local problem.”
Dr. Collins: “Our committee discussed that
phase of the problem. There will also be a com-
mittee on liaison with medical schools on the
county level, and it was felt that most of these
problems will be solved by the county committee
on the local level. It was also taken for granted
that the President, in appointing his committee,
would consult the respective county medical so-
cieties and obtain their advice in selecting a
member to represent that county society.”
Motion carried.
Report of
Committee on Medical Education and Hospitals
Walter E. Murphree, Chairman
At the 1956 meeting of the Florida Medical Associa-
tion the Alachua County Medical Society presented a res-
olution on the Relationship Between Medical School Fac-
ulties and Physicians of the Community. The House of
Delegates approved this resolution in spirit and referred it
to the Committee on Medical Education and Hospitals to
act in conjunction with the Medical Advisory Committee
of the University of Florida, with instructions to report
to the Board of Governors in September.
This was a new experience for the Committee on
Medical Education and Hospitals as, in the past, its ef-
forts have been limited to seeking donations to the
AMEF and of publicizing the aims of the AMEF. In-
tensive study was made on the subject of medical school
faculties, especially of the report on “Private Practice by
Medical School Faculty Members,” presented to the House
of Delegates of the American Medical Association by the
Council on Medical Services. This report contains detailed
surveys from both medical school deans and state and
county medical associations and was made available to all
members of the Committee for their study.
On August 5, 1956, a combined meeting of the two
committees, to which the question had been referred, was
called in Gainesville, Florida. After considerable study and
discussion of the problem, the following was recommended
to the Board of Governors at its September meeting:
1 . That the action of the American Medical Associa-
tion House of Delegates, June, 1956, in adopting
the Culpepper resolution is accepted.
2. The adoption of that section of the American Med-
ical Association House of Delegates action in June,
1956, dealing with publicity.
3. That it be the primary responsibility of the admin-
istrators of medical schools to exercise adequate
controls over the extent of private practice in order
to maintain proper relationship between teaching
responsibilities and private practice.
4. See No. 3 of Report of Medical Schools Liaison
Committee, page 45.
5. That a Liaison Committee be established as a sub-
committee of the Committee on Medical Educa-
tion and Hospitals. This Committee shall be ap-
pointed by the President of the Florida Medical
Association and shall consist of seven members
to be selected as follows:
a. One member from the medical faculty of the
University of Miami School of Medicine and
one member from the medical faculty of the
University of Florida College of Medicine.
b. One member of the Dade County Medical As-
sociation and one member of the Alachua Coun-
ty Medical Society.
c. One member from each of the other two medi-
cal districts of the Florida Medical Association
other than where the medical schools are lo-
cated, and one member from the Florida Medi-
cal Association at large.
6. That the appointments to the Liaison Committee
should be made for four years and the initial
terms to be staggered to provide for a minimum
change of members in any one year.
7. That the function of this Committee to be in line
with those recommended in the report adopted by
the American Medical Association House of Dele-
gates, June, 1956.
The action of the Board was to approve the report of
the committee with the exception of No. 5, which states,
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
45
“That an appropriate limit of ‘take home pay’ be set for
geographical full-time faculty members by the Medical
School Deans.” The Board directed that the Liaison Com-
mittee, as authorized by this action, study this particular
recommendation further, investigate it, and recommend
such changes as were deemed advisable.
The membership of the Liaison Committee is now
complete and is as follows:
Dr. Walter E. Murphree, Gainesville, Florida — State
at Large
Dr. Merritt R. Clements, Tallahassee
Dr. Henry H. Graham, Gainesville
Dr. James N. Patterson, Tampa
Dr. Edward W. Cullipher, Miami
Dr. Homer F. Marsh Jr., University of Miami Medi-
cal School
Dr. George T. Harrell Jr., University of Florida Med-
ical School
This Committee will meet in the near future and
should have a supplementary report for the House of
Delegates.
The action of this Committee in behalf of the AMEF
has been limited to correspondence. The total donations
for 1956 is not available at this writing. The quota for the
State of Florida was $20,000. Dr. Jack Cleveland, the pre-
vious chairman of the Committee, attended a meeting of
state chairmen of Medical Education Committees on Jan-
uary 27, 1957. This has been an annual meeting for Dr.
Cleveland for several years. His comments in regard to
this national meeting, as a representative of this Commit-
tee, will be made in a supplemental report.
Supplement
The American Medical Education Foundation was
organized and sponsored by the AMA in 1951 to seek
financial contributions in behalf of the medical schools.
The medical profession’s annual goal is $2,000,000, which
goal has not as yet been met in any one year.
AMEF State of Conditions, Dec. 31, 1956
Amount transferred to National Fund for
Medical Education and distributed to
Medical Schools since 1951 $4,684,312.00
Amount available for distribution
Dec. 31, 1956 1,072,727.00
Total Income — 1951 to date 5,757,039.00
1956 Source of Income
Physicians $ 534,074.51
AMA 225,000.00
Other societies, organizations
and clinics 216,623.47
Woman’s Auxiliary and laymen 90,988.89
$1,066,686.87
Interest 6,040.13
TOTAL $1,072,727.00
The Fifth Annual Report of the foundation shows
that of the 2980 Florida physicians, 57 contributed to the
Foundation in 1955 or 1.9%. Their contributions
amounted to $4,799.00. During the same period 640
Florida physicians made financial contributions totaling
$19,558 directly to the alumni programs of their own
schools. In 1956 only 73 of Florida’s approximately 3,000
physicians contributed to AMEF, with a total of $4,640.00.
Only 13 other states in the union contributed less than
Florida. These statistics prove that Florida physicians
need to be educated as to the needs of the AMEF.
Florida’s equitable quota of the national whole is esti-
mated to be $20,000.00, and the AMEF campaign would
be a success if each member contributed a minimum of
$10 toward this quota. It is felt that this idea would
meet with success for there have been almost sixty
contributions of $10 or $20 for members of the FMA
in the months of January and February 1957.
This committee recommends to the House of Dele-
gates that each member of the FMA be encouraged to
donate $10 or more to the Florida Medical Foundation
to be used for whatever purpose he designates as defined
in the Charter.
Report of Medical Schools Liaison Committee
Walter E. Murphree, Chairman
This Committee met in Gainesville on March 31 to
consider the question referred to it by the Board of
Governors. All members were present with the excep-
tion of Dr. Edward W. Cullipher, representative of Dade
County, and Dr. George T. Harrell, who was represented
by Dr. Sam Martin.
The meeting was a harmonious one, and it was pleas-
ant to note that the thinking of the two medical schools
in regard to earned remuneration for geographic faculty
members was almost identical. We think that this augurs
well for the future relationships between the schools and
the members of FMA. The consensus of the committee
was that it would be impossible for this committee to
spell out in dollars and cents the salaries of the various
faculty members because of the many variables involved,
especially in the keeping of a proper ratio between asso-
ciate professors and heads of departments for instance,
and the supplementation of salaries of basic science in-
structors who would have no opportunity to supplement
their own salaries. The idea of allowing one to make
100% of one’s base salary was not found objectionable
in principle, but impossible to apply practically. It was
agreed that in the implementation of this problem there
would of necessity have to be a good deal of faith in one
another and in one another’s principles. There was no
evident lack of such faith at this meeting. Therefore,
the committee’s formal report and recommendations to
the Board of Governors are as follows:
1. That the limit of “take home pay” be set for
geographic full time faculty members by the Ex-
ecutive Committees and Deans of the medical
schools, with the full knowledge of the Medical
Schools Liaison Committee, which subject shall
be an item on the agenda of the committee at its
semi-annual meetings.
2. That the Medical Schools Liaison Committee shall
meet twice yearly to consider any problem that
might arise in such liaison.
3. That recommendation No. 4 of the Report of the
Committee on Medical Education and Hospitals of
August 6, 1956 shall read: “That all patients
treated in medical school facilities be used for
teaching purposes. That all private patients treat-
ed by geographic full time faculty members must
be referred by a licensed physician.
4. That the Board of Governors be requested to ask
County Medical Societies where medical schools
are located to establish a liaison committee of not
more than three members to meet with an equal
number to be appointed by the Dean of the
Medical School. The purposes of these committees
to be essentially the same as the state committee,
though on a local level, and to cooperate with
the state committee.
“The report of the Committee on Medical
Economics, Dr. Robert E. Zellner, Chairman is
approved as printed in the Handbook.
“The Committee wishes to stress the impor-
tance of the enrollment of at least 60% of the
members of the Florida Medical Association in
the insurance plan, so that it may be available
to all members. The Committee further wishes
to commend the Chairman, Dr. Robert E. Zellner,
and his committee for their work.
“Mr. President, 1 move the adoption of this
portion of the report.”
I
46
SECOND HOUSE OF DELEGATES
Volume X I . I V
X umber 1
l
Seconded by Hr. Walter C. Jones.
Motion carried.
Report of Committee on Medical Economics
Robert E. Zellner, Chairman
The work of the Medical Economics Committee this
year has been a continuation of projects previously initi-
ated. The Association’s first group insurance endeavor was
begun with the offering of its Disability Insurance and
Catastrophic Hospitalization plans. The effective date of
the plan was delayed some six weeks by complaints to the
Insurance Commissioner by the Florida State Association
of Health and Accident Insurance Underwriters. The plan
was re-examined by the Commissioner and, after minor
changes suggested by the Attorney General, offered to the
members of the Association.
Florida law requires that sixty percent (60%) of the
membership of an organization must participate in an in-
surance program before it can qualify as a true group. To
date only about thirty percent (30%) of the membership
of the Association has applied. Until this percentage figure
is reached, it is necessary for the underwriter to consider
each individual application. This means that those with
unfavorable past medical histories will not be accepted. As
soon as the required sixty percent (60%) participation is
met, all rejected applicants will be invited to re-apply for
insurance and all restrictive riders on any issued policies
will be removed.
The Committee urges that all members of the Asso-
ciation carefully study the advantages of the Association
plan and that all those who intend to purchase this in-
surance do so promptly in order that the benefits of this
insurance may become available to those of our members
who are otherwise uninsurable.
This past year witnessed the first raise in rates for
professional liability insurance since 19S2. The Association
has successfully resisted three previous attempts on the
part of the National Bureau of Casualty Underwriters to
obtain rate increase. On Oct. 8, 1956, the Insurance Com-
missioner held a meeting in Tallahassee for the purpose of
ascertaining the justice of the Bureau companies’ request
for rate increases. Despite a very spirited and effective
presentation of the medical profession’s attitude on this
matter by Mr. F'rank Kelly, jointly representing the Flor-
ida Medical Association and the Dade County Medical As-
sociation, the Commissioner granted an eighty-seven per-
cent (87%) increase in professional liability rates for phy-
sicians and one hundred thirteen percent (113%) increase
for surgeons.
The Chairman feels that despite the rate increases,
this meeting accomplished two things:
1. It afforded the opportunity for the profession to
present to the Commissioner and the National Bu-
reau Companies its dissatisfaction with the way
malpractice claims and professional liability insur-
ance are being handled in Florida. Representatives
of 27 of the 37 county medical societies represent-
ing seventy-five percent of the membership of the
Association were present at the meeting.
2. For the first time, the insurance companies recog-
nized that the Association, and not just the indi-
vidual physicians, has some interest and should
have a voice in matters related to malpractice.
The latter point was further emphasized when a Com-
mittee from the Association of Casualty Companies at the
urging of the Insurance Commissioner, requested a meet-
ing with representatives of the Association. The Medical
Economics Committee met with this Committee on Nov.
4, 1956, in Jacksonville. The insurance representatives
agreed to urge their members and their companies to seek
the assistance of the Florida Medical Association and the
various county medical society insurance committees
whenever claims of malpractice arose and to request the
claim men’s associations throughout the state to have
representatives from the Association to speak at their
meetings on the medical Association’s program.
The Committee urges that those county societies
which have not yet organized insurance committees do so
soon. The practice which some county societies have of in-
cluding a discussion of medical ethics, grievance committee
activities, and malpractice in their indoctrination program
for new members is heartily endorsed and recommended to
all county societies.
The chairman wishes to express his appreciation to
the members of the Committee, to Dr. Day, Dr. Langley,
and to Mr. Gibson for their help and advice.
“The report of the Committee on Represent-
atives to Industrial Council, Dr. Chas. L. Farring-
ton, Chairman, is not approved.
“It was noted in this report that the chairman
recommended that this committee be discontinued.
The Committee felt that this was not wise be-
cause of many future problems which will arise
due to growth of industry in the state. It is felt
that this committee could work to better advant
age if its duties were more clearly defined.
“Mr. President. I move that this portion of
the report be not approved and not published in
The Journal.”
Seconded by Dr. Leffie M. Carlton Jr.
Motion carried.
“The report of the Grievance Committee, Dr.
David R. Murphey Jr., Chairman, is approved
as printed in the Handbook.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Charles R. Sias.
Motion carried.
Report of the Grievance Committee
David R. Murphey Jr., Chairman
As has been the custom since the formation of this
Committee, one meeting is held each year in conjunc-
tion with the meeting of the State Association. The
last meeting was held at the Fontainebleau Hotel under
the chairmanship of Dr. Herbert E. White. The next
meeting will be held at the Hollywood Beach Hotel, at
the 1957 Annual Meeting of the Association.
It has been the policy of the State Committee to
refer all complaints to the local county grievance com-
mittees and these committees have functioned efficiently
and promptly during the past year.
The number of complaints received this year has not
increased over the past year. The types of complaint
vary and those that are not obviously from psychopathic
personalities, arise from misunderstanding between the
patient and physician, usually over the fee. There are
only two or three hold-over complaints that have not
been settled.
As Chairman of the Committee I want to thank the
other members for their cooperation and especially the
local county grievance committees for their prompt at-
tention to complaints arising in their localities.
“The report of the Committee on Nursing,
Dr. Jere W. Annis, Chairman, with its supple-
mental report, is approved.
“I move the adoption of this portion of the
report.”
Seconded by Dr. James T. Cook Jr.
Motion carried.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
47
Report of Committee on Nursing
Jere W. Annis, Chairman
The Committee on Nursing met in the Roosevelt Ho-
tel at Jacksonville Nov. 4, 1956, immediately following a
called meeting of the House of Delegates.
Numerous reports from the county medical societies
regarding the appointment of committees on nursing were
at hand and apparently each society has appointed an in-
dividual or a group to deal with local nursing problems.
Communications from various societies were consid-
ered and the advisability of consideration by this Commit-
tee of unsolved local nursing problems was discussed. Sev-
eral societies availed themselves of the opportunity of hav-
ing representatives present at the meeting. No other busi-
ness of significance was transacted.
No specific Committee action has been taken on any
nursing problems. Local committees in the various county
societies have been established, and it is hoped that any
problems affecting nursing and the medical profession will
be funnelled through these committees to the State Asso-
ciation.
Supplement
In mid-April a part of the Committee met in Talla-
hassee with members of the nursing profession who were
about to introduce into the State Legislature amendments
to the Nursing Practice Act. These amendments were in
many respects inimical to the best interests of the medical
profession and concerned chiefly the regulation of the
physician’s office assistant as well as the limitation of
the scope of activity of the licensed practical nurse.
The Committee was successful in effecting the dele-
tion of all objectionable features from the Bill which
was then approved and which has since been reported
out of committee in both Houses of the Legislature.
“The report of the Committee on Blood, Dr.
Louis E. Pohlman, Chairman, is approved as
printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. James N. Patterson.
Motion carried.
Report of Committee on Blood
Louis E. Pohlman, Chairman
The Committee chairman represented Florida in a
panel discussion on “Blood Procurement in a Civil De-
fense Disaster” held by the Federal Civil Defense Admin-
istration at Fort Benning, Georgia, August 13, 1956. The
unrealistic criteria and standards regarding equipment,
staffing, as well as blood needs, was pointed out. The
need to impress “Type 0” blood donors as to the im-
portance of their blood was expressed. This fact is
doubly important when it is realized that only “Type O”
blood will be collected during the first 72 hours of any
disaster.
The Florida Association of Blood Banks held a Di-
rectors meeting in Miami during December. It was de-
cided to hold the annual meeting at a time when many
doctors attending the Florida Medical Association meet-
ing could also attend the blood banks meeting. This time
was to be in May just following the F.M.A. meeting.
Medicare
The future of blood procurement in regards to the
new Medicare Plan has not been determined. The efforts
of most health insurance groups has been to buy blood
outright and without regard to replacement. The Prog-
nosis for the Community Blood Bank is not good with
the symptoms now beginning to be observed along with
the inroads of socialized medicine.
The Joint Blood Council has failed to assume a posi-
tive role in coordination of blood collecting facilities on a
national scale and thereby allowing a lay group to con-
tract for collection of blood for civil defense. A.M.A. rep-
resentatives to the Council have been content to observe
recent activities within the federal government. A new
coordinating committee on blood in the Office of Defense,
the National Research Council’s Committee on Blood and
a blood procurement section of O.D.M. may well reach
the objectives outlined by the recently formed Joint Blood
Council.
“On the resolution on Non-cancellable Health
and Accident Insurance Policies, presented by the
Escambia County Medical Society, I move this
resolution be approved in principle and referred
to the Committee on Medical Economics.”
Seconded by Dr. Paul F. Baranco.
Motion carried.
Resolution
Non-Cancellable Health and Accident Insurance Policies
WHEREAS certain insurance policies do not clearly
state on the face of the policy as to whether or not the
policy is “cancellable” or “non-cancellable” and “guaran-
teed renewable,” and that certain health and accident
insurance policies are cancelled at the discretion of the
insurance carrier, be it therefore resolved that our Dele-
gates introduce a resolution to the Insurance Committee
of the Florida Medical Association that they work to-
ward legislation which would clearly mark health and
accident insurance policies on the face of the policies in
large letters as to whether or not the policy is “cancell-
able” or “non-cancellable,” “guaranteed renewable” or
“not guaranteed renewable,” and that such policies which
had been in continuous effect for a 3 year period cannot
be cancelled at the discretion of the company, as long as
the premiums are paid.
Resolution adopted by The Escambia County Medical
Society on April 9, 1957.
Respectfully submitted
Pascal G. Batson Jr., Secretary
Escambia County Medical Society
“Mr. President, I move the adoption of the
report as a whole.”
Seconded by Dr. Mallory.
Motion carried.
Other members of this committee were Drs. S.
Carnes Harvard, of Pasco-Hernando-Citrus,
Burns A. Dobbins Jr., of Broward. James T.
Cook Jr., of Jackson-Calhoun, and Leffie M. Carl-
ton Jr., of Hillsborough.
Report of Reference Committee No. .‘I
The Chair called for the report of Reference
Committee No. 3, Dr. Norval M. Marr Sr.,
Chairman.
Dr. Marr: “The report of the Board of Gov-
ernors as printed in the Handbook and the sup-
plemental report are approved, with the exception
of those portions of the supplemental report which
were referred to other reference committees.
"I move that this portion of the report be ap-
proved.”
48
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
Seconded by Dr. Mallory.
Motion carried.
Report of Board of Governors
Francis H. Langley, Chairman
During the administrative year and prior to the pub-
lication of this report, three regular meetings of the Board
were held on May 16, September 16 and January 27. In
addition the Board met in called session on August 18,
1956 to consider methods and procedures for implementa-
tion of the Dependents’ Medical Care Act, Public Law
569, 84th Congress, known as the Medicare program. An-
other meeting has been scheduled tentatively for April
prior to the meeting of the House of Delegates and will
he covered in a supplemental report.
Every member of the Board merits high commenda-
tion for his willingness to sacrifice time and convenience
to attend these meetings at personal expense. It is indeed
stimulating to note the sincerity, thoroughness and wis-
dom with which the Board considers an astonishing va-
riety of problems to the benefit of every member of the
Association. I wish to take this opportunity to express my
personal gratitude to the members of the Board and ex-
press on behalf of the Association deep appreciation for
this service and devotion.
Recommended By-Law Changes
Committee on Emergency Medical Service
A Committee on Emergency Medical Service has been
in existence for several years, but has not been officially
designated as a standing committee with appointments in
the same manner as other committees. It now appears that
this, or similar committee, will probably need to function
in the foreseeable future. It is therefore recommended that
the following by-laws changes be effected:
Chapter VII — Sec. 1. In line 23 following the term
“(Section 20)”, the period shall be replaced by a semi-
colon and the following added, “a Committee on Blood
(Section 21); a Committee on Nursing (Section 22); a
Committee on Emergency Medical Service (Section 23).”
In line 25 the term “(Section 21)” shall be changed
to read “(Section 24)”. In line 28 the term “(Section
22)” shall be changed to read “(Section 25).”
Chapter VII — Sec. 23 be changed to:
“Emergency Medical Service, Appointment
and Duties” — The Committee on Emergency
Medical Service shall consist of five members.
The President shall appoint four members, one
from each medical district, one for one year,
one for two years, one for three years, and one
for four years, and thereafter they shall be ap-
pointed for four years as the terms expire. The
President shall also appoint one member at large
for a term of one year. The President shall select
as chairman of this committee one of the five
members, who shall serve in that capacity for one
year. The duties of this committee shall be to co-
operate with the Federal Civil Defense Adminis-
tration, and particularly with the State Civil De-
fense Administrator and State Civil Defense Med-
ical Officer in an advisory capacity; to act in an
advisory capacity to the Red Cross in matters of
civil defense and disaster, and to encourage the
establishment and assist in the functioning of sim-
ilar committees in each county medical society;
and, in the event of a disaster, to aid in the
moving of medical personnel to the disaster area
in numbers consistent with the need.
The Chairman of the Committee on Emergency Medi-
cal Service is recommending in his report that the name of
this committee be changed to Civil Defense and Disaster
Committee.
“Sec. 23. (1956 Revision) Board of Past Presidents”
he changed to read “Sec. 24. Board of Past Presidents.”
“Sec. 24. (1956 Revision) Arrangements for Annual
Meeting” be changed to read “Sec. 25. Arrangements for
Annual Meeting.”
Recommendation
Annual Meeting Sites
1958 — Americana, Bal Harbour
The 1956 House of Delegates approved a recommen-
dation of the Board of Governors that the 1958 Conven-
tion be held in Jacksonville, contingent upon completion
of additional hotel facilities. It now appears that these
additional facilities may not be available in time for the
1958 meeting. It is, therefore, recommended that the
House of Delegates reconsider its action in selecting Jack-
sonville as the site for the 1958 Convention and designate
in its place the Americana in Bal Harbour.
The By-Laws provide that the Board of Governors
shall set the dates for these meetings. Your Board wishes
to call to your attention that the Americana is holding the
dates of May 10 through May 14, 1958 pending action by
this House. These are the earliest dates available to us in
that year.
1959 — Undetermined
As this handbook goes to press, it is known that ad-
ditional hotel facilities in Jacksonville will be available in
the near future. At this time it is impossible to determine
the earliest dates these will be available, the extent of
these facilities and whether they will be adequate for our
meeting. It is requested that the Board of Governors be
authorized to select Jacksonville as the 1959 Convention
site, if in its opinion adequate facilities are available. If it
becomes necessary to make another selection, recommen-
dations to that effect will be presented to the House at
the 1958 Annual Meeting.
Your Board earnestly requests that members or coun-
ty medical societies believing convention facilities in your
area adequate and desiring to have the meeting in your
community so advise the Board in order that these facili-
ties may be inspected to determine whether they be ade-
quate.
Number one project for the year was the completion
of the new permanent home for the Association at 735
Riverside Avenue, Jacksonville. Your beautiful new build-
ing of contemporary design was occupied for the first time
on August 15. It was formally dedicated on September 15.
The efficiency of your executive office has been greatly
improved and expansion of service to the members is
made possible by the enlarged and improved physical
plant. Not only has the Board met in the new building
but it has been utilized on numerous weekends by allied
and ancillary organizations for committee meetings. Every
member is urged to visit the headquarters building in
Jacksonville to observe personally the facilities which you
have provided for your association. A deep debt of grati-
tude goes to the Building Committee, Dr. Edward Jelks,
Chairman, Dr. Robert B. Mclver and Dr. Samuel M. Day.
The final recommendation of the Building Committee
just prior to being discharged at its own request was the
placing on one of the walls of the Board Room a photo-
graph accompanied by suitable inscription of the late Dr.
Stewart G. Thompson, Managing Director of the Asso-
ciation, 1926-1953.
Another major activity during the year, which has
made, and continues to make, great demands on the time
of Board members and the executive office is the Medicare
program. Following the lead of the American Medical As-
sociation, and acting under its recommendations from
planning on a national level, a contract with the Federal
Government was accomplished within the limitations set
by the House of Delegates at a called meeting in Jackson-
ville on November 4, 1956. Acting on your authority, Dr.
John D. Milton negotiated a fee schedule on the basis of
the California Relative Value Schedule within your con-
version factor limitations. Copies of a brochure containing
this fee schedule, known as the Schedule of Allowances,
and other essential information was mailed to each mem-
ber of the Association in late January. Blue Shield of
Florida, Inc. in compliance with your request is a party
to the contract with the Government to serve solely as
the fiscal administrator. In accordance with the provisions
of the contract, a Medicare Mediation Committee has
been appointed. This committee will hear complaints, re-
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
49
view special reports and recommend fees for unlisted pro-
cedures. Further, in accordance with a directive of this
House, a committee to study the Medicare fee schedule
to submit recommendations as a basis for the renegotia-
tion of the present contract, which expires June 30, has
been appointed. A listing of the members of this commit-
tee, selected from the major categories of medicine, sur-
gery, radiology, pathology and general practice, may be
found in the committee section of The Journal.
An operating budget for the fiscal year beginning
March 21, 1956, in the amount of $141,848 was presented
by Dr. Samuel M. Day, Secretary-Treasurer. To this was
added $1,400 authorized by the Board for salary adjust-
ments, $2,500 directed by the House of Delegates to reim-
burse the President and Secretary-Treasurer for travel ex-
penses and $600 for expenses of delegates to the Student
American Medical Association, making a total budget for
the fiscal year of $146,348. This budget was based on ex-
periences during the fiscal year as reflected in the audited
joint financial statement of the Secretary-Treasurer and
Managing Director, published in the July 1956 Journal. It
is anticipated that reports and financial statements for
1957 will be published in the July 1957 Journal.
As authorized by the 1956 House of Delegates, an Ex-
ecutive Committee of the Board of Governors was estab-
lished and has proved of inestimable value in long range
planning and the study of involved problems for recom-
mendations to the Board.
During the year, the Florida Medical Foundation au-
thorized by the 1956 House of Delegates was organized.
A Charter was drawn up and approved by the Judge of
the Circuit Court. This Charter designates members of the
Board of Governors as the members of the Foundation.
By-Laws were then drawn up and approved by the Board
of Governors, and in accordance with the provisions of
the Charter officers of the Foundation were elected. They
are: Drs. Edward Jelks, President, John D. Milton, Vice
President, and Clyde O. Anderson, Secretary-Treasurer.
Additional information on the Foundation and methods
by which contributions may be made to it will be pre-
sented to the members in the near future.
Your Board gave approval to the recommendation of
the Committee on Medical Education and Hospitals, Dr.
Walter E. Murphree, Chairman, of the establishment of a
Committee on Liaison with Medical Schools. Details of
this are contained in Dr. Murphree’s report.
Upon the recommendations of the Executive Com-
mittee and the Chairman of the Scientific Work Com-
mittee, Dr. George T. Harrell Jr., your Board carefully
considered and approved with commendation the schedule
and program for the Eighty-Third Annual Meeting. This
schedule as published in the April Journal and as con-
tained in the official program, contains certain changes
and innovations, including the first meeting of the House
of Delegates at 3 p.m., Sunday, May 5. It is believed that
this arrangement has definite advantages which will im-
prove the meeting and will increase the efficiency of the
House of Delegates by allowing Reference Committees
more time to consider reports and resolutions. It will also
make possible for current delegates to be seated at the
Annual Meeting of Blue Shield.
An innovation to the scientific program is a closed
circuit television panel program sponsored by Smith, Kline
& French Laboratories. The program will originate in
Chicago and the state associations of North Carolina,
Louisiana, Oklahoma and Kansas, who are meeting si-
multaneously will be included in the hook-up. This is
scheduled for 3 to 4 p.m., Monday afternoon, and our
portion of the program will be moderated by Dr. Robert
J. Needles, of St. Petersburg. Any member of the tele-
vision audience may submit questions to the panel by
telephone during the course of the telecast.
Due to the fine facilities available in the motion pic-
ture theater at the Hollywood Beach Hotel, scientific mo-
tion pictures have been scheduled for Mondav night, May
6.
Your Board has been kept advised of the progress of
the disability insurance program, details of which may be
found in the report of the Chairman on Medical Eco-
nomics, Dr. Robert E. Zellner. Members of the Associa-
tion who have not already done so are encouraged to in-
vestigate the coverage offered in this program under spon-
sorship of the Association. It is only when the required
participation is reached that it will be possible for all
members of the Association under age 70 to be eligible for
disability insurance regardless of medical history.
Your Board took under advisement and careful con-
sideration a resolution from the Hillsborough County
Medical Association with reference to changes in service
features of Blue Shield contracts. This resolution is being
referred to Reference Committee No. 3, Finance and Ad-
ministration.
As directed by the 1956 House of Delegates, a Blue
Shield Liaison Committee has been appointed and is now
functioning under the capable leadership of Dr. Henry J.
Babers Jr., of Gainesville, Chairman. This is a seventeen
man committee comprised of two representatives from
each Councilor district and one member at large. The list
of the full committee may be found in the committee
section of your Journal.
At the request of the American Medical Association
and the Chairman of the Poliomyelitis Medical Advisory
Committee, Dr. Richard G. Skinner Jr., your Board gave
approval of Association sponsorship through the county
medical societies of a program designed to have all people
in the country under the age of 40 vaccinated against
poliomyelitis. You are referred to Dr. Skinner’s report in
this handbook for further details.
At the January 27 meeting, the Board’s attention was
directed to a disturbing proposal for industrial group in-
surance which would require physicians to sign an agree-
ment guaranteeing full-service benefits, with specified ex-
ceptions, over which the profession would have no juris-
diction. After careful consideration the Board decided to
request the component societies to call this proposal to
the attention of their members, urging them to exercise
caution before making any definite commitment and to
await the action of this House on a resolution to be pre-
sented, but which was not drawn in time to be included
in the published Handbook. This resolution is being re-
ferred to Reference Committee No. 2, Public Policy, and
all interested members of the Association are urged to be
present to express their views and aid the committee in
its deliberations.
As directed by the 1956 House of Delegates, your
Board took under advisement the resolution submitted by
the Broward County Medical Association on Standard
Insurance Forms. Investigation disclosed that this matter
had already been worked out by the Health Insurance
Council, in cooperation with representatives of the A.M.A.
It was found impossible to utilize just one form for all
insurance claims, but a minimum of forms has been de-
veloped and approved by the A.M.A. and are available to
any insurance firm desiring to use them.
At the request of Governor Collins, a list of nomina-
tions for State Board of Health appointments was sub-
mitted. Also the Governor requested a list of nominations
for vacancies which will arise on the State Board of Medi-
cal Examiners. As required by the By-Laws, nominations
were solicited from the county medical societies and will
be submitted to the Governor by the Committee on Leg-
islation and Public Policy.
The 1956 House of Delegates approved a resolution
by the Leon-Gadsden-Liberty-Wakulla-Jefferson County
Medical Society on study of driver licensing law. This res-
olution contained a provision that the Florida Medical As-
sociation appoint a Medical Advisory Committee to assist
50
SECOND HOUSE OF DELEGATES
Volume XT. IV
Number 1
the State of Florida as required in this capacity. This rec-
ommendation has been approved by the State Govern-
ment and a Medical Advisory Committee to the Florida
Highway Patrol has been appointed.
Your Board believes that a member who has served
the Association and the public the 35 years required by
the By-Laws to become eligible for Life Membership
merits an expression of appreciation. In view of this a
Certificate of Merit has been designed and will be issued
to each Life Member of the Association. It is planned
that in future years those members of the Association
achieving Life Membership status during the current year
will be recognized at the annual meeting and a certificate
awarded to them at that time. Because the Sarasota
County Medical Society on April 9 paid tribute to Dr.
Joseph Halton for having practiced in that community 50
years, and because Dr. Halton had a corresponding record
of 50 years’ membership in the Association, your President
was pleased to present the first of these certificates to Dr.
Halton at that time. All other current Life Members will
receive certificates either in the special ceremony at this
meeting, or, in the event they are unable to attend, will
be mailed to them as soon as possible following termina-
tion of this convention.
Sub-Committee to the Board of Governors on
Veterans’ Care
Frederick H. Bowen, Chairman
During the year 1956, 36,740 authorizations were is-
sued to physicians in the State of Florida for medical care
and treatment of eligible veterans. This required an obli-
gation of $362,780.00.
During 1956 a booklet containing the Fee Schedule
and agreement between the Florida Medical Association
and the Veterans Administration was prepared, and this
is being sent to physicians who are performing services for
the Veterans Administration. Any physician who wishes a
copy of this booklet may obtain one by writing Mr.
Ernest R. Gibson at the Jacksonville headquarters of the
Florida Medical Association. In the interest of economy,
a copy was not sent to all members of the Florida Medi-
cal Association.
It was stated during the special called meeting of the
House of Delegates in Jacksonville in November that the
Fee Schedule with the Veterans Administration was sup-
posed to be renegotiated each year. Your Chairman, in
the interest of saving time, did not correct that statement.
For the sake of accuracy, however, it should be stated
that the agreement with the Veterans Administration and
the Fee Schedule are renewed each year. Unless we can
present evidence that the cost of medical practice has in-
creased markedly since the time the last Fee Schedule was
negotiated, there is not much basis for arguing for a high-
er Fee Schedule. The cost of medical practice has in-
creased moderately in some of the metropolitan areas of
Florida, while in other areas this increase has been slight.
This Fee Schedule was renegotiated six or seven times af-
ter it was first negotiated in 1946. There have been no
major changes in the fees since 1952, and of course the
cost of living index has increased only slightly since that
time.
The first case of dispute between the Veterans Ad-
ministration and a member of the Florida Medical Asso-
ciation over fees is now being examined by our Board of
Review. The fact that this is the first case in our nine
years of operation speaks well for the functioning of the
Veterans Administration and the cooperation of our mem-
bers in the state.
Sub-Committee to Board of Governors on
Blue Shield
Russell B. Carson, Chairman
Following the 1956 annual meeting of the House of
Delegates, the President of the Florida Medical Associa-
tion followed the directive of the House and appointed
a Committee on Blue Shield. This committee, sometimes
known as The Committee of Seventeen, under the Chair-
manship of Dr. Henry Babers has functioned energetically
and enthusiastically, having met jointly with the Board
of Directors, sent representatives to each Board Meeting
and held several independent meetings. Cooperation has
immeasurably improved the understanding of the prob-
lems faced by Blue Shield.
In accordance with the resolutions presented by the
Active Members of Blue Shield to the Board of Directors
at the 1956 annual meeting, an attempt is being made to
more fully enlighten the members of the Florida Medical
Association of Blue Shield’s activities. The Committee
of Seventeen has been fully used in this capacity. A
News Note from Blue Shield of Florida is being sent to
each participating member once per month. The Blue
Shield Medical Care Plans Newsletter, prepared by the
Blue Shield Commission in Chicago, is also being distri-
buted to the active membership.
On Dec. 7, 1956, the Dependents’ Medical Care Act
became effective with Blue Shield selected to act as the
Fiscal Agent for the State of Florida. This program is
now beginning to function. However, the burden of this
added activity will require more time for observation
before a report can be made.
Under consideration, study, and preparation for final
action by the Board of Directors between now and the
1957 Annual Meeting are modifications of the By-Laws
to extend the functions of the Active Members; revision
of present contracts; presentation to the membership of
proposed additional contracts; and a careful observation
of the financial status of Blue Shield. A premium rate
increase on group contracts was required in October.
A rate increase for individual contracts will be required
in the near future. The utilization of Blue Shield dur-
ing 1956 has markedly increased over 1955 — i.e. : from
83.9% in 1955 to 88.3% for the twelve months ending
December, 1956. This usage of Blue Shield can be con-
trolled only by the participating physician. Otherwise,
it must be dealt with by increasing the cost to the
subscriber.
Supplement
This supplement to the report of the Board of Gov-
ernors is in addition to and a part of the original report
as printed in the Handbook. It is submitted to include
a meeting of the Board in Jacksonville on April 7, 1957.
Your Board, after careful consideration, approved:
1. A resolution disfavoring the participation of any
member in a group insurance proposal which would
require physicians to sign an agreement guarantee-
ing full service benefits. This was referred to in
the original report as published on page 32 of the
Handbook. The resolution is a follows:
Resolution
WHEREAS, the individual member of the med-
ical profession has secured professional, social,
economic and political advantages through mem-
bership in County, State and National Societies,
and
WHEREAS, in this age of centralization, such
groups as organized government, organized busi-
ness and organized labor are continuously endeav-
oring to take advantage of the medical profession,
and
WHEREAS, the individual member of the med-
position to exert pressure or influence except
through his medical societies, such as the Florida
Medical Association, and
WHEREAS, the participation by any members
of the profession in service type health insurance
plans which have not been investigated and ap-
proved by the Florida Medical Association is not
in the best interest of the medical profession as
a whole or the public,
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
51
BE IT THEREFORE RESOLVED, that the
Board of Governors of the Florida Medical Asso-
ciation strongly advise the individual member not
to participate in any such plan that has not been
thoroughly investigated both from the professional
and legal viewpoints and approved by the Florida
Medical Association.
2. The report of the Chairman of the Committee on
Legislation and Public Policy, Dr. H. Phillip
Hampton, with regard to bills introduced or antici-
pated being introduced into the Legislature affect-
ing the practice of medicine. The Board endorsed
the recommendations of the Chairman with addi-
tional instructions in certain instances. A more
detailed report will be presented by Dr. Hampton
as a supplement to his report at this session of the
House of Delegates. (Approved by Reference
Committee No. 4.)
3. An operating budget submitted by Dr. Samuel
M. Day, Secretary-Treasurer, for the fiscal year
ending March 20, 1958, as amended, in the amount
of $169,494.35. A copy of this budget is on file
in the Executive Office and will be made available
to any member on request.
4. Two nominees for each vacancy on the Blue
Shield Board of Directors for presentation to the
active members of Blue Shield at its annual meet-
ing on May 6, 1957, at the Hollywood Beach
Hotel. A slate from which these nominees were
selected was presented to the Board of Governors
by the Blue Shield nominating committee, Dr.
Clyde O. Anderson, Chairman.
5. Referral without recommendation to Reference
Committee No. 2, the proposal of the Committee
on Medical Education and Hospitals to the House
of Delegates in 1956 and again this year, a per
member assessment for contribution to the Ameri-
can Medical Education Foundation fund. Each
county medical society was requested to ascertain
from its membership its preference in this proposal.
As this report is being prepared, we have received
replies from 25 county societies. Of these 6 ap-
proved an assessment and 19 were opposed. The
replies from the county societies are being made
available to the reference committee to aid in its
deliberations. (See Report of Reference Commit-
tee No. 2.)
6. The progress report on the Florida Medical Med-
ical Foundation by Dr. Edward Jelks, President.
In my original report, you will find on page 30
reference to the Foundation with a statement that
information will be presented to members in the
near future. Your attention is directed to the dis-
play in the lobby of the hotel. It is hoped that
every member will visit this booth and avail him-
self of the opportunity to learn more about the
Foundation.
7. Proposed articles of incorporation and proposed
Constitution and By-Laws for the Woman’s Aux-
iliary. The Auxiliary is to be commended for this
progressive step.
8. The recommendations of the Committee on Liaison
with Medical Schools. (See Report of Reference
Committee No. 2.) On pages 22 and 23 of the
Handbook, in the report of the Committee on
Medical Education and Hospitals, Dr. Walter E.
Murphree, Chairman, and on pages 30 and 31 of
the original report of the Board of Governors,
reference is made to the establishment of a Com-
mittee on Liaison with Medical Schools. This
Committee held its first meeting in Gainesville on
March 31 and arrived at certain recommendations
which were approved by the Board on April 7.
These recommendations are:
(1) That the limit of “take home pay” be set for
geographic full time faculty members by the
Executive Committees and Deans of the medi-
cal schools, with the full knowledge of the
Medical Schools Liaison Committee, which
subject shall be an item on the agenda at its
semi-annual meetings.
(2) That the Medical Schools Liaison Committee
shall meet twice yearly to consider any prob-
lem that might arise in such liaison.
(3) That recommendation No. 4 of the Report of
the Committee on Medical Education and
Hospitals of August 6, 1956 shall read: “That
all patients treated in medical school facilities
be used for teaching purposes. That all pri-
vate patients treated by geographic full time
faculty members must be referred by a licensed
physician.”
(4) That the Board of Governors be requested to
ask County Medical Societies where medical
schools are located to establish a liaison com-
mittee of not more than three members to meet
with an equal number to be appointed by the
Dean of the Medical School. The purposes of
these committees to be essentially the same as
the state committee, though on a local level,
and to cooperate with the state committee.
10. The actions and correspondence of the Secretary
and the Chairman of the Committee on Legislation
and Public Policy with reference to bills introduced
into the House of Representatives by members of
the Florida delegation proposing additional Veter-
ans Administration hospital facilities in Florida,
particularly a neuro-psychiatric hospital at Gaines-
ville. You will recall that this same issue was
raised several years ago (1954) and that the House
of Delegates supported Dr. Herpel in his opposition
to these additional facilities. We believe that the
efforts of your officers, with the assistance of the
Washington Office of the A.M.A., have been effec-
tive and that such legislation is not likely to be
enacted during the current session. This serves to
remind of the ever constant threat of the social-
ization of medicine through the Veterans admin-
istration. Each member of the Association should
constantly endeavor to keep his congressmen in-
formed of the medical profession’s valid objection
to unnecessary expansion of veterans’ hospital
facilities with its terrific drain on the treasury.
11. The report of the current status of Medicare by
Dr. John D. Milton, Chairman, Medicare Media-
tion Committee. The Association has been advised
that the Office for Dependents’ Medical Care will
ask for an extension of contract prior to the expira-
tion date of July 1, 1957, due to insufficient time
having elapsed to acquire adequate information as
a basis for renegotiation. The tentative schedule
set up is for renegotiation for Florida in April,
1958. It is believed that the delay in negotiations
will be advantageous to both the Government and
the profession in view of the short time in which
the program has been in operation and due to the
multitude of problems which are constantly arising
and being solved day to day in the early stages
of the program.
“Your committee recommends that the Report
of the Committee on Necrology, with the supple-
mental report, by Dr. Alvin L. Stebbins, Chair-
man, be received and recorded.”
52
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
Dr. Langley asked that the House stand for a
moment of reverent silence in tribute to those who
have gone ahead.
Report of Committee on Necrology
Alvin L. Stebbins, Chairman
During the last fiscal year our Association lost by
death the members whose names are listed below:
Gail E. Chandler, Miami
Leonard H. Conly, Key West
Francis A. Copp, Jacksonville
Leroy B. Elliston, Fort Lauderdale
Frank J. Farley, Dade City
Harry T. Fenn, Mount Dora
Louis J. Garcia, Tampa
Robert B. Harkness, Lake City
Benj. F. Hodsdon, Jacksonville
Harvey J. Howard, Clearwater
Ray W. Hughes, Lake Worth
Frederick C. Keisling, Jacksonville
Prescott LeBreton, St. Petersburg
Samuel D. W. Light, Miami
John W. McClane, Fernandina Beach
John J. McGuire, Pensacola
William D. Nobles, Pensacola
Andrew M. O’Hara, Sneads
John H. Owens, Orange Park
Wm. R. Schnauss, Jacksonville
Robt. D. Sistrunk, Dade City
Rollin D. Thompson, Coral Gables
Leon M. Thurston, St. Petersburg
Russell S. Underwood, Perrine
Clayton D. Washburn, Jacksonville
Charlotte K. Wilkins, North Miami
Arthur G. Williams Sr., Lakewood
Carl A. Williams, Noank, Conn.
When possible, obituaries have appeared in The
Journal relative to the deaths of these doctors. Tributes
have been paid to them in the different communities
where they have practiced.
Supplement
Since the Handbook went to press, the following
members have been lost by death:
George E. Beckman, Jacksonville
Guy W. Heath, West Palm Beach
Gordon F. Henry, West Palm Beach
Wm. J. Lancaster, Tampa
Chas. W. Larrabee, Bradenton
Harrison G. Palmer, St. Petersburg
Adelbert F. Schirmer, Orlando
James A. Smith, Sanford
Ralph S. Torbett, Tampa
Theodore M. Trousdale, Sarasota
Benjamin A. Wilkinson, Tallahassee
“It is recommended that the Report of the
Committee on Advisory to Woman’s Auxiliary,
Dr. John P. Ferrell, Chairman, be approved as
printed in the Handbook.
“Mr. President, I move the adoption of this
portion of the report.”
Motion seconded and carried.
Report of Committee on Advisory
to Woman’s Auxiliary
John P. Ferrell, Chairman
The Woman’s Auxiliary, under the very capable
leadership of Mrs. Scottie J. Wilson, has functioned
smoothly and efficiently during the past year. Their mem-
bership has grown to over 1800. Our wives continue to
take an active part in nurse recruiting, mental health, edu-
cational foundation work, civil defense, cancer education,
public relations, legislation, and their Today’s Health proj-
ect. An excellent year book was also issued to all mem-
bers.
With the growth of the Auxiliary, it has become evi-
dent that it may be wise for them to incorporate. This is
a complicated process, but Mrs. Richard Stover has ac-
cepted the task of organizing the necessary rules, cnarter,
and legal advice along these lines, and we hope to be able
to present the final plans to the Florida Medical Associa-
tion at the 1957 meeting for final approval.
“The report of Councilor Districts and Coun-
cil and the supplemental report, by Dr. Herschel
G. Cole, Chairman, is approved.
“I move the adoption of this portion of the
report.”
Seconded by Dr. W. Dean Steward.
Motion carried.
Report of Council
Herschel G. Cole, Chairman
During the annual meeting of the Florida Medical
Association the Council was organized. This year only
two matters came to the attention of the Council. For-
tunately, a turn of events solved them without official
action.
The four district meetings were held in Tallahassee,
Ocala, Tampa, and West Palm Beach on October 30-31,
November 1-2, respectively. All the state officers were
present giving an interim report on the affairs of the As-
sociation. In addition, Dr John D. Milton attended each
meeting explaining in detail the federal law regarding the
medical care of military dependents. This was a long, tire-
some, and arduous task and the Council wishes to express
its deep appreciation to Dr. Milton. Dr. Edward Jelks al-
so deserves and is given special recognition for his un-
selfish giving of time and effort in explaining the “Indigent
Medical Care Program.”
Throughout the meetings the subject of medical and
surgical care of “Regional Ileitis and Colitis” aroused
much interest and discussion particularly in its relation-
ship to the President of the United States. The Council
expresses appreciation to all the officers and members of
the Association who so liberally gave time and effort in
staging the four excellent district meetings.
Deep gratitude is expressed to the officers of the La-
dies Auxiliary in providing work shops at each meeting.
President, Mrs. Scottie J. Wilson, and President-Elect,
Mrs. Perry D. Melvin, graced each meeting with their
presence. Compliments are extended to the Vice Presi-
dents, Mrs. A. F. Weekley, Mrs. Lee Rogers Jr.,
Mrs. Bernard M. Barrett, and Mrs. Willard Fitzgerald,
who, with local committees, arranged the “work shops”
in their respective districts.
Finally, I wish to express my deep appreciation for
the splendid cooperation of the members of the Council;
namely, Drs. Alpheus T. Kennedy; Walter J. Baker; Leo
M. Wachtel; Charles L. Park Sr.; C. Frank Chunn;
Gordon H. McSwain; Ralph M. Overstreet Jr., and Ralph
S. Sappenfield.
Supplement
Your council has considered the request and desire of
the Santa Rosa County physicians to affiliate themselves
with Walton-Okaloosa County Medical Society forming
a Tri-County Medical Society to be known as the Wal-
ton-Okaloosa-Santa Rosa County Medical Society.
Also, the request of the Suwannee County Medical
Society to change their name to the Suwannee-Hamilton-
Lafavettee County Medical Society was considered.
It is recommended that both these requests be ap-
proved.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
53
“The report of the Committee on Advisory to
Selective Service for Physicians and Allied Spe-
cialists, and the verbal supplemental report by
Dr. J. Rocher Chappell, Chairman, is recom-
mended for approval with an expression of appre-
ciation to Dr. Chappell for his fine work over a
period of many years. It is also recommended
that this committee be dissolved at the time it
legally ceases to function.
“I move the adoption of this portion of the
report.”
Seconded by Dr. Chas. J. Collins.
Motion carried.
Report of Committee on Advisory to Selective
Service for Physicians and Allied Specialists
J. Rocher Chappell, Chairman
1. Number of physicians in Priority I who have not
served in the armed forces and their current classi-
fications:
As of 31 December 1956 there are 47 Priority I
physicians who have performed no active duty in
the armed forces: Five (5) in Class I-D (Re-
serve) ; four (4) in Class II-A (essential occupa-
tion) ; thirty-one (31) in Class IV-F (not accept-
able for service) and seven (7) in Class V-A (over
age). There are twenty (20) Priority I physicians
currently serving in the armed forces.
2. Number of physicians who entered military service
in 1955 and 1956.
From records in this headquarters, approximately
fifty-four (54) physicians (who are also special
registrants) entered service in 1955 and approxi-
mately forty-one (41) physicians (who are also
special registrants) entered service in 1956. We
have no record of the number of physicians enter-
ing service who were not required to register un-
der Special Registration No. 1 by reason of being
members of reserve components of the armed
forces.
3. Number of physicians who have been commis-
sioned but not called to active duty.
As of December 31, 1956 there are thirty-eight
(38) physicians who have received commissions
and have not been called to active duty.
4. Total number of physicians who have entered mil-
itary service since the Doctor’s Draft Act was im-
plemented (9 September 1950). From records in
this office you are advised that approximately 250
physicians, who are also special registrants, have
entered military service from November 1950 to
December 31, 1956.
We have not had any meetings of the Committee dur-
ing the past year. The present work of the Committee
consists largely at the present time of writing innumerable
letters, answering innumerable telephone calls, and giving
interviews either to young physicians who are on immi-
nent call to military service, or to their relatives, friends
or patients who feel that they are essential to the com-
munity.
Supplement
Advice received from Washington by letter this week
states that this committee will cease to exist on June 30,
1957.
“The report of the Committee on Emergency
Medical Service by Dr. Rowland E. Wood, Chair-
man, is approved as printed in the Handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. Fred Mathers.
Motion carried.
. Report of Committee on Emergency
Medical Service
Rowland E. Wood, Chairman
Your committee has been requested by the State
Board of Health and the Florida Civil Defense Adminis-
tration to recommend locations for the storage of five
200 bed improvised hospitals in the State of Florida.
These hospitals are loaned to the State of Florida by the
Federal Government.
The hospital can be carried in 2,000 cubic square
feet. (The largest truck trailer is 10 ft. x 10 ft. x 20 ft.
or 2,000 square feet.) The generator (mounted on a trail-
er) will not go in this but must be brought by some other
means. The equipment of the hospital is very much like
that of an Army Clearing Company. Not included in the
equipment is a microscope and a centrifuge, which the
local communities must supply when the hospital goes in
operation.
In making these selections there are several things
that we believe should be borne in mind:
1. There are no primary target areas in Florida.
2. There are five secondary targets in. Florida, viz,
Jacksonville, Orlando, Miami, Tampa-St. Peters-
burg (considered one area) and Tallahassee.
3. Storage of these 200 bed hospitals should not be
in the target area, but rather 30-50 miles from the
target areas, but rapidly accessible to the areas.
4. Dade county already has a 200 bed improvised
hospital which they have made up on their own
initiative.
5. We understand that the County Commissioners of
Orange County have appropriated money for the
purchase of a hospital.
6. Population centers should have the first priority.
With these things in mind our recommendations are
as follows:
1. One hospital to service the Jacksonville area.
2. Two hospitals for the Tampa-St. Petersburg area.
3. One hospital plus the already available hospital for
the Miami area.
4. One hospital for the Tallahassee-Pensacola area.
The establishment of Emergency Medical Service
Committees, or preferably designated as Civil Defense and
Disaster Committees in each county medical society is
urged. We resubmit the program as contained in the report
of this committee last year as a guide for these county
level committees:
1. Develop a working plan for the duties and location
of work for doctors and allied professions in any
type of disaster.
2. Make a survey of available buildings and designa-
tion of same to care for patients in the event of a
disaster. It is to be recognized that the existing hos-
pitals will not be adequate in the event of a major
disaster.
3. Develop a plan for evacuation of surplus casualties
to adjacent areas if needed.
4. Contact and cooperate with the Federal Civil De-
fense Administration and the Red Cross in the de-
velopment of their plans.
5. Develop a plan to send teams of physicians to oth-
er areas if needed.
6. Make a survey of medical supplies available in the
area needed in case of a disaster. This should in-
clude hospitals, pharmacists, wholesale drug houses,
Red Cross and Federal Civil Defense Administra-
tion.
54
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
7. That the committee cooperate closely with the new
Committee on Blood.
It is recommended that the name of this committee
be changed to Civil Defense and Disaster Committee and
that it be made a regular standing committee of the Flor-
ida Medical Association as proposed in the report of the
Board of Governors.
“The report of the Blue Shield Liaison Com-
mittee and its supplemental report, by I)r. Henry
J. Babers Jr., Chairman, is recommended for
approval.
“I move the adoption of this portion of the
report.”
Seconded by Dr. W. Dean Steward.
Motion carried.
Report of Blue Shield Liaison Committee
Henry J. Babers Jr., Chairman
This committee made up of 17 representative doctors
throughout the state has undertaken to study the rela-
tions of the Florida Medical Association and Blue Shield
of Florida, Inc. After careful study and discussion, our
initial recommendations are these:
1. That Blue Shield is a worthwhile and important
phase of our medical practice and that it needs
help.
2. That to promote true understanding of the mu-
tual problems, every possible means of informing
our membership concerning the activities of Blue
Shield should be employed, and that every possi-
ble means of informing Blue Shield of the
thoughts and problems of our membership should
also be employed.
3. That we request Blue Shield to detail to this com-
mittee trained professional relations personnel, full
time if possible, to give technical help in inform-
ing ourselves and the membership.
4. That Blue Shield invite members of this commit-
tee to listen in at meetings of the Board of Di-
rectors of Blue Shield (this is already being
done).
5. That we emphasize the high caliber of men, both
professional and lay, on the Blue Shield Board of
Directors.
6. That we emphasize the method of selecting the
Board of Directors to Blue Shield and emphasize
that the voting delegates of the Florida Medical
Association are also the acting, voting member-
ship of Blue Shield.
7. That we urge the Association’s delegates to know
more about Blue Shield and emphasize that it is
their right and privilege and obligation to attend
the Annual Blue Shield Meeting.
8. That we withhold any discussion of fee schedules
and new contracts until the Florida Medical As-
sociation Committee on the revised relative value
schedule has reported.
9. We suggest that ideas of new and different con-
tracts be seriously studied by Blue Shield itself.
10. We feel that the present service income levels
should be kept the same for the present.
11. We recommend that the Blue Shield Board of Di-
rectors not make any changes in policy which
would affect the contract without prior consulta-
tion with this committee and prior approval of
this committee.
12. We recommend that the chairman set up some
method to pool our information on misdemeanors,
complaints, etc. by doctors, by Blue Shield, and
by patients. This is to be used for information
only and not as a grievance committee.
Supplement
On April 7, 1957, the Advisory Committee to Blue
Shield met in Jacksonville, Florida. We voted to make
two other recommendations: (1) We recommend to
Florida Medical Association that an additional informa-
tion meeting of the voting members of Blue Shield be
considered at an entirely different place than the annual
meeting of the Florida Medical Association. Such a
meeting should be long enough to allow proper reports
and discussion. (2) We request that Florida Medical
Association get a report from its relative value schedule
committee as soon as possible for use in discussion of
other Blue Shield contracts, aside from the Medicare
program.
“On the resolution on Blue Shield Service
Category, presented by the Hillsborough County
Medical Association, the committee believes that
this resolution, which was originally written in
1955. presented certain problems the solution to
which has been referred to the newly formed
Blue Shield Liaison Committee.
“The functions and objectives of the Blue
Shield Liaison Committee, as outlined in Dr.
Babers’ report, indicate that this committee will
provide for the requirements of the resolution.
Therefore, I move that this resolution not be
adopted and not be published in The Journal.”
Seconded by Dr. Mallory.
Motion carried.
“The committee recommends that the resolu-
tion on Blue Shield Fee Schedule, presented by
the Escambia County Medical Society be refer-
red to the Blue Shield Liaison Committee.
“Air. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Tolle.
Motion carried.
Resolution
Blue Shield Fee Schedule
Whereas, The appropriate fees for medical care are
not static and must change from time to time to reflect
changes in:
1. The general economy,
2. Accepted methods of treatment,
3. Our continuing re-appraisal of the relative value of
particular procedures,
Be It Resolved that the Florida Medical Association,
through one of its regular committees or through a special
committee, review the fee schedule of the Blue Shield Pro-
gram each two years and recommend any changes which
may seem indicated.
Respectfully submitted,
Pascal G. Batson Jr., Secretary,
Escambia County Medical Society
“It is also recommended that the Resolution
on Increased Blue Shield-Blue Cross benefits,
presented by the Broward County Medical As-
sociation, be referred to the Blue Shield Liaison
Committee.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
55
“I move the adoption of this portion of the
report.”
Seconded by Dr. Steward.
Motion carried.
Resolution
Blue Shield-Blue Cross Benefits
WHEREAS, it is felt that the only means of main-
taining high medical standards in the health insurance
field is to keep Blue Cross-Blue Shield a strong com-
petitor.
THEREFORE BE IT RESOLVED THAT the Florida
Medical Association approve and endorse the following
changes in Florida Blue Cross-Blue Shield:
1. Increase service benefits level to $5,000.00 and
$3,600.00 respectively for dependent and non-de-
pendent groups.
2. Increase the fee schedule.
3. Provide major medical coverage working with the
Florida Society of Internal Medicine, Florida
Academy of General Practice and the Florida
Pediatric Society to provide equitable payment.
4. To work with Florida Radiological Society in
adopting a plan whereby diagnostic x-rays can be
made in a doctor’s office and partially paid for
by Blue Shield.
5. To make all services customarily rendered by a
doctor a Blue Shield benefit and not Blue Cross.
6. To adopt a basic plan that would be acceptable to
join with other Blue Cross-Blue Shield plans in
obtaining national contracts.
7. To make all changes in service benefits or fee
schedules subject to the approval of the active
membership of Blue Shield.
Respectfully submitted,
Garland M. Johnson, Secretary
Broward County Medical Association
“It is recommended that the resolution on Re-
placement of Blood by Medicare Patients, pres-
ented by the Escambia County Medical Society,
be referred to the Committee on Blood, with these
recommendations :
“That the Committee on Blood take the initia-
tive in the creation and operation of a group
Medicare blood bank account for dependents of
the uniformed services, and ask the Service Faci-
lities to take the responsibility for maintaining
an adequate supply of blood in this account and
issue credits from this account to qualified reci-
pients.
“The reference committee recognizes the fact
that community blood bank service charges are
not provided for in the Medicare program and
recommends that some provision be sought to
encourage cooperation between the blood banks
and the hospitals for satisfactory billing for this
service.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Franklin J. Evans.
Motion carried.
Resolution
Replacement of Blood
WHEREAS, there has not been sufficient clarification
as to the Medicare use of blood from blood banks
in this State, and there have been no rules for replace-
ment of blood, be it resolved that the FMA through its
Delegates try to bring about such agreements as would
make it mandatory that Medicare patients replace blood
at the blood bank the same as other patients are expected
to do.
Resolution adopted by the Escambia County Medical
Society on April 9, 1957.
Respectfully submitted,
Pascal G. Batson Jr., Secretary
Escambia County Medical Society
“In his address to the First House of Dele-
gates, our President, Dr. Francis H. Langley,
made certain recommendations for revising the
Constitution and By-Laws and the reorganization
of The Journal, which were referred to this com-
mittee.
“These recommendations are approved and
it is suggested that the details be worked out by
the respective committees to be appointed by the
new President.
“I move the adoption of this portion of the
report.”
Seconded by Dr. Patterson.
Motion carried.
(See President’s address, page 19 of this issue.)
“Your reference committee wishes to consider
the resolution on Medicare, presented by the
Broward County Medical Association, and the
report of the Medicare Fee Schedule Committee,
by Dr. Donald F. Marion, Chairman, jointly.
“First, your reference committee wishes to
recommend the highest commendation to Dr.
John D. Milton for his unselfish contribution to
the members of the Florida Medical Association
regarding Medicare.
“Special recognition is also due the Medicare
Fee Schedule Committee, Dr. Donald F. Marion,
Chairman.
“Your reference committee approves the
Broward County Medical Association’s resolution
in principle, but offers the following resolution
in substitute:
“Mr. President, I move the adoption of the
substitute resolution.”
Seconded by Dr. Steward.
Resolution
Medicare
WHEREAS, the Florida Medical Association desires
that the Medicare program be carried out on the Ameri-
can principle of freedom of choice of physician and the
freedom of the physician to set his own fees, based, not
56
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
on a standardized formula or fixed fee schedule, but on
the usual fee charged for such services, and
WHEREAS, we have a firm conviction that better
medical care for the dependents will be provided, at lower
cost to the taxpayer; the present satisfactory physician-
patient relationship continued and incentive for advance-
ment in medical training and practices maintained, if
military dependents are cared for on the same basis as
other citizens,
BE IT THEREFORE RESOLVED:
1. That the fixed fee schedule contract now in effect
NOT be extended beyond the termination date of
June 30, 1957.
2. That the Florida Medical Association Board of
Governors devise a mechanism to provide depend-
ents with medical care under the provisions author-
ized by law until a new contract has been con-
summated.
3. That the Florida Medical Association negotiate a
new contract carrying out the principles of this
resolution.
4. That the Florida Medical Assoication and each
County Medical Society establish a committee to
evaluate and recommend the disposition of prob-
lems related to the Medicare program.
5. That a copy of this resolution be forwarded to the
Secretary and General Manager of the American
Medical Association.
Dr. Richard F. Sinnott: "I would like to ask
a question about the wording of that resolution.
If there is no fee schedule, it is my impression
there is no new contract. Perhaps I did not
phrase that correctly. I wonder why a contract
must be signed at all if we are not going to have
a fixed fee schedule?”
Dr. Marr: “We will have to have some form
of contract with the Defense Department. We
hope the contract will be on the basis of the
charge made by the individual physician rather
than on the basis of a fixed fee schedule.”
Dr. W. Dean Steward: “If I, as an individual
physician, am to present my bill, how shall I be
obligated by the Florida Medical Association hav-
ing signed a contract to provide certain services?
Why must a new contract be entered into if we
are going to submit our bills as individuals ac-
cording to the usual fees in our community?”
Dr. Marr: “I am of the opinion that it is the
wish of the committee that a new contract be
devised on the basis of individual fees, which is
not a fixed fee schedule.”
Dr. James R. Boulware Jr.: “We will have to
sign a contract in order to get our money. The
Government won’t pay us unless we have a con-
tract.”
Dr. Herbert L. Bryans: “Since Dr. Milton
was chairman of the original committee, I think
it would be very wise for us to listen to him.”
Dr. John D. Milton: “I was present on that
‘infamous’ day in November in Jacksonville, and
I was the ‘infamous’ guy who went to Washing-
ton. I have no apology for what I was able to do
in Washington.
“In principle, I think you have a good resolu-
tion. I asked the committee that if they did any-
thing, above all to keep organized medicine in this
thing, because if we are not kept in it, we are
going to be absolutely divided right down the
middle.
“Now you want to know how they handle
these things in other states in which they do not
have contracts with medicine. First, Indiana.
Indiana has a contract with the Defense Depart-
ment. There are things in this contract that I
do not like and I think other individuals would
not like either. They do not have any open
fixed fee schedule, but they have guaranteed the
Defense Department that they will not go over
a certain set fee for each item as an average.
Do you want to have the plan open and above-
board, or do you want your association to say
under the table, this is what it will be and if
they can’t come under it, we will send it to Wash-
ington for adjustment? Indiana has to pay all
of the expenses of operation, including those of
the committee for screening the fees.
“Ohio and Rhode Island do not have contracts
with the Government. What do they do? The
Department of Defense has a contract with a
private insurance company. In Ohio it is Mutual
of Omaha. The medical association is out; it has
nothing to do with it. The government gave Ohio
a fee schedule and private industry is carrying
out that fee schedule. Someone called Dr. Geo A.
Woodehouse yesterday. I understand it is work-
ing successfully, but medicine is on the outside.
"Rhode Island is another state and it has only
a handful of physicians. Private industry, some
insurance company, I don't know which one, is
handling Medicare for the Department of De-
fense. If you have any questions, I will try to
answer them.”
Dr. Bryans: “What is your opinion as to the
procedure we should follow from now on?”
Dr. Milton: "I have no suggestions. The only
thing I can say is that I don’t want organized
medicine written out of this contract. I think
we must have a voice. If we don’t they will
divide and conquer us. I think they have about
conquered us anyway.”
Dr. Steward: “I want to repeat in essence
what I said at the Jacksonville meeting. As long
as I can recall, organized medicine has been fight-
ing socialized medicine. When the Government
J. Florida. M.A.
July, 1957
SECOND HOUSE OF DELEGATES
57
sets the fee, and pays the money, that is social-
ized medicine. The present contract expires on
June 30, and this is our time to make a change.
You will recall the plight of the British physi-
cians; the government obtained an economic
squeeze and they couldn’t back out. A bill is al-
ready being prepared to extend this to the de-
pendents of men who have served 20 years, and
there is also a bill up for Federal employees and
their dependents. It is still more socialism. When
the doctor gets to the place that he is dependent
upon this money from the government, he cannot
afford to back out because he has to feed his
children and pay his insurance premiums.
“As you will remember Lenin said that the
socialization of medicine is the keystone of the
arch of the socialized state. It is time for the men
of Florida to stand up and be counted. If we
lead the way, other states will follow. They feel
the way we do. We will take care of the depend-
ents of service men, but let’s do it the American
way — -the way outlined by the Chairman of
Reference Committee No. 3, who, with his com-
mittee members, has done such an excellent job
in preparing this resolution.”
Dr. Burns A. Dobbins Jr.: “I would like to
correct a statement that Dr. Milton made. He
is not an ‘infamous’ person; there is no infamous
person, there is only an infamous principle. He
should be famous. He has done a good job in
negotiating this fee schedule. However, what ap-
plies in one section of the State, may not be right
in another section. There are vast differences in
this state. It is the principle involved in which
we are mainly interested and now is the time to
assert ourselves. We will care for these patients,
we want to care for them, but we want to do it
the way medicine has always been practiced in
the United States. I admit that there will be
some problems involved, it will take a great deal
of cooperation and it will take some supervision
of those who do not wish to conform. I want
to thank the reference committee for their work
and commend them for an excellent resolution.”
Dr. Herschel G. Cole; “I speak to you as a
delegate and also as chairman of the committee
of the Florida Orthopedic Society, which has in-
structed me to give you certain information. I
think Dr. Milton should be commended for his
tireless efforts and we should also commend the
committee for its work on this problem. Yester-
day afternoon, I spent a half-hour on the tele-
phone talking to the President of the Indiana
State Medical Association. He was very frank
about their operation. They have a contract;
they do not have a fee schedule. The individual
physician sends his bill directly to the medical
association, they review it. I believe there is a
limit of $300 per case. If there is a disagreement,
they try to get the doctor to reduce his fee. In-
diana does not have a schedule of fees for another
reason. If you are familiar with the geography
of the state, you know that the southern part is
economically very poor. The northern section is
highly industrialized and entirely different. That
is the reason they do not have a fee schedule.
“There are many of us here that did not ap-
prove the hurry up method that followed the
adoption of this law by Congress. Several years
ago when we fought socialized medicine so bitter-
ly, we just won an armistice, not a victory. Since
that time, the mi’itant socialists have regrouped
themselves and t’use of you who have engaged
in military activity will recognize the tactics of
infiltrate, divide and conquer. There is a bill to
include postal employees, social workers, and it
will go on and on. It is like termites getting into
your house, and eating and eating, until it falls
down. I don’t believe we can afford to concede
and concede and retrench. Your best defense is
attack, which should be done with cool reasoning
and good judgment and I believe your committee
has tried to do that.
“I want to present to you the recommenda-
tions of the Florida Orthopedic Society. \Ye are
definitely opposed to extension of the time. \Ye
believe the contract should be for one year only.
We are definitely opposed to any other group
deriving. the benefits of this system. That is my
personal opinion and 1 gave you the official opin-
ion of the Florida Orthopedic Society. As I recall,
the resolution stated the contract would not be
extended. I would like to offer an amendment to
the resolution to include in proper phraseology
that no further groups shall receive the benefits
under this act and under our contract.”
Seconded by Dr. Frank L. Fort.
Dr. Steward: "I don't see where we need an
amendment as long as we are renegotiating the
contract each year. No one else can be put in
under that contract.”
Dr. Milton: “I would like to reiterate what
Dr. Steward has said. It would take a law passed
by Congress to put anyone else under this con-
tract. I think if you adopt this amendment, you
will weaken a strong resolution.”
58
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
I'he Chair called for a voice vote and the
amendment was not carried.
Dr. Ashbel C. Williams: “I have heard all
the arguments here and while I agree with your
feelings, I think we have some precedent as to
how well physicians in any large medical associa-
tion will come through on a matter of this kind.
One example is the poor response we get from
you on the American Medical Education Founda-
tion. We have been asked to support it by giv-
ing $100 a year each, and I think we got $20,000
out of the whole state. Blue Shield could tell you
how doctors cooperate or fail to cooperate. I per-
sonally believe Dr. Milton did a marvelous job in
the contract he negotiated. There are many
aspects that were not considered due to lack of
time. I think they could be renegotiated and
ironed out. In a state where there are as many
military dependents as there are in Florida, as
was indicated Sunday when we had a represent-
ative from the Surgeon General’s office tell us
that there were only two states in the country
that had more military personnel than Florida,
that it is extremely important to the Government,
not like in Ohio or Indiana where they have only
a few, that the Government see that something is
set up that is feasible. I don’t advocate socialized
medicine in any shape or form. If any question
comes up of including postal employees, or others.
I would fight it tooth and nail. However. I think
we should be in favor of supporting, not killing,
something that has been started off in such a fair
manner to physicians. I would be in favor of re-
negotiating this contract at the earliest possible
time.”
Dr. Patterson: “After all this discussion, I
wonder if it would not be well for Dr. Marr to
read again the recommendations of his commit-
tee.”
Dr. Langley: “Do you wish to have the resolu-
tion read again?”
Many delegates replied in the affirmative.
Dr. Marr re-read the resolution.
Dr. Franklin J. Evans: “While the resolution
is fresh in your memories, I move the previous
motion.”
Seconded by Dr. Sackett.
Motion carried.
Dr. Marr: “I move the adoption of the entire
report of Reference Committee No. 3.”
Seconded by Dr. Sias.
Motion carried.
The other members of this reference commit-
tee were Drs. Francis T. Holland, of Leon-Gads-
den-Liberty-Wakulla-Jefferson, Donald W. Smith,
of Dade, James R. Boulware Jr., of Polk, and
Sidney Stillman of Duval.
The Chair recognized Dr. W. Dean Steward
on a point of personal privilege.
Dr. Steward: “It is very important that every
member of this House of Delegates go back and
acquaint the members of his county medical so-
ciety with the action of this House. We will need
the unanimous support of the medical profession
in Florida if we are going to stand against gov-
ernment medicine. 1 urge you to go back to your
county societies and tell them the why’s and
wherefore’s of this vote.”
Report of Reference Committee No. 4
The Chair called for the report of Reference
Committee No. 4, Legislation and Miscellaneous,
Dr. L. Washington Dowlen, Chairman.
Dr. Dowlen: “Your committee approves the
report of the Committee on Legislation and Pub-
lic Policy and recommends that this committee,
every county society and Mr. Harold Parham be
commended for their part in helping with the bill
on naturopathy.
“The Committee observed that the State De-
partment of Welfare's Indigent Hospitalization
Program will not be continued as such after July
1, 1957.
“The committee recommends the approval of
that portion of the supplemental report presented
by the Committee on Legislation and Public
Policy approving the action of the committee to
support a state appropriation for $4,000,000 for
the Hospital Service for the Indigent Program for
the biennium 1957-59, on a state-county match-
ing formula.
“Your committee recommends the approval
of that portion of the supplementary report which
recommends active support of the Jenkins-Keogh
bill now being considered by Congress.
“Your committee recommends the approval
of the action taken by the Committee on Legisla-
tion and Public Policy and approved by the FMA
Board of Governors on the various health bills
being considered by the present session of the
state legislature.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Patterson.
Motion carried.
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
59
Report of Committee on Legislation
and Public Policy
H. Phillip Hampton, Chairman
Your Committee has been active constantly (luring
the past year in an attempt to assume the responsibilities
placed upon us to represent the Association in promoting,
securing and maintaining legislation in the best interest of
public health and scientific medicine.
National Legislation
Close attention was given to our national legislative
program and requests from the A. M.A. Committee on
Legislation and the A. M.A. Washington Office to assist
with specific legislation were complied with. We were very
fortunate again this year to have among us in Florida,
Reuben B. Chrisman Jr., M.D., of Miami, a member of
the A. M.A. Committee on Legislation, whose broad
knowledge of medical legislation and generous assistance
has been of great value.
Our key contact physicians in Florida for national
legislation should also be complimented for their prompt
action when called upon for assistance.
State Legislation
Your Committee studied all the proposed legislation
received from the county medical societies, referred by the
Association’s President, requested by the House of Dele-
gates, referred by allied organizations and state officials.
This proposed legislation was presented with recom-
mendations to the Pre-Legislative Joint Meeting of the
F.M.A. Board of Governors, members of the House of
Delegates, Bureau of Public Relations and Committee on
Legislation and Public Policy held on May 14, 1956 in
Miami. The proposed legislation was discussed at this
meeting and a definite program was adopted.
The program will be presented to the Legislative
Committee and officers of each county medical society
urging them to inform the members of the society and
explain the program to their legislators prior to the 1957
Session of the Florida Legislature.
Many meetings and conferences have been held, per-
sonal contacts made, communications written and numer-
ous other activities which would be too voluminous to in-
clude in this report. Special note should be made that the
President of the Senate and Speaker of the House have
been contacted by representatives of the Association urging
them to appoint legislators to the Public Health Commit-
tee of the Senate and the House who will assure that fair
consideration is given to the Association’s legislation in
hearings before these committees.
An office will be maintained at Tallahassee during the
entire 1957 Session of the Legislature by Harold Parham,
of the Association’s executive office, and an attorney re-
tained by the Association. This office is for the conve-
nience of the legislators and others who may seek infor-
mation on problems concerning medicine, health and edu-
cation as they effect legislation for the protection and
benefit of Florida’s citizens.
Again your Committee would like to emphasize that
the success or failure of our Association’s state legislative
program depends primarily upon work done at the local
level by an informed membership in developing better re-
lations with legislators at home prior to the legislative
session.
Today’s Health, the American Medical Association’s
health magazine for lay readers, is being sent again this
year to Florida’s U. S. Senators and representatives, the
Governor and members of his Cabinet and state legislators.
On behalf of the Committee, I desire to express ap-
preciation for the assistance rendered by the President,
Secretary, and other state association officers, Supervisor
of the Association’s Bureau of Public Relations, and other
members of the executive staff, members of the legislative
committees of the county medical societies and the many
individual members who have responded when called on
for assistance.
“The report of the Committee on [Mental
Health, Dr. Sullivan G. Bedell, Chairman, is ap-
proved with commendation for the Committee.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Collins.
Motion carried.
Report of Committee on Mental Health
Sullivan G. Bedell, Chairman
Your Committee at its meeting in May 1956, set a
goal of placing the physicians of Florida in a position of
leadership in regard to mental health problems within our
state and considered long range problems for committee
action.
A comprehensive list of these problems to be con-
sidered follows:
I. Mental Health Topics Concerning Primarily the
Profession
1. Dissemination of information regarding men-
tal health topics among the profession.
2. The need for prevention of the sale of bro-
mides without a prescription.
3. Licensure versus certification of psychologists.
4. The use of hypnosis in general practice.
5. The use of tranquilizers in general practice.
II. Mental Health Topics Concerning the Public As
Well As the Profession
1. Research in mental health.
2. Training in mental health.
3. The care of psychotic and emotionally dis-
turbed children.
4. The care of psychotic and emotionally dis-
turbed old people.
5. Provision of state funds to reimburse local
communities for the care of committed pa-
tients awaiting transfer to state institutions.
6. Policies regarding state institutions.
7. Policies regarding mental health clinics.
8. Policies regarding psychiatric facilities in pris-
ons and training schools.
9. Policies regarding a counseling program in
public schools.
10. Problems relating to narcotic addiction.
11. Problems relative to sexual psychopathy.
12. Policies regarding the state alcoholic rehabili-
tation program.
Early in October, a planning and coordination meet-
ing was held by your Committee with legislators and
heads of mental health groups and agencies to promote
an understanding and united front with medical leadership
in this field.
Your Committee sponsored a statewide conference on
mental health in late October 1956, at Jacksonville. The
State Board of Health and the Florida Mental Health As-
sociation were co-sponsors. Invitations were extended to
each county medical society and to leaders of various or-
ganizations and agencies interested in mental health in
Florida. Sixty people attended. Mental health needs likely
to be considered at the next session of the Florida Legis-
lature were presented and discussed. The presentation of
positive recommendations which developed at the plan-
ning and coordinating meeting proved to be most bene-
ficial.
Your Chairman attended the public hearings of the
Interim Legislative Committee on Mental Health of the
Florida State Legislature in January 1957 and presented
the following report and recommendations:
The Mental Health Committee of the Florida Medical
Association respectfully recommends that the Joint
antibacterial
effectiveness for 24 hours
on a single (1 Gm.) dose
iex Sulfamethoxypyridazine is a completely new, long-act-
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Each quarter-scored tablet contains: sulfamethoxypyridazine
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1. Boger, W. P.; Strickland, C. S. and Gylfe, J. M.: Antibiot. Med. &
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fteadily acceptable by patients
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sulfamethoxypyridazine.
• 1ERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER, NEW YORK
62
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
Interim Legislative Committee favorably consider leg-
islation to accomplish the following:
1. Promotion of mental health clinics and provision
for mental health workers in county health units
through the Bureau of Mental Health of the State
Board of Health.
2. Funds for scholarships and training in mental
health professions and for a sizeable increase in
funds for mental health research.
3. Funds for improvements at Chattahoochee and
Arcadia, for promotion of the work at S.E. Flor-
ida Hospital, and for earliest possible completion
of the N.E. Florida Hospital.
4. Arcadia to be made an institution separate from
the one at Chattahoochee.
5. (a). Promotion of the work at the Florida Farm
Colony.
(b). Establishment of a new institution for the
mentally retarded.
6. Continuation of the work of the Florida State
Alcoholic Rehabilitation Program.
7. A program of educational and vocational guidance
in the public schools.
8. Psychiatric services at the State Penal and Cor-
rective Institutions.
9. In-patient care for psychotic and emotionally dis-
turbed children in connection with the new state
hospitals. $720,000 for unit at S.E. State Hospi-
tal— 48 beds.
10. Establishment of a position for a psychiatric ad-
ministrator as Coordinator of State Mental In-
stitutions.
The Interim Legislative Committee requested the of-
ficial position of the FMA on these recommendations,
therefore they were presented to the FMA Committee on
Legislation and Public Policy and FMA Board of Gov-
ernors. All recommendations were approved by both
groups in January 1957.
Your Chairman attended the third annual meeting of
the AMA Council on Mental Health in Chicago in No-
vember 1956, where discussion groups considered the fol-
lowing topics:
1. Use of Hypnosis in Medical Practice.
2. Alcoholic Patient as a Medical and Hospital Man-
agement Problem.
3. Benefits and Problems Encountered by General
Practitioners with Use of Newer Tranquilizing
Drugs for Patients with Emotional Illness.
4. In-patient Psychiatric Care of Children.
It is increasingly important for the Mental Health
Committee of the Florida Medical Association to have
close ties with mental health committees of the county
medical societies so that the local committees can partici-
pate in working out solutions to mental health problems
and can interpret to the county medical societies, to their
legislators, and to their committees the stand taken by
the Florida Medical Association.
Your Committee recommends that special attention be
given next year to the following:
1. Promotion of active mental health committees in
each county medical society.
2. Care of the sexual psychopath.
3. Care of the psychotic aged.
4. Care of the narcotic addict.
5. Prohibition of the sale of bromides without pre-
scription.
6. Work shop conferences on items 2-5 and other
topics, urging participation from the component
county medical societies.
7. A Fall meeting, attempting to bring together rep-
resentatives from all groups interested in mental
health.
Your Committee desires to express appreciation for
the assistance given by the officers and individual mem-
bers of the Association who have responded so well when
called upon to assist with the mental health program.
■‘The report of the Committee on State Con-
trolled Medical Institutions, by Dr. William D.
Rogers, Chairman, is approved as printed in the
Handbook.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Kennedy.
Motion carried.
Report of Committee on State Controlled
Medical Institutions
William D. Rogers, Chairman
As Chairman of the Committee on State Controlled
Medical Institutions, I take pleasure in submitting the
following report, covering the Florida Farm Colony at
Gainesville, the Alcoholic Rehabilitation Center at Avon
Park, the Florida State Hospital at Chattahoochee and the
Florida State Hospital at Arcadia, and the new South
Florida State Hospital presently under construction.
The Florida Farm Colonu
The Florida Farm Colony, which cares for mentally
retarded and epileptic patients, has made a great deal of
real progress during the past year. There has been further
expansion of the physical plant in addition to the profes-
sional staff. The Legislature of 1955 provided $2,250,000
for improvements and new construction and this program
is well under way. There have recently been completed 12
additional cottages, housing 36 patients each. Also under
construction is a nursery and infirmary building for Ne-
groes, which will house 96 patients, and an addition to
the infirmary for white patients of 40 beds. When the
present construction program is complete the institution
will have a capacity for approximately 2,000 children in
their current program.
In addition to patient facilities, new construction in-
cludes an Administration Building, Chapel, swimming pool,
occupational therapy building, and additions to the food
service department, as well as quarters for employees.
At present there are 581 employees on the payroll,
which amounts to $105,000 monthly. This institution has
recently added another physician to its staff, which gives
a total of three physicians. There has been an increase in
the number of registered nurses, and in the laboratory
staff providing three full-time technicians, and at present
there are two full time dentists. A school principal has
been added during the past year and several additional
teachers with a present faculty of 17. Three full time oc-
cupational therapists have been added during the past
year and additional teachers in the program for trainable
children.
There has been considerable improvement in medical
facilities in the institution as they now have trained per-
sonnel for electroencephalographic and x-ray work. A
medical record system has been set up which is approved
by the American Medical Association. They have also de-
veloped a cottage assignment committee for new patients,
and have established routine hospital staff meetings be-
tween the professional staff and other groups, discussing
improvements in the care of patients. They have also es-
tablished an identification system of patients, and have
added pre-employment physical examinations for all new
employees. They had a paper presented at the Antibiotic
Symposium and an exhibit presented at the Southern Med-
ical Association and the American Medical Association,
have received a research grant from the Atomic Energy
Commission in conjunction with the University of Florida
Biochemistry Department, have developed a training pro-
gram for employees, and have shown much progress in
their basic research, especially in the mongoloid patients.
The staff has had eight papers published during the
year, which resulted from research at the Florida Farm
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
63
Colony, and have already established good working rela-
tions with the Medical School of the University of Florida.
I might add that in view of the present size of this
institution and their long list of patients awaiting admis-
sion, plans are under way to locate and construct a new
institution for mentally retarded and epileptic children in
the southern part of the state.
The Florida Alcoholic Rehabilitation Program
The Florida Alcoholic Rehabilitation Program is a
new service afforded the alcoholic patients of our state,
and during the past year this program has continued to
develop its services along the three main lines of treat-
ment, education and study.
Treatment is the principal service offered by the Pro-
gram through four outpatient clinics located in Pensacola,
Jacksonville, Tampa and Miami, and through the 50 bed
Alcoholic Rehabilitation Center located in Avon Park. Dr.
Lorant Forizs continues as Clinical Director and Mrs.
Dorothy M. Johnson as Supervisor of Psychiatric Social
Work of the program, directing all treatment services.
Each of the clinics is headed by a senior physician, who
is a psychiatrist. They are as follows: Dr. C. Brooks Hen-
derson, Jacksonville Clinic; Dr. Louis Rogel, Miami Clinic,
Dr. Roger Sherman, Pensacola Clinic, and Dr. A. Carl
Herman, Tampa Clinic. Since the opening of the clinics in
1955 over 900 patients have been admitted for outpatient
treatment.
Each clinic is staffed by full time psychiatric social
workers, part time internists and psychologists and full
time clerical personnel. The various professions and disci-
plines compose clinic teams which are regarded as neces-
sary in the diagnosis and treatment of alcoholism.
The new Alcoholic Rehabilitation Center is planned
around the concept of intensive treatment of voluntary'
patients through a “therapeutic community” and group
psychotherapy in varied forms is used extensively. The
facility has the following multiple functions:
1. Housing the state headquarters for the Program.
2. Housing an outpatient clinic for a 17 county area
of South Central Florida.
3. Providing an admissions unit for short-term, in-
tensive, medical care of acute conditions.
4. Providing longer term care for intensive psycho-
therapy as a part of the rehabilitation of patients.
The new Rehabilitation Center admitted its first pa-
tients December 3. Its senior physician is Dr. James A.
Mosco, who was appointed at the end of December.
The educational work of the Alcoholic Program, car-
ried out on a state-wide basis, is engaged in the following
activities:
1. The dissemination of information through printed
materials, films, radio and televised programs, pub-
lic addresses, newspaper stories, and magazine arti-
cles.
2. Sponsoring, planning, and providing specialized
inservice training for related professional groups.
3. Coordinating any activities and plans for Public
School work with the general health education pro-
gram as it is now directed by Mr. Zollie Maynard,
Consultant in Health, Physical Education and Rec-
reation of the State Board of Education.
Educational activities of the Program are limited to
the subject of alcoholism and are directed by Statute to
the following groups: the general public, chronic alcoholics
or professional persons who care for or may be engaged
in the care and treatment of alcoholics. The state-wide
mailing list of the Program now has over 9,000 names and
addresses of residents who have requested the Program’s
printed material.
During the initial period of planning and developing
services, study and research have not been planned. It is
expected that clinical studies will take an important place
in the work of the Program after case loads have stabi-
lized.
Florida State Hospitals
The functions of the Florida State Hospital at Chat-
tahoochee and the Florida State Hospital at Arcadia will
be considered together, since the institution at Arcadia is
presently a branch of the hospital at Chattahoochee.
At the present time, there are 6,606 patients confined
in the State Hospital at Chattahoochee and 1,650 patients
in the institution at Arcadia. At the close of the last fiscal
year, June 30, 1956, a total of 2,578 patients had been ad-
mitted during the year; separations from both hospitals
during that period of time numbered 2,535. This extreme-
ly good record, we feel, was the result of better housing
and treatment facilities that had been provided previously,
as well as additional staff and the aid of the tranquilizing
drugs. With the rapid growth in state population, we are
anticipating that the admissions to both hospitals during
the coming year will possibly number 3,000.
During the past year many improvements have been
accomplished in hospital facilities. Two new buildings
have been opened for the care of patients at Chattahoo-
chee, one for aged patients and one for receiving and in-
tensive treatment. At Arcadia five 109 bed continued
treatment buildings have been opened.
The present program at Chattahoochee is not for an
increase in hospital population but to replace some of the
very old and dilapidated buildings now in use.
The psychiatric staffs of both hospitals have been in-
creased and at Chattahoochee the social service depart-
ment has developed considerably during this period. In
the present budget additional social workers have been
requested. At the present time the employees at the Flor-
ida State Hospital at Chattahoochee number 1,793, and
the number at Arcadia is 496. This gives a patient-em-
ployee ratio of some 3.7, which is slightly higher than the
national average of 3.6 for state mental institutions.
In budget recommendations for the next biennium,
additional facilities have been requested for the hospital at
Arcadia, including a medical and surgical unit, a receiving
and intensive treatment building for women patients,
chapel, warehouse, administration building, and expansion
of utilities. At Chattahoochee we are requesting one con-
tinued treatment building to replace an existing building,
which is beyond repair, and additional utilities.
It has also been recommended that the Florida State
Hospital at Arcadia be established as a separate hospital
and not a branch of the Florida State Hospital at Chat-
tahoochee, due to the increased size of the branch hospital
and the great distance between the two institutions.
New South Florida State Hospital
The new South Florida State Hospital, located in
Broward County, planned to begin receiving patients
about March 1, 1957. This institution is under the direc-
tion of Dr. Arnold H. Eichert. This institution will have a
capacity of slightly less than 500 patients, however, the
second phase of construction will begin soon, increasing
the capacity to some 1,300 beds. The staff of this hospital
is being organized at present.
New Northeast Florida State Hospital
The 1955 Legislature appropriated $4,200,000 for the
construction of a new mental hospital in Northeast Flor-
ida, which was located in Baker County some twenty-five
miles from Jacksonville. Plans are developing satisfactorily
for this new institution and it is hoped that bids for con-
struction will be taken in the late spring.
The Legislature is being asked for $6,500,000 more to
complete the second phase of construction of this institu-
tion.
These two new state mental hospitals will afford much
needed relief in the increasing demands made on the men-
tal hospitals and will also provide facilities near the
heavily populated areas.
“The report of the Poliomyelitis Medical Ad-
visory Committee, Dr. Richard G. Skinner Jr.,
Chairman, was approved with the following
64
SECOND HOUSE OF DELEGATES
Volume XL IV
.Number 1
amendment, that a paragraph be added to read:
The Poliomyelitis Medical Advisory Com-
mittee recommends to the House of Dele-
gates that they officially go on record as
requesting that the Congress of the United
States not renew the poliomyelitis vaccine
act which expires June 30, 1957.’
“The Reference Committee would also like
the House of Delegates to go on record as not
approving the use of state funds for the purchase
of polio vaccine for other than indigent persons
as outlined in the presently proposed budget of
the State Board of Health for the biennium
1957-59.’’
“Mr. President, 1 move the adoption of this
portion of the report as amended.’’
Seconded and carried.
Report of Poliomyelitis Medical
Advisory Committee
Richard G. Skinner Jr., Chairman
In the light of the national stimulus from the Ameri-
can Medical Association to increase the number of people
vaccinated against polio, President Langley requested that
our committee set up a program to carry out this respon-
sibility.
The principles of the program were approved by the
Board of Governors on January 27 and the actual details
were worked out in succeeding weeks.
The President of each county medical society was no-
tified as to the purpose of the program and the possible
ways in which it could be implemented. One member of
each medical society was provided w'ith rather complete
material in kit form to set up the program in his indi-
vidual county medical society. It is anticipated that state-
wide publicity through all possible means of communica-
tion wall be carried out and it is the hope of this commit-
tee that every doctor’s office will become an immunization
center.
Since the program is merely in its inception, the re-
sults of it are not available, nor the extent of its success.
We hope that this committee will be able to say next year
that at least 95 per cent of the people of the State of Flor-
ida have been vaccinated against polio.
The chairman wishes to express appreciation to the
members of his committee for their invaluable assistance,
Drs. Frank L. Fort, John H. Cordes, George S. Palmer
and Edw'ard W. Cullipher.
The Poliomyelitis Medical Advisory Committee recom-
mends to the House of Delegates that they officially go
on record as requesting that the Congress of the United
States not renew' the poliomyelitis vaccine act which ex-
pires June 30, 1957.
“The resolution on changes in State Welfare
Law, submitted by Escambia County Medical
Society, is approved as printed in the handbook.
“I move the adoption of this portion of the
report.”
Seconded by Dr. Kennedy.
Motion carried.
Resolution
Changes in State Welfare Law
It has become increasingly evident to physicians par-
ticipating in the Indigent Hospitalization Program that
many present recipients of welfare aid should not, be-
cause of the financial status of their children, be eligible
for this program. The law is inconsistent in that it pro-
vides for relative responsibility in the Aid to the Disabled
Program, but not in the Aid to the Blind and Old Age
Assistance. At the present time any individual over 65
years of age with homestead property assessed at $5000 or
less and with other resources of less than $600 (if single
or $900 if married) is eligible for Old Age Assistance. Le-
gally no consideration is given to the ability of the rela-
tives to support these aged persons, although in practice,
the Department of Public Welfare does make every effort
possible to locate and interview the applicants’ children to
determine their willingness to support their parents. A
statement regarding “unwillingness” or inability to sup-
port them is sufficient to qualify the oldster for state aid.
This defect in the State Welfare Law has allowed to be
placed on the welfare rolls many individuals who could be
adequately taken care of by their children if their welfare
income were withdrawn. This has placed an unnecessary
burden upon the taxpayers of the State of Florida and has
also reduced the quantity of assistance available to those
individuals w'ho truly need State Assistance.
BE IT THEREFORE RESOLVED that the Escam-
bia County Medical Society recommend to the Florida
Medical Association the active participation of its mem-
bership in a concerted effort to effect the necessary
changes in the State Welfare Law and that the State De-
partment of Public Welfare be advised of our willingness
to share in this effort.
Respectfully submitted,
Pascal G. Batson Jr., Secretary,
Escambia County Medical Society
“The resolution on Workman’s Compensation
Fee Schedule, submitted by the Escambia Coun-
ty Medical Society is approved with the recom-
mendation that it be referred to the appropriate
committee at the discretion of the Board of
Governors.
“I move the adoption of this portion of the
report.”
Seconded and carried.
Resolution
Workman’s Compensation Fee Schedule
Whereas, The appropriate fees for medical care are
not static and must change from time to time to reflect
changes in:
1. The general economy,
2. Accepted methods of treatment,
3. Our continuing re-appraisal of the relative value of
particular procedures,
Be It Resolved that the Florida Medical Association,
through one of its regular committees or through a special
committee, review the Workman’s Compensation Fee
Schedule each two years and recommend any changes
which may seem indicated.
Respectfully submitted,
Pascal G. Batson Jr., Secretary,
Escambia County Medical Society
“The resolution on Indigent Service, submitted
by the Orange County Medical Society, is ap-
proved with the following amendment: In item 2,
under certification of professional opinion, change
the words ‘to the best of my knowledge and
belief’ to read ‘so far as I know.’ It is recom-
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
65
mended that the Advisory Committee to the State
Board of Health for Indigent Hospitalization
make the requested change.
“Mr. President, I move the adoption of this
portion of the report as amended.”
Seconded by Dr. Steward.
Motion carried.
Resolution
Indigent Service
WHEREAS, Many patients are medically indigent al-
though not dependent on Welfare, and
WHEREAS, Many patients, although medically indi-
gent, have children that are financially able to assist them,
and
WHEREAS, Although many patients are medically
indigent regarding hospitalization, they are able to pay
partially for medical service,
BE 'IT THEREFORE RESOLVED, that the Florida
Medical Association recommend:
1. That family responsibility be included in all Wel-
fare and Medically indigent cases.
2. In the Application and Authorization Hospital
Service for the Indigent (Form PA-66, Florida State
Welfare Department or Form ‘‘A” Florida State Board
of Health), change the first section from:
This is to certify that I am unable to pay for
medical treatment or the cost of hospitalization hereby
requested.
To: This is to certify that I am unable to pay
the cost of hospitalization hereby requested.
Change the 2nd section from:
This is to certify it is my professional opinion:
(1) The patient is acutely ill or injured: (2) Hospital-
ization is essential to the treatment of this patient, and
(3) This patient can be helped markedly by treatment
in a hospital. As far as I know this patient is unable
to pay for medical treatment or for the cost of hospital-
ization.
Respectively submitted,
W. Ansell Derrick, Secretary
Orange County Medical Society
“The resolution on Abolition of Tuberculosis
Board, submitted by the Orange County Medical
Society, is recommended for referral to the Com-
mittee on Tuberculosis and Public Health.
“I move that this portion of the report be
adopted.”
Seconded and carried.
Resolution
Tuberculosis Board
WHEREAS, the Florida Tuberculosis Hospital System,
under the present management of the Tuberculosis Board
of five members, appointed by the Governor for staggered
terms, has achieved the lowest tuberculosis morbidity
and mortality rate of any state in the South Eastern
United States as seen by U.S. Public Health spot maps
and statistics.
WHEREAS, the House Bill 578 and Senate Bill 406
proposing the abolition of this nonpolitical board would
place the Tuberculosis Hospital System under administra-
tion of the Governor and his cabinet, subject to recurrent
change with each new head of our state government, and
would subject the program to political effects detrimental
to the health and welfare of the people of F'lorida.
RESOLVED, that the Orange County Medical So-
ciety recommend that the Florida Medical Society go on
record as opposing the passage of House Bill 578 and
the similar Senate Bill 406 which would abolish the pres-
ent State Tuberculosis Board and place the operation of
the Tuberculosis Hospital System under direction of the
Governor and his Cabinet.
Respectively submitted,
W. Ansell Derrick, Secretary
Orange County Medical Society
“The resolution on Minimum Standards for
Motor Vehicle Licensing, presented by the Pinellas
County Medical Society, is approved with the fol-
lowing amendments: In the 3rd paragraph the
words ‘on today’s crowded highways’ are deleted.
“Because the A. M.A. has been working on
this matter for 1 l/z years, we recommend that this
be sent to the Secretary of the A. ALA. for infor-
mation and that a copy be sent to the F.M.A.
Medical Advisory Committee to the Florida
Department of Public Safety.
“Air. President, I move the adoption of this
portion of the report as amended.”
Seconded by Dr. H. Phillip Hampton.
Alotion carried.
Resolution
Minimum Standards for Motor Vehicle Licensing
WHEREAS, the operation of a motor vehicle on the
public highways is a grave responsibility and not an in-
herent right of the free citizen because life and public
property are frequently in peril; and
WHEREAS, the operation of a motor vehicle safely
on our crowded highways requires certain physicial, men-
tal, and psychological proficiencies; and
WHEREAS, there are no recognized minimum phy-
sical, mental, and psychological standards by which
drivers may be measured in determining fitness for driv-
ing safely.
NOW, THEREFORE, BE IT RESOLVED that the
Pinellas County Medical Society urge the American Med-
ical Association, through the Florida Medical Association,
to lead the way with the cooperation of the National
Safety Council and American Liability Insurance Under-
writers in establishing minimum standards of physical,
mental, and psychological ability for the safe operation
of motor vehicles, and that these minimum standards
be presented to the Joint Governors’ Conference in the
development of uniform driver regulation to require ac-
ceptance of the responsibilities dependent upon the as-
sumption of driver privileges.
Respectfully submitted,
Whitman C. McConnell, Secretary
Pinellas County Medical Society
“The resolution on the Annual Dinner, sub-
mitted by the Escambia County Aledical So-
ciety is disapproved with the recommendation that
it be passed on to the Board of Governors so that
they may be advised of the feelings of the Escam-
bia County Medical Society on this matter.
“Mr. President, I move this portion of the
report not be approved.”
Motion seconded.
Dr. Herbert L. Bryans: “The intent of that
resolution was more or less to have an expression
of this group whether they wish to abolish the
66
SECOND HOUSE OF DELEGATES
Volume XLIV
Number 1
Annual Dinner. This information is needed as a
guide to the Board of Governors. They want an
expression from this group.”
Dr. Eugene G. Peek Jr.: “1 think we certain-
ly should have an Annual Dinner. I think it is
high time we got back to recognizing our Past
Presidents, members of the Board and the various
committees, those men who serve during the entire
year so unselfishly. They should be presented to
the entire Florida Medical Association and recog-
ized at the Annual Dinner.”
Dr. Turner Z. Cason: ‘‘1 am seriously and
heartily in favor of the dinner. The cocktail par-
ty is fine, but it should not precede the dinner.
It should be held the night before. The dinner
should be held on Tuesday night. Then, a little
more thought should be given to selecting a
speaker who will say something that is worth-
while to all of us.”
Dr. William H. Grace: “I would like to en-
dorse what Dr. Cason said.”
Dr. Samuel M. Day: “I would like to express
appreciation for bringing up that motion. We felt
that the membership did not want the dinner.
We have had such poor cooperation along certain
lines and they seemed not to want to do what
they were asked to do, and we had come to feel
that the annual dinner was no longer wanted.
The Chair called for a voice vote.
Motion not carried.
Dr. Langley: We will endeavor to continue
ihe Annual Dinner.
Resolution
Annual Dinner
WHEREAS, it has been the usual custom to have an
annual dinner at the yearly meeting of the Florida Medi-
cal Association, be it resolved that the annual dinner of
the Florida Medical Association meeting be continued.
Resolution adopted by the Escambia County Medical
Society on April 9, 1957.
Respectfully submitted,
Pascal G. Batson Jr., Secretary
Escambia County Medical Society
Dr. Dowlen: "The letter from the Orange
County Medical Society regarding Senator Smath-
ers’ Senate Bill No. 727 ‘Scholarships for chil-
dren of veterans,’ is approved with the recom-
mendation that the FMA go on record as oppos-
ing this bill.
“Mr. President, I move the adoption of this
portion of the report.”
Seconded by Dr. Steward.
Motion carried.
May 2, 1957
Florida Medical Association
P.O. Box 2411
Jacksonville, Florida
Gentlemen:
At the regular monthly meeting of the Orange County
Medical Society on April 17, 1957, Senator Smathers’
Bill S. 727 “To provide for the investment of certain
funds obtained under the provisions of the Trading With
the Enemy Act, and to provide for the use of interest
from such investments for scientific scholarships and fel-
lowships for children of veterans” was presented by the
Chairman of the Legislation Committee.
Following a discussion, it was felt the Society should
go on record as expressing opposition to this bill which
in its intent sets up a privileged class. Furthermore, it
was moved and seconded that the action of our Society
be communicated to the House of Delegates of the
Florida Medical Association and to the Florida Com-
mittee for Better Government.
Very truly yours,
(Signed)
W. Ansell Derrick, M.D., Secretary
“Mr. President. I move the adoption of the
whole report, as amended.”
Seconded by Dr. Patterson.
Motion carried.
Dr. Day presented Life Membership certifi-
cates to other Life Members who had arrived after
the first presentation.
The Chair recognized Dr. Chas. J. Collins, of
Orange.
Dr. Collins: “I understand that three of our
past presidents were unable to be present because
of unfortunate circumstances. Dr. Robert B. Mc-
Iver is ill, Dr. John S. McEwan is in the hospital
and Dr. Walter C. Payne Sr. could not be here
on account of an accident to Mrs. Payne. I move
that the Secretary send a telegram to each con-
veying our wishes for a speedy recovery.
Seconded by Dr. Sinnott.
Motion carried.
Dr. Langley: “It is now eleven-thirty. We
will recess until 12:00 noon, when we will have
our election of officers.”
Dr. H. Phillip Hampton: “I move that the
rules be suspended so that we may hold the elec-
tion now.”
Seconded by Dr. Madison R. Pope.
Motion carried by required two-thirds major-
ity.
Dr. Langley asked for nominations for the
office of President-Elect and recognized Dr. James
R. Boulware Jr., of Polk.
Dr. Boulware: “Mr. President and Fellows
of the House of Delegates:
“It is with extreme pleasure that I place in
nomination for the office of President-Elect of
the Florida Medical Association the name of a
very dear friend. I have known him for twenty
years, and have learned to admire his ability, his
J. Florida, M.A.
July, 1957
SECOND HOUSE OF DELEGATES
67
sincerity, his community spirit, and his willingness
to undertake any assignment for the benefit of
organized medicine.
He was graduated from Cornell College in
Iowa, and received his medical degree from the
University of Minnesota. Following an intern-
ship at the Minneapolis General Hospital, he ob-
tained a three-year Fellowship at the Mayo Clinic,
and in 1938 became associated with the Watson
Clinic in Lakeland.
He served as Secretary of the Polk County
Medical Association both before and after his
5-year tour of duty in the Army Medical Corp,
became President and is now a Trustee. He has
been a delegate to the Florida Medical meeting
for many years, serving on many reference com-
mittees.
He is an associate Editor of our Journal, and
has served on the Scientific Work Committee for
several years, and on your Board of Governors.
At present he is also Chairman of the Florida
Medical Committee on Nursing, is a member of
the Committee on Fee Schedule for Military De-
pendents, a Director and on the Executive Com-
mittee of Blue Shield, and is a member of the
State Hospital Advisory Council.
Professionally, he holds memberships in many
organizations. He is a Diplomate of the Ameri-
can Board of Internal Medicine; is a member of
the American College of Physicians; a member
of the American College of Cardiology; and a
member of the American Gastroscopic Society.
Not only has this doctor shown his ability and
willingness to work for organized medicine, but
he is an example of that type of doctor who be-
lieves a doctor should be a citizen and a leader
in his community. He is Vice-President of the
Chamber of Commerce, a member of the Board
of Trustees of the Guidance Center, Chairman of
Health and Safety of the District Boy Scouts,
Advisor to the local Chapter of Red Cross, Med-
ical Director of the Polk County Civil Defense,
and the District Chairman of the Florida Medi-
cal Committee for Better Government.
Mr. President, I have the honor and privilege
of placing in nomination for President-Elect of
the Florida Medical Association — Dr. Jere Wright
Annis of Lakeland.”
Dr. Patterson: “On behalf of the Hillsbor-
ough County Medical Association, I would like to
second the nomination of Dr. Jere Annis of Lake-
land. We know Jere better than many other
groups and our society went on record unani-
mously as endorsing his candidacy. You all know
of his outstanding accomplishments in the Flor-
ida Medical Association. I am sure if given this
high honor Dr. Annis will bring further greatness
to the Florida Medical Association.”
Dr. Leo M. Wachtel: “The delegation from
Duval received no instructions on coming to this
House of Delegates, except to vote for Jere
Annis.”
Dr. Donald F. Marion: “I would like to ex-
press the feeling of Dade County Medical Asso-
ciation in seconding this nomination.”
Dr. Chas. J. Collins: “Orange County takes
great pleasure in seconding this nomination.”
Dr. Wachtel: “I move that nominations be
closed.”
Seconded by Dr. Franklin J. Evans.
Motion carried.
Dr. Langley asked Dr. Marion Hester and
Dr. Charles Larsen Jr. to escort Dr. Annis to the
rostrum.
Dr. Annis: “I am very much honored and
very much scared — scared for both you and my-
self. I will try to do a good job for you. I will
obviously need your help and friendship and
something comes to my mind that my father-in-
law told me. Some 70 years ago, he was being sent
to Colorado for what they thought was TB and
he objected because he was morbidly afraid of
snakes. He spoke to his father who tried to re-
assure him that he would probably never be bit-
ten, but even if he were bitten, something could
be done about it. He said, ‘Suppose a snake bites
you on the wrist, you just suck out the venom
and spit it out.’ But the boy asked, ‘What if he
bites me in the seat of the pants,’ to which the
father replied, ‘Son, that’s when you find out who
your real friends are.’ ”
Dr. Langley asked for nominations for First
Vice President.
Dr. Cole: “For the office of First Vice Presi-
dent, we need someone with ability and exper-
ience. This has been exemplified by President
Eisenhower, who has given Vice President Nixon
so many duties. There is a parallel situation in
our organization. 1 have in mind a man whose
training, experience and devotion to duty makes
him eminently suitable, Dr. Ralph W. Jack, of
Miami.”
Dr. George F. Schmitt Jr. moved that nomi-
nations be closed.
Seconded by Dr. Franklin J. Evans.
Motion carried.
The Chair called for nominations for Second
Vice President.
68
SECOND HOUSE OF DELEGATES
Volume XUV
Number 1
Dr. Richard A. Mills: “I would like to place
in nomination the name of Dr. Walter E. Mur-
phree, of Gainesville, whose work in our organiza-
tion is very well known.
It was moved that nominations be closed.
Seconded and carried.
Dr. Langley asked for nominations for Third
Vice President.
Dr. Francis T. Holland: “I would like to
nominate Dr. James T. Cook Jr., of Marianna.”
Dr. Alpheus T. Kennedy moved that nomina-
tions be closed.
Seconded and carried.
The Chair called for nominations for Secre-
tary-Treasurer.
Dr. Ralph S. Sappenfield: “I have no desire
to run for any office in this Association; just
the privilege of coming to this meeting this year
to offer in nomination the name of Sam Day as
Secretary-Treasurer of the Florida Medical As-
sociation.”
Dr. Steward moved that nominations be
closed.
Seconded and carried.
Dr. Langley: “Nominations for the Editor of
the Journal are now open.”
Dr. David R. Murphey Jr.: “It is usually
customary to enumerate the accomplishments of
a candidate in such a manner that all that needs
to be added is a date for it to be a suitable obi-
tuary. In the case of my candidate, such a dis-
sertation on his accomplishments is not necessary.
He has been Editor of The Journal continuously
since 1925 with the exception of three years when
he was relieved of this obligation to serve you as
President-Elect and President.
“Our Journal is outstanding among state med-
ical journals. It is with great pleasure that I
place in nomination the name of our distinguished
editor, Dr. Shaler Richardson of Duval County.”
Dr. Patterson moved that nominations be
closed.
Seconded by Dr. Collins.
Motion carried.
Dr. John D. Milton: “Since we have had all
of the officers nominated, I move that we elect
them to their respective posts.”
Seconded by Dr. Jelks.
Motion carried.
Dr. Langley: “My parliamentarian told me
that it was not necessary to have the secretary
cast a ballot.”
“I would like to ask Dr. Herbert L. Bryans
and Dr. David R. Murphey Jr. to escort Dr.
Roberts to the Chair.”
“Dr. Roberts, it is a great pleasure to wel-
come you. The best I can wish for you is that
you will have the support during your administra-
tion that I have had. It will give you the best
feeling in the world and you have my best per-
sonal wishes. It is my pleasure to present your
gavel and turn over to you the reins of office.”
Dr. Roberts: “Dr. Langley, Members of the
Florida Medical Association, Distinguished
Guests: I am in the same fix I was in last year
when you gave me this high honor. Through the
years I thought I had courage, but last year you
just knocked the courage out of me. During my
year as president-elect, I have had such wonder-
ful and enthusiastic response to my requests for
members to serve on committees, that I am now
gaining a little more courage. When Dr. Langley
tells me what excellent cooperation he has had,
I grow taller in the saddle.
“Through the year, I realize that we are going
to have trials and tribulations. We will have
many problems; we already have them. It will
be my duty often to make decisions when I won’t
have the advice of the Board of Governors or
the Councilors; but, I promise you that I will
not make a decision of any kind that will mater-
ially affect the Florida Medical Association until
I have secured the best advice possible in this
entire Association.
“I know for sure when I get to the end of the
line next year, I will be plenty ‘frazzed.’ I may
be lame, maimed, dead. I know for sure I will
be ‘broke.’ But please, may I ask, when I am
through, don’t wear me out to a ‘frazzle’ like you
have John Milton.
“I am going to try to serve as your president
fair and square.
“Saturday last a very historic race took place,
the eighty-third running of the Kentucky Derby.
Coincidentally we have a doctor in our audience
who has run that many races. You saw her get
her certificate. Further, coincidentally, the Flor-
ida Medical Association has just run its eighty-
third race. The Kentucky Derby came up with
a winner by a nose — a photo finish — but the
eighty-third race of the Florida Medical Associa-
tion came up with a winner and he did not win
by a nose. He won so far out on the track that
when he hit the wire you could not tell there
was anybody else in the race. That winner was
D”. Francis Langley. I know for sure I will not
J. Florida, M.A.
July, 1957
SCIENTIFIC ASSEMBLIES
69
be able to fill his shoes but I certainly hope I can
at least try on his bedroom slippers occasionally.
Dr. Langley has served you better than you know.
He is not the type of man that does a lot of ‘yak-
yaking’ like your present president. When he
speaks, he knows what he is speaking about. I
don’t think that we will ever have a president
that will do a better job for your Association than
Dr. Francis Langley. So, the old adage that a
good beginning makes a bad ending, I want you
to help me prove that it isn’t true. One of the
finest things that will happen to me this year is
the privilege of presenting to Dr. Francis Lang-
ley his Certificate of Honor for having served
us well.
“The Past President’s pin is worn by those
who have earned the right to wear these buttons.
They are not big enough; they should be lard
can size so that everyone would know what these
men have done for the Association. It grieves me
that I don’t see lots of them around, because there
have been many given. It puts the stamp of ap-
proval on Francis Langley.
“Francis, I want you to know you have earned
the right to wear this stamp of approval and I
am not going to relegate you to pasture. Since
you have won this race, you are still going to stay
in there and pitch and in the future you will win
many more races.”
Dr. Langley: “It is with a feeling of great
emotion that I step down from the Chair, but
Scientific
The First Scientific Assembly convened at
9:30 a.m., Tuesday, May 7, in the Pageant Room,
Hollywood Beach Hotel, with Drs. Donald F.
Marion of Miami and George T. Harrell Jr. of
Gainesville presiding. The following papers were
read and discussed:
“Toxoplasmosis, Congenital and Acquired;
Ocular Manifestations,” Sherman B. Forbes, Tam-
pa.
“Hazards in the Management of Peptic Ulcer
with Anticholinergic Drugs: A Reemphasis, ” Hy-
man J. Roberts, West Palm Beach.
“Diffuse Idiopathic Pulmonary Fibrosis,” Au-
gustus E. Anderson Jr., Jacksonville, and G. Leo-
nard Emmel, Gainesville. Presented by Dr. Ander-
son.
“Surgical and Physiologic Consideration in
the Development of an Artificial Heart-Lung for
Clinical Use,” Robert S. Litwak , Miami.
believe me, I have no doubt about the future of
the Florida Medical Association with Dr. Roberts
at the head, and his successor and the successors
through the years. Thank you so much for the
honor and for the help you have given.”
Dr. Roberts: “We know that our problems
are going to be tough, but we must build a strong
organization. It will be my goal this year to get
the county medical societies really organized and
the county organizations will make FMA strong.
When we are strong enough, we will not be
divided in our own camp, and we can laugh at
opposition. The eyes of the nation are on Florida.
Our actions in the last few years in fighting the
socializing of medicine have been holding actions.
Holding actions are good in war but they do not
win battles. I want the Florida Medical Associa-
tion to take thought of that, talk these things
over in your county medical societies. We have
got to have it; we must have it.
Dr. Roberts announced that there would be
a meeting of the Board of Governors in the Wind-
sor Room immediately following adjournment.
Dr. Richard A. Mills announced that the
Broward County Medical Association would like
to invite any interested physicians to attend its
next regular meeting to hear a special guest
speaker.
On motion by Dr. Sias, duly seconded and
carried, the Eighty-Third Annual Meeting was
adjourned at 12:10 p.m.
Assemblies
“Value of Combined Heart Catheterization in
the Selection of Patients for Valvular Heart Sur-
gery,” Philip Samet, Miami Beach.
“Complications of Acquired Diseases of the
Aorta,” Samuel M. Day, Jacksonville.
The Second Scientific Assembly convened at
2:00 p.m., Tuesday, May 7, in the Pageant Room.
Hollywood Beach Hotel, with Drs. Charles Mel).
Harris Jr. of West Palm Beach and Richard
Reeser Jr. of St. Petersburg presiding. The fol-
lowing papers were read and discussed:
“Transplantation of the Ureters into on Iso-
lated Illeal Loop,” J. Harold Newman, Jack-
sonville.
“Reconstructive Arterial Surgery,” James D.
Moody, Orlando.
“Facial Fractures, Their Recognition and
Management,” Bernard L. N. Morgan, Jackson-
ville.
70
REGISTRATION
Volume XI.IV
Number 1
“Incidence of Skin Cancer Arising from Pre-
cancerous Dermatoses,” Wesley W. Wilson,
Tampa.
“Sarcoma Botryoides,” Howard C. Duckett,
Jacksonville.
“New Technics in the Study of Carcinoma
of the Uterine Cervix,” Sam W. Denham, Jack-
sonville.
REGISTRATION
The registration for the 83rd annual meeting
at Hollywood far exceeded that of any previous
Convention of the Association. The total number
registered was 2,108. The registrants include 988
members of the Association, 200 visiting phy-
sicians, 101 other guests, 507 members and guests
of the Woman’s Auxiliary, 25 scientific exhibitors
and 287 representatives of exhibiting firms. There
were 22 other states and 1 foreign country rep-
resented.
Registration List
OFFICERS
Francis H. Langley, M.D., President St. Petersburg
William C. Roberts, M.D., Pres-Elect Panama City
Meredith Mallory, M.D., 1st Vice Pres. Orlando
Kenneth A. Morris, M.D., 2nd Vice Pres. Jacksonville
Cecil M. Peek, M.D., 3rd Vice Pres. W. Palm Beach
Samuel M. Day, M.D., Secy-Treas. Jacksonville
Shaler Richardson, M.D., Editor Jacksonville
MEMBERS
APOPKA: Thomas E. McBride. ARCADIA: Charles
H. Kirkpatrick, Frank J. Liddy, Gordon H. McSwain,
Anthony D. Migliore. AVON PARK: Hubert W. Cole-
man, Donald C. Hartwell, Carl J. Larsen. BARTOW:
Milo H. Holden, Alfred S. Massam, William F. Pea-
cock. BELLE GLADE: Wilbert O. Norville (Col.).
BLOUNTSTOWN: Grayson C. Snyder. BOCA RA-
TON: Willard Machle Sr. BRADENTON: Taylor D.
Bailey, Joseph B. Ganey, Irving E. Hall Jr., Richard V.
Meaney, Millard P. Quillian, Albert A. Simkus, William
D. Sugg, Willett E. Wentzel, Frederic H. Wood. BRAN-
FORD: Edward G. Haskell Jr. BROOKSVILLE: S.
Carnes Harvard.
CALLAHAN: David D. Bennett Jr. CANTON-
MENT: Frank E. Williams. CHIPLEY: Walter H.
Shehee. CLEARWATER: M. Elridge Black, Raymond
H. Center, James V. Freeman, John T. Goodgame, Julio
J. Guerra, Percy H. Guinand, Charles A. Johnson Jr.,
John A. Lauer Jr., George H. Schoetker. COCOA:
Thomas C. Kenaston, Lee Rogers Jr., Charles E. Russell.
CORAL GABLES: John C. Ajac, A. Daniel Amerise,
Charles R. Burbacher, Reuben B. Chrisman Jr., Jack Q.
Cleveland, Victor Dabby, Franklin J. Evans, Joseph R.
Galluccio, George Gittelson, Francis W. Glenn, Edward
E. Hodsdon, Jim S. Jewett, Robert P. Keiser, Warren
Lindau, Jerome A. Megna, William T. Mixson Jr., R.
Sam Mosley, Wesley S. Nock, Robert C. Piper, Frederick
P. Poppe, Warren W. Quillian, T. D. Sandberg, Irvin Sea-
man, Ben J. Sheppard, Harold M. Silberman, William P.
Smith, Chauncey M. Stone Jr., Richard E. Strain,
Franklyn E. Verdon, William L. Wagener Jr., Arthur H.
Weiland, Bernard Yesner, Warren Zundell. CRAW-
FORDVILLE: Thomas D. Head. CRYSTAL RIVER:
Samuel R. Miller Jr.
DADE CITY: John S. Williams. DANIA: Fred
E. Brammer. DAYTONA BEACH: Fred H. Albee Jr.,
Charles A. Brown, John J. Cheleden, James W. Clower
Jr., C. Robert DeArmas, John A. Failla, David W. God-
dard, William L. Jennings, Alphonsus M. McCarthy,
Achille A. Monaco, Howard W. Reed, Charles L. Rickerd,
Arthur Schwartz, Russell C. Smith, Gerald S. Williams.
DEERFIELD BEACH: Helen M. Ahmann. DeFUNIAK
SPRINGS: William D. Cawthon. DeLAND: Robert
0. Burry, William R. Hutchinson. DELRAY BEACH:
John W. Jolley, Graham W. King Jr., Robert E. Ra-
born, Charles A. Robinson, Thomas Whitehead. DUNE-
DIN: James C. Fleming, John A. Mease Jr., James F.
Spindler, Walter H. Winchester, Clifton A. Young. EAU
GALLIE: Jack T. Bechtel. FERNANDINA BEACH:
Cecil B. Brewton.
FORT LAUDERDALE: Edward A. Abbey, Louis
L. Amato, Norris M. Beasley, Curtis D. Benton Jr.,
Beverly R. Birely, Oliver C. Brown, Mark Butler, Mil-
ton N. Camp, Andre S. Capi, Russell B. Carson, Eugene
E. Christian (Col.), Elmer R. Conrad, Henry R. Cooper,
Forest W. Cox, Alfred E. Cronkite, Earl S. Davis, Frank
Denniston, James W. Dickey Jr., Burns A. Dobbins Jr.,
Frederick J. Driscoll, Robert L. Elliston, Robert S.
Faircloth, Roland F. Fisher, Walter J. Glenn Jr., Francis
C. Haberman, George Hamerick Jr., Benjamin F. Hart,
Roger K. Haugen, Anne L. Hendricks, Thomas F. Huey
Jr., Paul W. Hughes, Garland M. Johnson, William H.
Kirkley, Clifton B. Leech, Gaetano A. LoPresti, M.
Austin Lovejoy, Thomas L. McKee, Richard A. Mills,
Robert U. Moersch, Floyd A. Osterman, Richard D.
Owen, Henry J. Peavy Sr., William K. Peck, Claus A.
Peterson, Francis D. Pierce, Robert J. Poppiti, Thomas
L. Roberts Jr., Leigh F. Robinson, David R. Rogers,
Lees M. Schadel Jr., Charles F. Seymour, Paul G. Shell,
Daniel C. Smith, Vincent V. Smith, Curtis H. Sory,
Robert G. Talley, Jack L. Valin, Charles L. Wadsworth,
James M. Weaver, W. Dotson Wells, John I. Williams,
Walter S. Williams, Scottie J. Wilson.
FORT MYERS: Fred D. Bartleson, Gustave F.
Bieber, Ernest Bostelman, James L. Bradley, Merwin E.
Buchwald, A. Louis Girardin Jr., Angus D. Grace, Wil-
liam H. Grace, George D. Hopkins 11, Curtis R. House,
H. Quillian Jones, Newton W. Larkum, Joseph L. Selden
Jr., John S. Steward. FORT PIERCE: Alfred J. Cor-
nille, Russell L. Counts, Hugh B. Goodwin Jr., Richard
F. Sinnott, Wilbur S. Turner, Laurance D. Van Tilborg,
Maltbv F. Watkins, Melvin Wolkowskv. FORT WAL-
TON BEACH: Frederic E. Caldwell. GAINESVILLE:
Edwin H. Andrews, Henry J. Babers Jr., F. Emory
Bell, Charles H. Carter, Eugene H. Cummings, Charles
H. Gilliland, George T. Harrell Jr., James M. McClam-
roch, Walter E. Murphee, Charles Pinkoson, George H.
Putnam, Glenn O. Summerlin, William C. Thomas Sr.,
1. Irving Weintraub. GRACEVILLE: Redden L. Miller.
GROVELAND: John D. Bloom. HIALEAH: Leon S.
Eisenman, Joseph L. Greene, Karen Howard, William C.
Hutchison. HOLLYWOOD: Thomas S. Adams, Dale
T. Anstine, Selig J. Bascove, Manuel G. Carmona, Gor-
don B. Carver, Milton P. Caster, Jess V. Cohn, Bertram
J. Frankel, Howard J. Fuerst, Anthony C. Galluccio,
lerome M. Greenhouse, Robert R. Harriss, John R. Hege
Jr., Michael S. Lazzopina, David J. Lehman Jr.. Charlotte
E. Mason, Elbert McLaury, John H. Mickley, Bernard
J. Florida, M.A.
July, 1957
REGISTRATION
71
Milloff, Alexander E. Morse Jr., Louis J. Novak, Robert
J. Patterson, Harry M. Permesly, William J. Ramel,
Edward J. Saltzman, Bernard B. Seltzer, Randall W.
Snow, S. Elliott Wilson. HOMESTEAD: Joseph H.
Shain. INVERNESS: Gail M. Osterhout.
JACKSONVILLE: Samuel J. Alford Jr., Risden T.
Allen, Augustus E. Anderson Jr., Sam C. Atkinson, Archie
J. Baker, S. James Beale, Sullivan G. Bedell, James D.
Beeson, Dominick A. Bianchi, C. Ashley Bird, John B.
Black, James L. Borland, Frederick H. Bowen, Charles
W. Boyd, Robert J. Brown, Edward Canipelli, Cornelia
M. Carithers, Hugh A. Carithers, Claude L. Carter, Tur-
ner Z. Cason, Howard C. Chandler, Cecil C. Collins Jr.,
Charles D. Cooksey, Silas M. Copeland, Sam W. Den-
ham, Simon D. Doff, Howard C. Duckett, Lucien Y.
Dyrenforth, Merton L. Ekwall, Joseph A. J. Farrington,
Emmet F. Ferguson, Frank L. Fort, Lawrence E. Geeslin,
John M. Gorman, A. Judson Graves, Karl B. Hanson,
Albert V. Hardy, O. E. Harrell, William G. Harris, Char-
les F. Henley, Clarence H. Houston, Floyd K. Hurt, Wil-
liam Ingram Jr., Gordon H. Ira, John F. Ivey, Edward
Jelks, Marvin H. Johnston, Raymond R. Killinger, F.
Gordon King, Raymond H. King, William J. Knauer Jr.,
Camillus S. L’Engle, Samuel S. Lomardo, John F. Love-
joy, Joseph J. Lowenthal, Edward W. Ludwig, James
G. Lyerly Sr., James G. Lyerly Jr., E. Frank McCall,
Marvin V. McClow, Charles F. McCrory, Charles B.
Mabry, Carl C. Mendoza, John H. Mitchell, Bernard
L. N. Morgan, Thomas E. Morgan, A. Sherrod Morrow,
Seymour Morse, Nelson A. Murray, J. Harold Newman,
Aaron Z. Oberdorfer, Lorenzo L. Parks, George I. Ray-
bin, Harry W. Reinstine Jr., Ferdinand Richards, Wade
S. Rizk, C. Burling Roesch, Clarence D. Rollins, Albert
D. Rood, Joseph H. St. John, John H. Shackleton Jr.,
Clarence M. Sharp, Eugene D. Simmons, Richard G. Skin-
ner Jr., Lauren M. Sompayrac, Wilson T. Sowder, John
T. Stage, Sidney Stillman, Max Suter, Richard P. Thomp-
son, James R. Trimble, Daniel R. Usdin, Leo M. Wachtel,
Nathan Weil Jr., Louis A. Wilenskv, Albert H. Wilkinson,
Ashbel C. Williams, Jonathan H. Wood.
KEY BISCAYNE: John V. Handwerker Jr. KEY-
STONE HEIGHTS: Donald M. Christoffers. KEY
WEST: Ralph Herz. KISSIMMEE: John O. Rao.
LAKE ALFRED: Edgar B. Hodge. LAKE CITY:
Thomas H. Bates, Louis G. Landrum, Robert M. Sasso.
LAKELAND: Jere W. Annis, James R. Boulware Jr.,
Samuel J. Clark, John P. Collins, John E. Daughtrey,
Fred I. Dorman Jr., Henry Fuller, Fred S. Gachet,
Spencer R. Garrett, Ralph B. Hanahan, August C. Her-
man, Marion W. Hester, William A. Hodges Jr., William
S. Johnson, David S. Kenet, Everett S. King, Charles
Larsen Jr., George H. Mix, James T. Shelden, David
Sloane, Henry M. Stern, S. L. Watson, John W. Williams.
LAKE WALES: Edward C. Burns Jr., Willard E.
Manry Jr., John P. Tomlinson Jr. LAKE WORTH:
Sidney Davidson, Richard F. Kidder, Carl M. Pults,
Arthur T. Rask, James H. Rester Jr., H. John Richmond,
Alvah L. Rowe, A. Scott Turk, Edward W. Wood.
LARGO: Henry M. Katz. LEESBURG: George E.
Engelhard, Marion B. O’Kelley. MACCLENNY: John
E. Watson. MADISON: Wilmer J. Coggins. MARIAN-
NA: James T. Cook Jr., Henry I. Langston. MEL-
BOURNE: John M. Gayden, Oswald A. Holzer, Theodore
J. Kaminski, Isabel Roberts, James A. Sewell, Arthur
C. Tedford, Ludo Von Meysenbug.
MIAMI: Bernard Abel, Lawrence Adler, Julius Alex-
ander, Lassar Alexander, James L. Anderson, Edward
R. Annis, Samuel Aronovitz, William G. Aten Jr., Harold
P. Auslander, George C. Austin, Hubert A. Barge, William
J. Barge, Ernest R. Barnett, Robert C. Barlett, Harry E.
Beller, Morris H. Blau, Abraham Bolker, John C. Bran-
ham, John A. Broward, Andrew G. Brown, Earlsworth
C. Brunner, John E. Burch, Bruce D. Carroll, Gerard F.
Carter, Chester Cassel, Gus G. Casten, Turner E. Cato,
Silas E. Chambers, Isaac B. Cippes, Marcus B. Cirlin,
George D. Conger, Francis N. Cooke, Maurice P. Cooper,
Vincent P. Corso, Edward W. Cullipher, Harold E. Davis,
Robert F. Dickey, L. Washington Dowlen, Carl E. Dun-
away, Albert J. Ehlert, James O. Elam, Wm. H. Ellis,
Bruce M. Esplin, Charles D. Ettinger, John J. Farrell,
Frederick E. Farrer, Willard L. Fitzgerald, M. Jay Flipse,
Joseph Freeman, Edmond Gamse, Michael M. Gilbert,
Bernard Goodman, Edwin F. Gouldman, J. Raymond
Graves, Maurice M. Greenfield, Thos. S. Griggs, Howard
H. Groskloss, David E. Hallstrand, Morton L. Hammond,
Henry C. Hardin Jr., Robert M. Harris, W. Tracy
Haverfield, Ella M. Hediger, John A. Heffernan, Andrew
H. Hinton, James W. Holmes, H. Carlton Howard,
Paul E. Howard, William M. Howdon, R. Spencer
Howell, Jack Humphreys, Ralph W. Jack, Joseph T.
Jana Jr., Paul S. Jarrett, Albert C. Jaslow, Walter C.
Jones, Samuel Kaplan, Harold S. Kaufman, Christian
Keedy, Jack Keefe, David Kirsh, Erna K. Klass, Morris
E. Kuckku, William T. Lanier, George W. Lawson,
Robert M. Lee, Hilbert A. P. Leininger, Alfred G. Levin,
Morris J. Levine, Simon M. Lipton, A. Buist Litterer,
Joseph Lomax, Robert O. Lyell, E. Norton McKenzie,
Norman W. McLeod Jr., Jesse C. McMillan, Martin P
Mahrer, Ronald J. Mann, Stanley Margoshes, Donald F.
Marion, Wayne B. Martin, Isidore Marx, Lawrence R.
Medoff, Frank L. Meleney, Perry D. Melvin, Hyman
Merlin, David R. Millard Jr., John D. Milton, Leon
H. Mims Jr., Harry M. Moore, S. Robert Nash, Elwin
G. Neal, Samuel Neustein, Humberto M. Nogueiras,
Russell K. Nuzum Jr., Arturo C. Ortiz, Samuel W. Page
Jr., Raymond E. Parks, Frazier J. Payton, Colquitt
Pearson, Homer L. Pearson Jr., Nelson T. Pearson, Max
Pepper, Maxine R. Perdue, Irwin Perlmutter, Benton B.
Perry, Kenneth Phillips, Roland F. Phillips, Joseph B.
Pomerance, Edwin P. Preston, James H. Putman, Gerard
Raap, John R. Ramey, Harold Rand, Jack O. W.
Rash, Homer A. Reese, Maurice Rich, John R. Richard-
son, Julian A. Rickies, Samuel J. Roberts, George W.
Robertson III, Hunter B. Rogers, Charles Rosenfeld,
Manning J. Rosnick, Robert L. Roy, Ruth W. Rumsey,
Lyle W. Russell, Walter W. Sackett Jr., S. Marion Salley,
Ralph S. Sappenfield, Milton S. Saslaw, Chaffee A. Scar-
borough, Oden A. Schaeffer, George F. Schmitt Jr., Louis
W. Schneider, Marie L. A. Schuh, Charles A. Schwarz,
Louis D. Silvers, Donald W. Smith, Marvin H. Smith,
Clifford C. Snyder, John W. Snyder, Donald G. Stannus,
Joseph S. Stewart, Richard F. Stover, William M.
Straight, Theodore R. Struhl, Collins W. Swords Jr.,
Charles F. Tate Jr., Wm. A. Terheyden Jr., Kelly C.
Thomas, Ludwig M. Ungaro, Harrison A. Walker, Isaac
N. Weinkle, Philip Weinstein, Robert C. Welsh, Lynn W.
Whelchel, Kenneth S. Whitmer, William Wickman,
Edward H. Williams, John E. Williams, Leo H. Wilson
Jr., Oliver P. Winslow Jr., Arthur W. Wood Jr., Frank
M. Woods, Jack L. Wright, Meyer Yanowitz, Corren P.
Youmans, Thomas J. Zaydon, Leo A. Zuckerman.
MIAMI BEACH: Mortimer D. Abrashkin, Irving
L. Alberts, Lester I. Berk, Theodore M. Berman, Wil-
liam H. Bernstein, Charles I. Binder, Otto S. Blum,
Herman Boughton, Herman Cohen, Max Dobrin, Maurice
I. Edelman, David W. Exley, I. Leo Fishbein, Elias
Freidus, Milton S. Goldman, Max Gratz, Robert J.
Grayson, Irvin M. Greene, Arnold Grier, Lewis L. Julien,
Saul H. Kaplan, Maurice Kovnat, Maurice D. Krauss,
Andrew J. Leon, George N. Leonard, Samuel P. Leslie,
Alexander Libow, Marvin L. Meitus, Cayetano Panettiere,
Maurice J. Rose, Philip Samet, Maxwell M. Savet, Rich-
ard D. Shapiro, Benjamin L. Steinberg, John H. Tanous,
Earl R. Templeton, Efton J. Thomas, M. P. Travers,
Robert J. Trope, Harold D. Van Schaick, Leonard L.
Weil, Marvin L. Weil, D. Ward White, Daniel H. Zim-
merman, Nelson Zivitz.
MIAMI SHORES: Robert A. Maver, Jack A. Rud-
olph MIAMI SPRINGS: Clyde T. Thompson. MOUNT
DORA: J. Basil Hall, Fred A. Vincenti. MULBERRY:
John A. Ray. NAPLES: John C. Garland, Daniel B.
Langley, Ethel H. Trygstad, Reider Trvgstad. NEW-
BERRY: George W. Karelas. NEW PORT RICHEY:
Frank Y. Robson. NORTH MIAMI: George R. Mc-
Clary, Milton S. Monyek. OCALA: William H. Ander-
72
REGISTRATION
Volume XI,IV
Number 1
son Jr., Henry L. Harrell, Eugene G. Peek Jr., Thos. H.
Wallis. ORLANDO: Rex M. Bleakney, Willard H.
Boardman, Frank C. Bone, Dorothy D. Brame, J. Rocher
Chappell, Louis N. Christensen, Chas. J. Collins, Nor-
man F. Coulter, Horace A. Day, W. Ansell Derrick, James
G. Economon, George W. Edwards II, Elwyn Evans,
Harry H. Ferran, Benjamin Glaser, Frank IJ. Gray,
George W. Griffin, Maurice C. Guest, G. Tayloe Gwath-
mey, Joseph C. Howarth, Joseph L. Hundley, Eldridge
W. Johnson, Eugene L. Jewett, Solomon D. Klotz, Mor-
ton Levy, Newton C. McCollough, Carl S. McLemore,
James A. McLeod, Charlotte C. Maguire, Fred Mathers,
Alexander P. Maybarduk, Frederick E. Medlock Jr., Roy-
ston Miller, James I). Moody, Pleasant L. Moon, Louis
C. Murray, Robert G. Neill, Joseph E. O’Malley, Louis
M. Orr, W. Grady Page, Roger E. Phillips, Louis E. Pohl-
man, Frank J. Pyle, Joseph G. Seltzer, Rodman Shippen,
Charles R. Sias, Philip F. Simensky, Abraham H. Spivak,
Joseph L. Stecher, Alfred S. Stevenson, W. Dean Stew-
ard, Sam N. Sulman, Byrne E. Taylor, Miles W. Thorn-
ley, Robert L. Tolle, Jack P. Ward, Bradford C. White,
Breckinridge W. Wing, Robert W. Young. ORMOND
BEACH: B. Arthur Smith. PAHOKEE: Ernest C.
Johnson Jr. PALATKA: Alfred P. Peretti. PALM
BEACH: Robert M. Alexander, Alvin E. Murphy, Wal-
ter R. Newbern, David A. Newman, Herman G. Rose,
Bailey B. Son,' Jr., Joseph R. West. PALMETTO:
Warren G. Darty. PANAMA CITY: Daniel M. Adams
Jr., William F. Humphreys Jr., James IJ. Nixon, C. W.
Shackelford, Harold E. Wager. PENSACOLA: Egbert
V. Anderson, Constantine A. Asters, Paul F. Baranco,
Herbert L. Bryans, Mayhew W. Dodson, Joseph W.
Douglas, Luther C. Fisher Jr., Charles J. Heinberg, Wil-
liam P. Hixon, Alpheus T. Kennedy, Albert Lehmann,
M. A. Lischkoff, Clyde E. Miller Jr., George W. Morse,
Wendell J. Newcomb, John M. Packard, Nathan S.
Rubin, William M. C. Wilhoit, Earl G. Wolf.
PERRY: John H. Parker Jr. PLANT CITY: Earl
H. Diehl, Richard M. Kafka, William G. Meriwether,
Madison R. Pope. POMPANO BEACH: Alexander A.
Bolton Jr., Paul E. Gutman, Wilks O. Hiatt Jr., Richard
S. Lewis, George S. McClellan, Frank L. Mikes. PORT
ST. JOE: John W. Hendrix. QUINCY: Julius C. Davis,
George H. Massey. RIVIERA BEACH: Frank M. Hew-
son Jr., Kaden Tierney, Robert Y. Wheelihan. ROCK-
LEDGE: James R. Doty, Myron L. Habegger. ST. AU-
GUSTINE: S. Raymond Cafaro, William J. Gibson,
Herbert E. White.
ST. PETERSBURG: Harry L. Allan Jr., Arnold S.
Anderson, Clyde O. Anderson, George H. Anderson,
Grover W. Austin, Walter H. Bailey, John P. Boyle,
John R. Butter, Elmer B. Campbell Sr., Elmer B. Camp-
bell Jr., Harry R. Cushman, Virgil C. Daniels Jr., Wil-
liam J. Dean, Charles K. Donegan, John W. Dowswell,
Woodrow B. Estes, Ira C. Evans, John P. Ferrell, Wil-
liam D. Futch, N. Worth Gable, Chester L. Goodnow,
Sidney Grau, Douglas W. Hood, L. Wayne Johnson,
Robert M. Kilmark, Alfred D. Koenig, Whitman C.
McConnell, Norval M. Marr Sr., Robert J. Needles,
John R. Neefe, Orville N. Nelson, David T. Overbey Jr.,
Nell T. Pattengale, Joseph W. Pilkington, Charles L.
Rast Jr., Walter Rautenstrauch Jr., Richard Reeser Jr.,
Harry F. Rolfes, Franklin W. Roush Jr., Walter L.
Schafer, Richard H. Sinden, Benjamin H. Sullivan, Paul
F. Wallace, Abbott Y. Wilcox Jr., Alvin J. Wood, Row-
land E. Wood.
SAFETY HARBOR: David P. Wollowick. SAN-
FORD: Thomas F. McDaniel, Daniel H. Mathers, Leon-
ard Munson, Vann Parker, William V. Roberts. SARA-
SOTA: Alfons R. Bacon, John M. Butcher, Thomas G.
Dickinson, Michael A. DiCosola, Frederick D. Droege,
T. Vernon Finch, Rudolph C. Garber Jr., Ernest M.
Grochowski, Martha W. MacDonald, Henry G. Morton,
Karl R. Rolls, William A. Shannon, Melvin M. Simmons,
William G. Sutherland, Samuel R. Warson, Millard B.
White. SOUTH MIAMI: Henry H. Bryant III, Thomas
S. Gowin, Henry W. Griffith, John F. McKenna, James
H. Mendel Jr. STARKE: Andrew J. Barry.
STUART: Walter F. Davey, John M. Gunsolus.
SURFSIDE: Samuel N. Tippett. TALLAHASSEE:
Edson J. Andrews, Merritt R. Clements, Francis T. Hol-
land, William J. Hutchison, Charles F. James Jr., George
N. Lewis, David J. McCulloch, Robert H. Mickler,
George S. Palmer, Luther L. Pararo Jr., Henry L. Smith
Jr., Naomi T. Stinger, William R. Stinger.
TAMPA: Frank S. Adamo, Samuel H. Adams, Efrain
C. Azmitia, William C. Blake, Ernest R. Bourkard,
Harold O. Brown, Lyle W. Burroughs, J. Robert Camp-
bell, Leffie M. Carlton Jr., Harold Carron, Jonas Carron,
Frank V. Chappell, C. Frank Chunn, Herschel G. Cole,
Lewis T. Corum, James T. Cowart, Marvin L. Cullen,
Daniel S. de la Penha, Joshua C. Dickinson, R. Renfro
Duke, Richard T. Farrior, Sherman B. Forbes, Elsie M.
Gilbert, Arturo G. Gonzalez, John E. Gottsch, Chas.
McC. Gray, Maurice Haddad, H. Phillip Hampton, John
S. Helms J r., Linus W. Hewit, Samuel G. Hibbs, A. M. C.
Jobson, Blackburn W. Lowry, Paul J. McCloskey,
Taverno A. Martini, Alfonso F. Massaro, David R.
Murphey Jr., Thomas F. Nelson, Julien C. Pate Sr.,
Julien C. Pate Jr., James N. Patterson, Anthony P.
Perzia, Neal J. Phillips, Walter C. Price, William M.
Rowlett, Joseph J. Ruskin, Zack Russ Jr., Joseph D.
Scolaro, Hawley H. Seiler, M. Crego Smith, Wray D.
Storey, Joseph W. Taylor Sr., Joseph W. Taylor Jr.,
Augustine S. Weekley, Albert A. Wilson, Wesley W.
Wilson, James A. Winslow Jr.
TARPON SPRINGS: Peter J. Spoto, James E.
Thompson, Willie J. Vinson. TAVARES: James R. Han-
son. TREASURE ISLAND: James W. Allee. VENICE:
Samuel E. Kaplan, Douglas R. Murphy. VERO BEACH:
William L. Fitts 3rd, Vernon L. Fromang, John P.
Gifford, Erasmus B. Hardee, Kip G. Kelso, Walter W.
McCorkle, James C. Robertson, Enoch J. Vann Jr.
WEST PALM BEACH: Willard F. Ande, Robert V.
Artola, Horace D. Atkinson, John M. Baber, Harry E.
Bierley, William E. Bippus, Edwin W. Brown, Clarence
L. Brumback, Victor Clarholm, James F. Cooney, Joseph
J. Daversa, C. Jennings Derrick, Hugh Dortch Jr., Wil-
liam H. Everts, W. Wellington George, Julian J. Good-
man, John P. Greene, Charles McD. Harris Jr., Frederick
K. Herpel, Richard M. Irwin, Lorenzo James, V. Mark-
lin Johnson, Oliver L. Jones, Edgar A. P. Kellerman,
Lawrence R. Leviton, R. Gaylord Lewis, W. Ambrose
McGee, David W. Martin, Glenn H. Morton, Lloyd J.
Netto, Theodore Norley, S. Richard Ombres, Ralph M.
Overstreet Jr., William H. Proctor, Hyman J. Roberts,
Raymond S. Roy, William Y. Sayad, W. Lawson Shackel-
ford, Roslyn Skyer, James R. Sory, Vale D. Stone, Laurie
R. Teasdale, Wm. E. Van Landingham, Harold A. Yount.
WINTER GARDEN: Edward Bradford. WINTER
HAVEN: Henry F. Keiber, Arthur J. Moseley Jr., Ches-
ter L. Nayfield. WINTER PARK: Warren A. Brooks,
Marshall N. Jensen, Walter B. Johnston, William L.
Musser, Leroy S. Safian.
Visiting Doctors
ARCADIA: Joseph W. Lawrence. AVON PARK:
Burton C. Ostling. BELLE GLADE: Kenneth C. Rich-
mond. BOYNTON BEACH: Edgar A. Dillard Jr.
BRADENTON: John A. Shively. CLEARWATER:
Morris W. Dexter. CORAL GABLES: George S.
Baldry, Henry Barancik, Jack Reiss, Gaetano T. Samar-
tino, Louis Zasly.
DEERFIELD BEACH: Theodore W. Hahn. DUNE-
DIN: Malcolm MacKenzie. FORT LAUDERDALE:
Rosarie Bender, James J. Callahan, Vincent Coppola Jr.,
Leonard A. Erdman, William J. Fanizzi, J. C. Gilbert Jr.,
Charles M. Hendricks Jr., George W. Hoover, David C.
Lane, Grover C. McDaniel, Richard A. Martin, Natalie
A. Nadeau, Oscar E. Nadeau, Marshall C. Sanford,
T. Florida, M.A.
July, 1957
SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
73
Frank P. Tocci. FORT MYERS: Reginald H. Johnson
Jr. HIALEAH: Theodore Hirsch, George H. Wessel V.
HOLLYWOOD: Vernon B. Astler, Robert L, Berger,
Calvin M. Cerrato, Seymour Dunn, Morris E. Goldman,
Samuel J. Hodkin, Asher Hollander, Colin A. Munroe,
Donald L. Peterson, Thomas F. Regan, Alexander S.
Rogers, Hyman Sporn. JACKSONVILLE: Thomas B.
Christian, William H. Garvin Jr., Thomas H. Gouchnour,
A. D. James, Amelia B. Sheftall, Robert B. Simons, Wil-
liam L. Whitehurst.
LAKE CITY: Treadwell L. Ireland. LAKELAND:
Robert H. Nickau, Robert J. Pfaff. LANTANA: Antonio
V. Camera. MIAMI: William A. Abelove, Norman H.
Azen, Jesse K. Bailey, Jerome Benson, Rufus K. Broad-
away, Stanford B. Cooke, David L. Crane, Edward Cut-
ler, George P. Daurelle, Claude G. Eccles, John J. Fomon,
Ralph J. Fusco, Nathan Glover, Winston F. Harrison,
James M. Harsha, Cal S. Kellogg, Simon I. Kemp, Ray-
mond R. Killinger Jr., Frank T. Kurzweg, Taylor Lewis,
Robert S. Litwak, Joan W. Mayer, Paul W. Mayer,
Morton L. Miller, Maximilian Morgen, Lloyd R. New-
houser, Morton S. Notarius, Milton L. Pearce, Robert
C. Schwartz, Winston K. Shorey, Harold C. Spear,
Charles M. Stephenson, E. Henry Valentine Jr., M. W.
Williams, Jesse G. Wright.
MIAMI BEACH: Richard G. Alper, Michael A.
Cogan, Lee W. Elgin Jr., Joseph Harris, Lewis A. Shep-
perd, Raymond J. Simmons, Melvin M. Sylvan, Rud-
olph T. Wagner, Jack Widrich.
OAKLAND PARK: Robert B. Walker. OCALA: Wil-
liam C. Butscher Jr. OPA LOCKA: Karl Y. R. Brook.
PALM BEACH: Max R. Rubenstein, John Van Boven
III. PERRINE: Alfred Glattauer. POMPANO BEACH:
Max Klinghoffer. RAIFORD: Charles W. Bush. ST.
PETERSBURG: Milton B. Cole, Charles C. Yerburv.
SOUTH MIAMI: M. David Sims. TAMPA: William M.
Douglas, James Gibson, William B. Hopkins Jr., William
B. King, Lawence A. Ratchford, Manuel F. Rubio, Henry
L. Wright Jr. WEST HOLLYWOOD: Milton G. Abar-
banel. WEST PALM BEACH: John D. Bacon, James
R. Brandon, Maximilian A. Crispin, Richard D. Hoover,
George J. Nassef, Loren M. Rosenbach, Malcolm S. Van
De Water.
CALIFORNI A-SALINAS : Fredk. W. Kraft. WAT-
SONVILLE: James F. Culver. COLORADO-DENVER :
M. Ray Gottesfeld, Bernard C. Sherbok. DISTRICT
OF COLUMBIA-WASHINGTON: Bruce W. Halstead,
G. Foard McGinnes. GEORGI A-AUGUSTA : Thos. P.
Findley Jr. SAVANNAH: Walter Kanter. ILLINOIS-
CHICAGO: Bernard V. Chern, Ernest B. Howard, Ed-
ward J. Levine, Julius I. Mandel, Jack H. Sloan,
Jerrold Widran. DECATUR: Jack O. Spicer. IN-
DIANA-EVANSVILLE : Thomas H. Nichols. FORT
WAYNE: Leland J. Mortenson, John H. Nill, Donald
S. Painter. INDIANAPOLIS: Robert F. Nagan. SOUTH
BEND: Raymond A. Gaffney. KENTUCKY-LOUIS-
VILLE: Mever M. Harrison. MORGANFIELD: John
P. Welborn Jr. LOUISIANA-NEW ORLEANS: A.
Seldon Mann. SHREVEPORT: Joseph S. Shavin.
MARYLAND-BETHESDA: John R. Heller. SILVER
SPRING: Louis R. Long. MASSACHUSETTS-BUZ-
ZARDS BAY: Abram Krakower. MICHIGAN-DEAR-
BORN: Andrew H. Bracken. DETROIT: Russell P.
Bolton Jr., Stephen Malina. HUDSON: Arnold O.
Abraham JACKSON: Henrv W. Sill. YPSILANTI :
Donald W. Martin. MINNESOTA-MINNEAPOLIS:
Robert R. Cooper, Charles E. Merket. ST. PAUL:
Richard O. Leavenworth
MISSOURI-ST. LOUIS: Maurice J. Keller. NEW
HAMPSHIRE-MANCHESTER : Robt. Flanders. NEW
JERSEY-PATERSON: Francis R. Mevers. SOUTH
ORANGE: Milton W. Amster. NORTH CAROLINA-
DURHAM: Emil B. Cekada, Wiley D. Forbus. LIN-
COLNTON: John H. Fitzgerald Jr., Boyce P. Griggs.
NEW YORK-BUFFALO: Clarence A. Straubinger.
JAMESTOWN: Harold M. Childress. NIAGARA
FALLS: Richard A. Baer. POUGHKEEPSIE: Oleksei
A. Leonidoff. NEW YORK CITY: Victor Baum, Henry
W Cave, William T. Robinson, Marilyn T. Schittone.
OHIO-CINCINNATI: O. Herman Dreskin, Lawrence F.
Gibboney. CLEVELAND: Victor C. Laughlin, Milton
Linden, Alexander P. Orfirer. COLUMBUS: Reuben B.
Hoover. CUYAHOGA FALLS: Robert J. F. Burkhard.
LYNCHBURG: John G. Anderson. YOUNGSTOWN:
Edwin R. Brody, Robert B. Poling. PENNS YLVANIA-
PITTSBURGH: Leonard M. Cohen, Geo. E. Crum, An-
thony J. Nicolette. MCKEESPORT: Richard H. Parks.
SOUTH CAROLINA- CHARLESTON HEIGHTS: Alvin
L. Rittenberg. TENNESSEE-MEMPHIS: Lemuel W.
Diggs. WISCONSIN-CUDAHY: Manfred Landsberg.
MILWAUKEE: Timothv T. Couch, Robert B. Pittelkow,
Henry Rettig. CANADA-SUDBURY-ONTARIO: Jean
M. Cloutier.
ANNUAL JOINT REPORT
Secretary -Treasurer, Samuel M. Day, M.D.
Managing: Director, Ernest R. Gibson
The administrative year of 1956-1957 was of historic
significance to the Association. For the first time in its
eighty-three years it has its own home. The attractive
headquarters building at 735 Riverside Avenue, Jackson-
ville, was first occupied on August 15, 1956 with formal
dedication one month later.
It has exceeded expectations functionally and the
efficiency of operation has been noticeably increased. It
is surprising to note the increase in telephone calls, visit-
ors and correspondence now that the name of the Asso-
ciation is exposed to constant public view. The Board
Room is in use frequently for meetings of Association,
allied and ancillary groups.
The tangible value of the building is shown in Ex-
hibit “A,” under assets, of the financial statement included
in this report.
Following is a summarization of the activities of the
departments which make up the executive office.
PUBLICATIONS
The Department of Publications continues with its
assigned duties of publishing The Journal, under direction
of the Editor and Managing Editor, preparation and
distribution of the Association’s newsletter “Briefs,” mul-
tilithing publishing the Florida Medical Directory, House
of Delegates Handbooks, programs for the annual and the
district meetings and the mailing of the quarterly Journal
of the Florida Academy of General Practice.
Mr. Tom Jarvis supervises the Department and serves
as Assistant Managing Editor of The Journal. He is
assisted by Mrs. Louise Rader, Journal technician. Mrs
Edith B. Hill assists in publication of The Journal as
editorial consultant.
The Journal
Actual production cost of The Journal this fiscal year
amounted to $30,342.19. This figure does not include
salaries because duties of employees include work in re-
lation to other departments. Income from advertising,
subscriptions from non-members and miscellaneous sales
amount to $29,870.10. Income from allocation of sub-
scriptions from dues paid by members totaled $14,010.00.
This year, 40,475 copies of The Journal were printed,
an increase of 2,200 copies over the previous year. An
effort is made to supply back issues when requested. This
is not always possible because only a small supply of each
74
SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
Volume XI.IV
Number 1
issue remains after each subscriber has been provided
a copy.
“Briefs”
Thirteen issues of “Briefs” have been printed and
mailed to members this year by the Department. In-
formation of particularly current value to members,
prompting each issue, may be drawn from the Managing
Director or Supervisor of the Bureau of Public Rela-
tions. Copy for the issue is not always prepared by this
Department.
Multilithing
Printing by the Department has been forms, reports,
booklets, letters and the Auxiliary Yearbook. The De-
partment also printed a revision of the VA. Fee Schedule
which severely taxed the facilities.
Directory
A total of 4,500 copies of the 1957 Florida Medical
Directory was printed at a cost of $3,342.45. Each Asso-
ciation member was sent a copy. Most of the remainder
has been or will be sold for $2.00 per copy. Revenue
from individual sales and advertising in the 1956 Di-
rectory amounted to $2,872.00. Copy for all rosters is
provided by the Administration Department. Design,
artwork and layout is done by the Department of Pub-
lications.
House of Delegates Handbook
Reports from the various Association committees; the
agenda of the House of Delegates’ meetings and the list
of delegates, both provided by the Administration, is
utilized by this Department in production of the Hand-
book.
Programs
Type used originally in The Journal is used again in
production by this Department of programs for the
Annual Meeting and for the Medical District Meetings.
Design, artwork and layout is done by the Department.
Copy for all programs is prepared by the Department
from material provided by Administration.
Journal of the Florida Academy of General Practice
Mailing facilities of the Association are utilized by the
Department in distributing quarterly the Journal of the
Florida Academy of General Practice. At the request of
the Academy, the Department performs this service at an
agreed rate of two cents per copy, the approximate cost
of the service.
PUBLIC RELATIONS
The policies of the Bureau of Public Relations are
determined by the Board of Governors and implemented
through its liaison member for public relations and the
Committee on Legislation and Public Policy. The Bureau
is directed by Mr. W. Harold Parham, Supervisor, who
also serves as the Association’s Assistant Managing Di-
rector. He is assisted by Mr. Eugene L. Nixon. Miss
June Palmer serves as Bureau secretary.
Although several varied projects were undertaken dur-
ing the past year, the primary activities of the Bureau
have been concerned with planning, promoting and co-
ordinating the Association’s public relations and legisla-
tive programs and assisting county medical societies
with local programs.
Field Work
As in previous years, much of the staff’s time has been
devoted to field work. Countless contacts were made
with county society officers and committee chairmen,
pubic officials, news media, organizations, agencies and
individuals in efforts to achieve increased understanding
and implementation of the Association’s policies.
Florida Medical Foundation
During the year, the Bureau was called upon to assist
in implementing the establishment of the Florida Medi
cal Foundation. Facilities of the Bureau are continuing
to be utilized in its administration.
Legislation
Continued emphasis was placed upon assisting the
Committee on Legislation and Public Policy in carrying
out activities relating to national legislation and the
Association’s state legislative program. Considerable time
and effort were devoted by the staff in supporting the
program of Governor LeRoy Collins to abolish the prac-
tice of naturopathy in Florida. An office was maintained
in Tallahassee during the 1957 session of the Florida
Legislature through which information pertaining to the
Association’s legislative program was provided to legisla-
tors. As in the past, a constant check was maintained
on all health and medical legislation introduced during the
session.
Science Fairs
A new project initiated by the Association this year
was in the field of science fairs. Special Association awards
were presented to winning junior and senior high school
students whose exhibits showed the best aptitude for the
medical sciences in the State Science Fair held in Gaines-
ville. Winners were selected by a judging committee of
physicians.
Rural Health
As an outgrowth of the continuing statewide program
in rural health, the Association took the leadership last
year in the creation of a new joint state rural health com-
mittee. The Florida Committee on Rural Health is com-
posed of representatives of the Agricultural Extension Ser-
vice of the two state universities, the Florida Farm
Bureau Federation, the State Board of Health and the
Association. Dr. Francis T. Holland, of Tallahassee, was
elected as the Committee’s first chairman. The Commit-
tee is expected to provide increased effectiveness of leader-
ship, planning and co-ordination in the state rural health
program.
Exhibits and Displays
Assistance was provided to county medical societies in
presenting health displays at the Pensacola Interstate
Fair, Pensacola; North Florida Fair, Tallahassee; Florida
State Fair, Tampa, and Central Florida Fair, Orlando.
The Florida State Fair exhibit was a joint project of
the Association and the local county medical society. The
favorable public response to these exhibits continued to
emphasize the importance of the fair exhibit as a health
education and public relations medium.
Other Projects
Other projects now underway or continuing include a
statewide poliomyelitis immunization campaign, a pro-
gram of cooperation between physicians and attorneys
and a study of organized labor as it relates to medical
practice.
Public Information
All publicity concerning the Association’s activities was
prepared or processed by the Bureau. The popular weekly
column “Health Topics” has continued to bring authentic
medical information to the public. A monthly health
column was begun in the state’s leading farm magazine.
As a result of increased public interest in health and
medicine, the Bureau has been called upon frequently to
interpret and explain medical events to representatives
of the popular news media. Transcribed radio programs
and films for television and private showing were dis-
tributed throughout the state in cooperation with county
medical societies.
The Bureau has assisted other committees of the Asso-
ciation and county medical societies upon request. The
facilities of the Bureau are available at all times for use
by the county societies in planning and implementing
local programs.
ADMINISTRATION
This division of the headquarters office carried out
the many directives of the House of Delegates, Board
of Governors and Managing Director and it is the re-
sponsibility of this department to see that other members
of the staff are kept advised of the numerous current pro-
grams as well as problems which present themselves from
day to day.
Among the many important activities of this de-
partment are: bookkeeping and accounting records, pur-
chasing, inventory of stock and all correspondence files.
All billing for journal and directory advertising and for
technical exhibit space is handled here. All work in the
administrative department is handled by six staff members
J. Florida, M.A.
July, 1957
SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
75
under supervision of Mrs. Zoe Pack, office manager.
Other members of this department are Mrs. Mae Mason,
assistant office manager, Miss Frances Pesce, bookkeeper
and Mrs. Janice Goin, Mrs. Berwyn Binkley, Mrs. Rita
Fitzgerald, steno-clerks.
Membership Records
The records of the approximately 6,900 licensed
doctors, with additional records for over 3,000 members,
including an addressograph mailing list are maintained.
The net gain in membership for the year was 160.
Annual Meeting
Before one annual meeting is over, plans and ar-
rangements are underway in connection with the next one.
This includes many contacts with specialty groups, the
chairman of the Scientific Work Committee, technical
exhibitors, guests, essayists and others. A large volume
of correspondence, telephone calls and personal contacts
are required between this office and the Convention Hotel
to complete the many details required for a large meet-
ing. Each of our annual meetings is greatly enhanced
by the participation of the many drug, surgical and
speciality firms who spare no expense in presenting a vast
array of the latest scientific developments and technics.
The gross proceeds from technical exhibit space, $17,030
for the current fiscal year, add substantially to the
Association’s income. During the meeting stenographic
and clerical duties are performed by members of our
staff in connection with registration, House of Delegates
and scientific sessions as well as the reference committee
meetings. The assembled material is transcribed, checked,
edited and turned over to the Publications Department
for publication in the Proceedings Number of The
Journal.
Orientation
Each new member of the Association is furnished
several phamphlets to acquaint him with the purposes
and activities of the Association and we stand ready to
assist him in every way possible upon request.
Placement
We maintain listings of communities seeking doctors
as well as those doctors who are looking for locations in
Florida. A steadly increasing number of doctors call at
the office where they have the opportunity of reviewing
our complete files on the various locations available.
Board and Committee Meetings
Stenographic services are rendered the Board of Gov-
ernors, Executive Committee and the several committees
who hold meetings throughout the year. This includes
notification of meeting dates as well as the transcription
and duplication of the minutes. A large volume of cor-
respondence results from the many directives.
Multilith Reproduction
All masters are typed in this department for “Briefs,”
the Yearbook of the Woman’s Auxiliary, the County
Committee Booklet, state and AMA rosters, record cards,
forms and form letters.
Special Services
On request, envelopes are addressed and stuffed cov-
ering our complete membership for doctors and allied
organizations. A charge is made for this service.
Directory
Each year all copy for the Florida Medical Directory
is prepared and the printer’s proof checked for errors
before turning this information over to the Publications
Department. All Florida licensed non-members are con-
tacted by form letter to verify address and determine
whether or not they wish to purchase directories.
Miscellaneous Activities
Local and long distance calls, Western Union messages,
all incoming mail and packages and the major portion of
these outgoing items are handled in this department. All
visitors are greeted by a receptionist. It is the respon-
sibility of the Office Manager to work closely with the
building custodian relative to the maintenance and care
of the building and grounds.
Finances
Assets of the Association for the fiscal year ending
March 28, 1957 total $294,992.77, of which ' $177,896.76
is in real estate, building and equipment. Cost of op-
eration continues to advance with constantly increasing
prices for supplies and services.
The financial statements appearing at the end of this
report are published for the information of the mem-
bers. The books and records of the Association are open
to members and we will gladly endeavor to answer in-
quiries of any nature upon request. The books have been
audited by Goodrich and Varnedoe, Certified Public Ac-
countants, and a certificate of the audit is incorporated in
the statements which follow.
Respectfully submitted,
Samuel M. Day, M.D., Secretary-Treasurer
Ernest R. Gibson, Managing Director
Dr. Samuel M. Day, Secy.-Treas.
Florida Medical Association
Jacksonville, Florida
Dear Sir:
In compliance with request of Mr. Ernest R. Gibson,
Managing Director, Florida Medical Association, we have
examined the books of account, vouchers and other rec-
ords of the association, maintained in his office, for the
period March 21, 1956 to and including March 20, 1957,
and submit herewith our report consisting of:
EXHIBIT “A”— Balance Sheet, March 20, 1957
EXHIBIT “B” — Income Statement from March 21,
1956 Through March 20, 1957
SCHEDULE “B-l” — Schedule of Expense
EXHIBIT “C” — Schedule of Investments, March 20,
1957
EXHIBIT “D” — Schedule of Additions to Fixed
Assets
We determined that all recorded receipts were de-
posited to the credit of the association, and that the
disbursements appeared to be for proper purposes. The
item on the liabilities side of Exhibit “A”, under caption
“Reserve For Deferred Income” is the aggregate of the
membership dues unpaid as at March 20, 1957 and the
amount due the Journal Fund by advertisers.
The investments in U. S. Treasury Bonds were verified
by actual count in the safe deposit vault. Matured inter-
est coupons totaling $400.00 were attached to bonds on
date of verification.
Construction of the permanent quarters of the asso-
ciation was completed in 1956. The total cost of the
building amounted to $122,708.52.
The form of our report this year is different from
those submitted in prior years. This change, we feel,
will be more in keeping with current acounting trends
and will serve to convey more readily the operating re-
sults of the association.
We made no attempt to verify amounts due from
various county societies or by advertisers in the Journal.
Yours very truly,
(Signed) Goodrich & Varnedoe
Certified Public Accountants
CHG/d
(See following pages for Exhibits A, B, B-l, C and D
referred to in above letter.)
76 SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
Exhibit “A”
BALANCE SHEET
March 20, 1957
ASSETS
CURRENT ASSETS
Cash :
Atlantic National Bank
$ 35,135.23
Florida National Bank
8,556.55
Petty Cash Fund
50.00
$ 43,741.78
Accounts Receivable:
Due from County Societies — Dues
$ 48,520.00
Due from Journal Advertisers
6,028.76
54,548.76
Inventory — Stationery, Etc.
2,650.10
TOTAL CURRENT ASSETS
INVESTMENTS
U. S. Treasury Bonds — From Exhibit “C”
FIXED ASSETS
COST
Accumulated
Depreciation
Book
Value
Land
$ 35,833.31
$
$ 35,833.31
Office Building
122,708.52
2,147.39
120,561.13
Furniture, Fixtures & Equipment
... 32,857.51
11,355.19
2 1,502.32
$191,399.34
$ 13,502.58
TOTAL ASSETS
LIABILITIES AND NET WORTH
CURRENT LIABILITIES
Reserve for Deferred Income
NET WORTH
Balanced — March 20, 1956 $217,106.90
Net Gain for Year — Exhibit “B” 23,337.11
Balance — March 20, 1957
TOTAL LIABILITIES AND NET WORTH
Exhibit “B”
INCOME STATEMENT
For The Period March 21, 1956 Through March 20, 1957
INCOME
Dues — Delinquent $49,080.00
Current 63,560.00 $112,640.00
Entrance Fees 2,520.00
Advertising — Journal $29,260.85
— Directory 610.00 29,870.85
Journal Subscriptions & Sales 609.25
Directory Sales 2.262.00
Technical Exhibits 17,030.00
Reprints — Non-Member — Net 286.79
Interest Earned 8,234.49
Miscellaneous Income 1,556.20
TOTAL INCOME
EXPENSE
Administrative $ 55,134.53
Public Relations 32,266.19
Publications 54,497.76
Building Operations 9,773.99
TOTAL EXPENSE
NET GAIN FOR PERIOD — To Exhibit “A”
Volume XLIV
Number 1
$100,940.64
16,155.37
177,896.76
$294,992.77
$ 54,548.76
240,444.01
$294,992.77
$175,009.58
151,672.47
$ 23,337.11
J. Florida, M.A.
July, 1957
SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
77
Schedule “B-l”
Schedule of Expenses
For The Period March 21, 1956 Through March 20, 1957
BUILDING
ADMINIS- PUBLIC PUBLICA- OPER-
TRATIVE RELATIONS TIONS ATIONS TOTAL
Postage & Express
$ 1,285.05
$ 1,213.74
$ 1,284.20
$
$ 3,782.99
Office Supplies
287.19
1,172,11
752.10
2,211 40
Telephone & Telegraph
1,401.42
1,330.69
477.07
3,209 18
Travel Expense
1,417.93
3,457.63
65.63
4,941.19
Delegates To A. M.A. Convention
2,059.77
2,059.77
Office Rent
589.75
563.50
589.75
1,743.00
Maintenance — Office Equipment
325.36
221.74
246.74
793.84
Employees Insurance
183.85
97.30
66.60
17.70
365.45
Building Insurance
819.59
819 59
Federal & State Taxes
782.96
526.99
1,347.77
358.79
3,016 51
Books, Pamphlets, Etc
335.99
531.97
289.84
1,157.80
Salaries
26,228.84
14.812.78
7,793.20
1,574.00
50,408.82
Contractor Fees
- 1,045.01
66.65
3,666.65
4,778.31
Pension Plan Premium
6,712.57
1,168.50
951.83
8,832.90
President’s Expense Fund
311.87
311.87
Secretary’s Expense Fund
69.33
69.33
Printing & Engraving
938.44
1,193.70
2,057.45
4,189.59
Convention Expense — Net Expense
6,712.23
6,712.23
Committee Expense
1,999.32
1,999 32
Dues
218.00
236.50
454.50
Miscellaneous
818.56
23.30
185.00
1,737.53
2,764.39
Patio Party — Net Expense
296.00
296.00
Medicare
204.57
204.57
Depreciation
910.52
456.48
11.07
3,149.47
4,536.54
Special Projects
1,877.04
1,877.04
Legislation — Public Policy
3,306.57
3,306.57
Printing Journal
31,452.86
31,452.86
Printing Directory
3,260.00
3,260.00
Utilities
949.03
949.03
Janitor’s Supplies
1,167.88
1,167.88
TOTAL— To Exhibit “B”
$55,134.53
$32,266.19
$54,497.76
$9,773.99
$151,672.47
Exhibit “C”
Schedule of Investments
As of March 20, 1957
DATE MATURITY FACE NUMBER OF
PURCHASED DATE VALUE BONDS COST
U. S. Treasury Bonds 3/20/54 1962-67 ' $1,000.00 1 $ 978.44
U. S. Treasury Bonds 3/20/54 1962-67 5,000.00 3 15,176.93
TOTAL INVESTMENTS— To Exhibit “A” $16,155.37
Exhibit “D”
Schedule of Additions to Fixed Assets
From March 21, 1956 Through March 20, 1957
Land
F'urniture
Fixtures &
Building
Equipment
Total
BALANCE — March 21, 1956 $ 34,716.31
Additions 1,117.00
$
44,125.07 $ 21,543.39
78,583.45 11,314.12
$ 100,384.77
91,014.57
BALANCE — March 20, 1957 $ 35,833.31 $ 122,708.52 $ 32,857.51 $ 191,399.34
78
SECRETARY-TREASURER’S AND MANAGING DIRECTOR’S REPORT
Volume XLIV
Number 1
Exhibit “E*
Dues and Entrance Fees Collected March 21, 1956 Through March 20, 1957
Name of Society
Total
Members
Arrears
1957 Dues
Back Dues Entran
Members
No. Paid
No. In
Collected
Collected
Fees
Alachua
63
58
5
2,040
640
70
Bay
29
22
7
800
1,080
30
Brevard
SO
43
7
1,480
400
90
Broward
158
132
26
4,920
440
170
Collier
9
9
0
320
Columbia
10
9
1
200
10
Dade
773
46
727
40
29,040
520
DeSoto-Hardee-Highlands-Glades
28
24
4
760
880
Duval
324
193
131
6,120
5,920
270
Escambia
109
97
12
3,480
560
60
Franklin -Gulf
6
6
0
200
Hillsborough
211
168
43
6,080
1,920
150
Indian River
10
10
0
320
Jackson-Calhoun
17
17
0
600
40
Lake
31
23
8
760
160
Lee-Charlotte- Hendry
Leon-Gadsden-Liberty-
38
34
4
1,200
360
80
Wakulla-Jefferson
72
39
33
1,280
560
60
Madison
7
5
2
120
80
Manatee
29
29
0
1,000
200
10
Marion
34
7
27
40
280
20
Monroe
13
2
11
320
10
Nassau
9
8
1
240
Orange
207
156
51
5,760
1,400
180
Palm Beach
156
136
20
4,960
840
100
Pasco-Hernando-Citrus
19
19
0
640
120
10
Pinellas
262
246
16
9,160
600
330
Polk
116
94
22
3,360
440
110
Putnam
11
10
1
280
40
10
St. Johns
21
21
0
720
40
10
St. Lucie-Okeechobee-Martin
25
19
6
720
160
20
Sarasota
70
66
4
2,440
40
70
Seminole
20
17
3
560
40
10
Suwannee
11
9
2
240
280
10
Tavlor
5
5
0
120
40
10
Volusia
91
71
20
2,520
1,360
80
Walton-Okaloosa
22
3
19
720
20
Washington-Holmes
3
3
0
80
80
Totals
3,069
1,856
1,213
63,560
49,080
2,520
Dues Not Payable:
49,080 Back Dues Collected
Co., Soc. Secys
37
112,080 Total Dues Collected
Life
105
2,520 Entrance Fees Collected
Excused
36
115,160 Dues and Entrance Fees
Honorary
74
Military Ser
15
267
Paying Dues
1,589
J. Florida, M.A.
July, 1957
79
Report of the Editor of The Journal
Shaler Richardson, M.D.
In continuing the improvements begun two years ago
when The Journal was made a part of the Department of
Publications, the major changes this year has been a
gradual shift in editorial policy.
It has been the function of The Journal to record the
activities of the Association and as a historical record to
follow the Association’s leadership. Thus The Journal
served in a passive manner.
The Association is in a period of change and is rapidly
becoming a vibrant organization which requires not a
mere chronicler of its history, but also an active voice
which can speak to the membership in an explanatory and
advisory manner. The efforts of The Journal staff this
year have been directed toward this end.
The feature editorial for each item was prepared by
either an associate or an assistant editor on the subject
which, in his opinion, should be presented. In some in-
stances there has been disagreement because of the positive
position, however by and large, the reception has been
gratifying. So far only the readers who disagree have let
us know. We hope the ones who remained silent thus
signify their approval.
Following this feature editorial, we have made every
attempt to report, before they have happened, the various
projects and activities of the Association. Emphasis has
been on scientific meetings which the physician might be
interested in attending; on postgraduate courses given in
the state that would provide him the opportunity to
keep abreast of the newest technics without having to
travel great distances.
Reports of postgraduate courses and other meetings
scheduled for metropolitan medical centers have been
published in the State News Items in order that physicians
may be aware of them.
The shift in editorial policy does not mean The Jour-
nal will cease to record the history of the Association.
We hope to be successful in both undertakings, as the
official organ of the Association and the recorder of its
history.
There have been changes in format and make-up.
These were necessary for attractiveness and easier read-
ing. More pictures have been used, and for the first time
in The Journal’s 42 years, a picture was used on the
cover. Appropriately enough, the picture was of the Asso-
ciation’s new headquarters building.
Last year, 54 scientific papers were published and 45
abstracts. The 12 issues totaled 1,278 pages. Total in-
come was $28,005.89. Expenditures were $30,342.19. Sal-
aries are not included in expenditures because staff mem-
bers have duties other than publication of The Journal.
Nor does the income figure include a $5.00 per member
subscription allocation from dues. The Journal just about
breaks even financially.
Sincere appreciation is expressed to the Assistant Edi-
tors, Drs. Webster Merritt and Franz H. Stewart, and to
the Associate Editors, Drs. Louis M. Orr, Joseph J.
Lowenthal, Jere W. Annis, Herschel G. Cole, Wilson T.
Sowder, Carlos P. Lamar and Walter C. Payne Sr.
To Drs. Chas. J. Collins and James N. Patterson,
members of the Committee on Publication, I also express
sincere appreciation. One or both of them have read and
approved each scientific paper published this year before
it was referred to me.
I am indebted to Dr. Kenneth A. Morris, Chairman,
and his assistant, Dr. Walter C. Jones, for the smooth
functioning of the Abstract Department.
Mrs. Edith B. Hill, Editorial Consultant, has been
constantly on the job. She has rendered valuable service
and many Journal authors join with me in extending
appreciation to her.
Mr. Ernest R. Gibson, Managing Editor, has directed
the work of actual publication most efficiently. He has
maintained the high standards established for The Journal
and at the same time been alert to improvements. But,
the real credit for the improved Journal with the new
look goes to those who live and work with it constantly
and continuously, forever fighting a deadline, Mr. Tom
Jarvis, Assistant Managing Editor, and Mrs. Louise
Rader, Technician.
For the past 29 years, it has been my privilege to be
Editor of The Journal. I am grateful for the confidence
the members of the Association have shown by thus hon-
oring me year after year.
80
Volume XUV
Number 1
William Carmel Roberts, M.D.
President 1957-1958
Florida Medical Association
J. Florida, M.A.
July, 1957
81
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
SHALER RICHARDSON, M.D., Editor
Managing Editor
Editorial Consultant Ernest R. Gibson
Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman. .. Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman .. Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
William Carmel Roberts, M.D., President
Dr. William Carmel Roberts is a native of
Wilcox County, Alabama. The son of William
Pinson Roberts, M.D., and Ruby Estelle Young-
blood Roberts, he was born at McWilliams on
Oct. 19, 1905. He attended local elementary
schools and was graduated from the Dothan High
School at Dothan, Ala., in 1923. He received his
academic training at the University of Alabama,
where he was awarded the degree of Bachelor of
Science in Medicine in 1928. He then turned to
the neighboring state of Tennessee for his medi-
cal training. In 1930, the University of Tennessee
College of Medicine conferred upon him the de-
gree of Doctor of Medicine.
After completing an internship at St. Johns
Hospital in Tulsa, Okla.. Dr. Roberts returned
to Tennessee in 1931. He received further train-
ing at Memphis General Hospital and the Baptist
Hospital in Memphis. Some years later he en-
gaged in postgraduate work at the Cook County
Graduate School of Medicine in Chicago. His
fraternities are Theta Kappa Psi and Pi Kappa
Phi.
Dr. Roberts entered the private practice of
medicine in Florida, locating in Panama City in
1932. He has continued to practice there to the
present time, engaging in the specialty of obstet-
rics and gynecology.
From 1949 until 1956 he served as Chief of
Staff of Bay Memorial Hospital, and during his
term of office the hospital was fully accredited by
the American College of Surgeons and the Joint
Commission on Hospital Accreditation. In recog-
nition of his services, the staff presented him with
an engraved plaque. He is a member of the cour-
tesy staff of Adams Hospital and Lisenby Hos-
pital.
In 1933, soon after establishing his practice
in Panama City, Dr. Roberts reorganized the
Bay County Medical Society as an active com-
ponent of the Florida Medical Association and
served as its president during that year and also
in 1936 and 1948. From 1938 to 1942 and in
1947 he held the office of secretary. From 1933
to 1941 and since 1946 he has been a delegate to
the annual meetings of the state society.
Active in the Florida Medical Association for
a quarter of a century, Dr. Roberts has served in
82
EDITORIALS AND COMMENTARIES
Volume. XLIV
Number 1
numerous capacities. His committee memberships
have included Necrology, 1935; Representatives
to Industrial Council, 1940; Woman’s Auxiliary
Advisory, 1940; and Medical Economics, 1952 to
1956. He was District Councilor in 1942 and
from 1946 to 1948. In 1952 he was Chairman of
the Council. He has served on the Board of
Governors since 1954, and in 1956 was President-
Elect. At present he is a member of the Medical
Advisory Committee for the College of Medicine
of the University of Florida. He also serves on
the Board of Directors of Blue Shield of Florida,
and as an ex officio member of the Board of
Directors of the Florida State Chamber of Com-
merce.
Dr. Roberts is a fellow of the American Col-
lege of Surgeons and of the International College
of Surgeons. In addition, he is a founding fellow
of the American College of Obstetrics and
Gynecology and a senior fellow of the Southeast-
ern Surgical Congress. He holds membership in
the American Medical Association, the Southern
Medical Association, the Gulf Coast Clinical So-
ciety, and the Florida Obstetric and Gynecologic
Society.
During World War II, Dr. Roberts served in
the Air Corps from 1942 to 1946 and was sepa-
rated from the service with the rank of major.
While with the 74th Field Hospital during the
Okinawa Campaign, he made the first motion
picture in color of war surgery up front. By
invitation, this copyrighted film was shown and
narrated by him on the scientific program of the
International Postgraduate Medical Association of
North America in 1948 and on the scientific pro-
gram of the Section on General Practice of the
American Medical Association in 1949. The War
Department borrowed the film to aid in compiling
a training film on war surgery. In addition to
this valuable contribution, Dr. Roberts has con-
tributed a number of articles to medical literature,
all pertaining to his specialty.
Locally, Dr. Roberts has through the years
been most active in civic and social affairs. A
past president of the Panama City Kiwanis Club,
he is also a past president of the Panama City
Country Club and past commodore of the St.
Andrew’s Bay Yacht Club. He is a member of
the board of trustees and a former chairman of
the board of stewards of the First Methodist
Church. His hobbies are quail hunting, golf and
sailing.
Dr. Roberts and Mrs. Roberts, the former
Miss Mary Ann Chaffee of Memphis, have one
son, William Carmel Roberts Jr.
The 1957 Annual Meeting in Review
Several innovations featured the Eighty-Third
Annual Meeting of the Florida Medical Associa-
tion, held at the Hollywood Beach Hotel in Holly-
wood on May 5 to 8, 1957. Rearrangement of
the program with a view to better organization of
the Association’s work during the annual conven-
tion was a major change which scheduled the first
session of the House of Delegates on Sunday
afternoon and the closing session on Wednesday
morning. Monday was devoted to a general ses-
sion in the morning, and in the afternoon a new
feature was a closed circuit television program
in conjunction with other state societies meeting
concurrently. The annual meeting of Blue Shield
of Florida followed the Videclinic. In order to
permit the House of Delegates and the Reference
Committees to meet without conflict with other
activities, the scientific papers were all presented
in a single day, the two sessions being held on
Tuesday.
Highlighting the actions of the House of Dele-
gates was the stand taken on the Medicare pro-
gram. In expressing its disapproval of extending
the Medicare contract, the House directed that
the fixed fee schedule contract in effect at that
time be terminated on June 30, 1957, and that
a new contract, based on the physician’s usual
fee for services, be negotiated. It also stipulated
that the Board of Governors devise a mechanism
to provide dependents with medical care during
the interim between contracts and that each coun-
ty medical society establish a committee to handle
problems related to Medicare.
The members of the Association were urged to
make donations to the Florida Medical Founda-
tion. It was pointed out that the Foundation
hopes to get sizeable contributions from outside
sources, but that others will not be interested
until the doctors themselves contribute. Con-
tributions may be directed wherever the donor
J. Florida, M.A.
July, 1957
EDITORIALS AND COMMENTARIES
83
Officers 1957-1958
Jere W. Annis, M.D., Lakeland
President-Elect
Ralph W. Jack, M.D., Miami Walter E. Murphree, M.D., Gainesville Janies T. Cook Jr., M.D., Marianna
First Vice President Second Vice President Third Vice President
Samuel M. Day, M.D., Jacksonville
Secretary-Treasurer
Shaler Richardson, M.D., Jacksonville
Editor of The Journal
84
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 1
wishes them to go, within the broad provisions
of the charter. It was recommended that each
Association member be encouraged to donate $10
or more to the Foundation, which has a wonder-
ful opportunity to render a great service.
The progress report on the Association’s first
group insurance, begun with the offering of its
Disability Insurance and Catastrophic Hospital-
ization plans, contained a plea for wider participa-
tion of the members. When 60 per cent of the
membership participates, the underwriter will no
longer have to consider each individual applica-
tion, and this coverage will be available to all
members under 70 years of age. To reach this
figure, the number of participants must be dou-
bled. All members of the Association were urged
to study the advantages of the Association plan
and avail themselves promptly of its benefits so
that these benefits may also become available
to those members who are otherwise uninsurable.
Active support of the Jenkins- Keogh legisla-
tion under consideration by the Congress was
urged. These bills, HR 9 and 10, would permit
self-employed persons to establish annuities with
deferred income tax provision. The importance
of members advising their respective Congress-
men and Senators of their wishes regarding these
bills was stressed.
The House gave its approval to a change in
name of two county medical societies in accord-
ance with the request of members in the areas
and as recommended by the Council. The Su-
wannee County Medical Society became the
Suwannee-Hamilton-Lafayette County Medical
Society, and the Walton-Okaloosa County Medi-
cal Society became the Walton-Okaloosa-Santa
Rosa County Medical Society.
The House designated the newly formed Med-
ical Schools Liaison Committee a subcommittee
of the Committee on Medical Education and Hos-
pitals. Its seven members are appointed by the
President of the Association, who is to select one
member from the medical faculty of the Univer-
sity of Miami School of Medicine and one from
the medical faculty of the College of Medicine of
the University of Florida, one member of the
Dade County Medical Association and one mem-
ber of the Alachua County Medical Society, one
member from each of the other two medical dis-
tricts of the Florida Medical Association other
than where the medical schools are located, and
one member from the Florida Medical Associa-
tion at large.
Attention was directed to the appointment
of Dr. William C. Thomas Jr., of Gainesville as
Director of the Division of Postgraduate Educa-
tion of the College of Medicine of the University
of Florida, effective July 1, 1957. Appreciation
of the unselfish and untiring efforts of Dr. Turner
Z. Cason in promoting and directing the post-
graduate work in the state for 26 years was ex-
pressed. Dr. Cason continues to head the Asso-
ciation’s Committee on Medical Postgraduate
Course, and the close cooperation between the
Association, the Florida State Board of Health,
and the College of Medicine in the presentation
of postgraduate medical education is expected to
continue.
The comprehensive and polished address of
President Francis H. Langley reviewed the accom-
plishments of his year in office and made gracious
acknowledgment of the excellent cooperation from
many quarters which had sustained his admin-
istration. Among his constructive recommenda-
tions were a sound and effective revision of the
Association’s Constitution and By-Laws and care-
ful scrutiny of the organization, procedures and
policies of The Journal to determine how it can
best serve the Association. His informative and
stimulating address, concluding with a strong plea
for union and solidarity within the profession,
is published in this issue of The Journal and is
recommended reading for every member of the
Association.
The report of Mr. Marvin I. Baker, who
represented the Florida Student Medical Asso-
ciation chapter of the College of Medicine of the
University of Florida at the 1957 convention of
the Student American Medical Association, in-
formed Association members of the problems of
medical education from the student viewpoint.
These problems included sources of information
on internships, the economic plight of married
interns, malpractice suits against interns and
residents, and the need of many medical students
for financial aid. Appreciation was expressed to
the Association for providing the opportunity for
the Florida Student Medical Association to be
represented at the national convention.
Among the innovations at this year’s meeting
was the institution of a custom that is timely.
Life Members are now to receive a Life Member-
ship Certificate. In recognition and appreciation
of 35 years’ service of active members, certificates
will be awarded annually at the convention. The
roll of Life Members was called, and certificates
J. Florida, M.A.
July, 1957
EDITORIALS AND COMMENTARIES
85
were presented to those in attendance. Those not
present were subsequently to receive their certifi-
cates by mail.
It was the consensus of the members that the
custom of having an Annual Dinner be restored.
The President’s guest speaker was Dr. Lemuel
W. Diggs of the University of Tennessee College
of Medicine, Memphis. Other eminent guests who
addressed the convention were Dr. Ernest B.
Howard, Assistant Secretary of the American
Medical Association, Chicago, Dr. J. R. Heller,
Director of the National Cancer Institute, Be-
thesda, Md., Dr. Thomas Findley of the Medical
College of Georgia, Augusta, and Lt. Col. E. G.
Rivas, MSC, Director, Liaison and Special Activi-
ties, Office to Dependents’ Medical Care, Office
of the Surgeon General, Department of the
Army, Washington, D. C.
Dr. William C. Roberts, of Panama City, ac-
ceded to the presidency, succeeding Dr. Langley,
of St. Petersburg. He will also serve as Chairman
of the Board of Governors. The choice for Presi-
dent-Elect was Dr. Jere W. Annis, of Lakeland,
who will assume the office of President at the
1958 Annual Meeting. Drs. Ralph W. Jack, of
Miami, Walter E. Murphree, of Gainesville, and
James T. Cook Jr., of Marianna, were elected
Vice Presidents. Dr. Samuel M. Day, Secretary-
Treasurer, and Dr. Shaler Richardson, Editor
of The Journal, both of Jacksonville, were re-
elected.
Of the 1,188 physicians in attendance, 988
were members of the Association and 200 were
visiting doctors. Both the physician attendance
and the total registration of 2,108 were records.
The 1958 convention will be held at the Hotel
Americana, Bal Harbour, adjacent to Miami
Beach, and the dates set by the Board of Gov-
ernors are May 10 to 14.
Board of Governors, 1957-1958. (Seated left to right) Dr. Samuel M. Day, Jacksonville; Dr. Jere W.
Annis, Lakeland; Dr. William C. Roberts, Panama City; Dr. Francis H. Langley, St. Petersburg. (Standing left
to right) Dr. Reuben B. Chrisman Jr., Miami; Dr. George S. Palmer, Tallahassee; Dr. Clyde O. Anderson, St.
Petersburg; Dr. Meredith Mallory, Orlando; Dr. John D. Milton, Miami; Dr. Edward Jelks, Jacksonville; Dr.
Eugene G. Peek Jr., Ocala, and Dr. Herbert L. Bryans, Pensacola.
86
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 1
Ophthalmologists Awarded Citations
by Florida Council for the Blind
At the last meeting of the Blind Advisory
Committee of the Florida Council for the Blind,
it was recommended that the Council issue cita-
tions to all physicians of the Panel who have
rendered services for five years or more. This
committee, composed of outstanding blind citi-
zens, evaluates and advises on policies and pro-
grams of the agency pertaining to the visually
handicapped. It proposes this gesture in appre-
ciation of the great amount of medical and sur-
gical opthalmologic work that is rendered gratui-
tously by the members of the Panel. The ophthal-
mologists comprising the Panel take care of Coun-
cil cases, performing examinations, rendering
treatment and providing operative care for the
patients.
The following ophthalmologists are listed for
such citation: Drs. William H. Anderson Jr.,
Ocala; Edson J. Andrews, Tallahassee; Alan E.
Bell, Pensacola; Bernard T. Bell, St. Petersburg;
Curtis D. Benton Jr., Fort Lauderdale; Charles
W. Boyd, Jacksonville; Henry E. Branca, Fort
Pierce; Lee E. Bransford Jr., Jacksonville; James
W. Clower Jr., Daytona Beach; Paul T. Cope,
St. Petersburg; R. Renfro Duke, Tampa; G. Tay-
loe Gwathmey, Orlando; Chas. J. Heinberg, Pen-
sacola; Marion W. Hester, Lakeland; Edward E.
Hodsdon, Coral Gables; Ned W. Holland, Tam-
pa; Hollis C. Ingram, Orlando; Garland M.
Johnson, Fort Lauderdale; Odis G. Kendrick Jr.,
Tallahassee; George W. Lawson, Miami; Eric H.
Lenholt, Daytona Beach; Albert G. Love IV7,
Gainesville; Blackburn W. Lowry, Tampa; Char-
les F. McCrory, Jacksonville; Thomas L. McKee,
Fort Lauderdale; Orville N. Nelson, St. Peters-
burg; Manasseh B. Park, Coral Gables; Hugh E.
Parsons, Tampa; Sherrel D. Patton, Sarasota;
Anthony P. Perzia, Tampa; Younger A. Staton,
West Palm Beach; Joseph W. Taylor Jr., Tampa;
Joseph W. Taylor Sr., Tampa; Laurie R. Teas-
dale, West Palm Beach; Harold E. Wager, Pana-
ma City, and Frances C. Wilson, Tampa.
The Medical Advisory Committee of the Coun-
cil will also be honored with citations. Its mem-
bers are: Drs. Shaler Richardson, chairman, Jack-
sonville; Sherman B. Forbes, Tampa; Charles C.
Grace, St. Augustine; Ralph E. Kirsch, Miami;
Carl S. McLemore, Orlando; Robert M. Oliver,
Miami; Nathan S. Rubin, Pensacola; William Y.
Sayad, West Palm Beach; Francis C. Skilling,
Miami, and Kenneth S. Whitmer, Miami.
Postgraduate Obstetric-Pediatric Seminar
The Postgraduate Obstetric-Pediatric Seminar,
will be held again at the Daytona Plaza Hotel in
Daytona Beach on September 9, 10 and 1 1, 1957.
This is the seventh consecutive year for this semi-
nar, which now has become one of the most popu-
lar meetings of its type in the southeastern Unit-
ed States. The former name, Tri-State Obstetric-
Pediatric Seminar, has been changed because a
fourth state, Alabama, has become associated with
the group.
As in the past the program will consist of
formal presentations on obstetric and pediatric
subjects of current interest by some of the na-
tion’s leading medical figures. In addition, there
will be the usual panel type discussion of ques-
tions submitted by the audience to a panel of ex-
perts. This is a particularly valuable meeting for
pediatricians, obstetricians, gynecologists and
those in general practice.
The meeting is jointly sponsored by the Bu-
reaus of Maternal and Child Health of the State
Health Departments of Florida, Georgia, South
Carolina and Alabama, and the Maternal Wel-
fare Committees of the four State Medical Asso-
ciations. It is approved by the Academy of Gen-
eral Practice in Category II.
Florida Medical Association Golf
Tournament
The annual Florida Medical Association Golf
Tournament held at the Hollywood Beach Hotel
course during the Eighty-Third Annual Conven-
tion was entered by 58 physicians, according to
Dr. Curtis D. Benton Jr., of Fort Lauderdale,
chairman of the Golf Committee.
Dr. Benton announced the names of the win-
ners and awarded prizes at the Patio Party, Tues-
day evening, May 7.
Dr. Edson J. Andrews, of Tallahassee, with
an even par 70, was awarded the Duval County
Medical Society Trophy for low gross. The other
winners on gross scores were: 2nd, Dr. Julian A.
Rickies, Miami; 3rd, Dr. Maxwell M. Sayet,
Miami Beach ; 4th, Dr. Walter F. Davey, Stuart;
5th, Dr. Joseph L. Hundley, Orlando; 6th, Drs.
William M. C. Wilhoit, Pensacola, J. Raymond
Graves, Miami, and David W. Martin, West
Palm Beach.
Dr. Paul J. McCloskey, of Tampa, won the
Orlando Loving Cup for low net. The other win-
J. Florida, M.A.
July, 1957
EDITORIALS AND COMMENTARIES
87
ners on low net scores were: 2nd, Dr. Curtis D.
Benton Jr., Fort Lauderdale; 3rd, Dr. Joseph
J. Ruskin, Tampa; 4th, Dr. Lloyd U. Lumpkin,
Fort Lauderdale; 5th, Drs. Walter R. Newbern,
West Palm Beach, and George H. Massey, Quincy.
In the tournament for members of the Wom-
an’s Auxiliary held concurrently under chairman-
ship of Mrs. Paul W. Hughes, of Fort Lauderdale,
Mrs. Edson J. Andrews, of Tallahassee, won the
Orange County Trophy for low gross score. Mrs.
Robert C. Piper, of Coral Gables, was second.
Winner for low net score was Mrs. Walter J.
Newbern, of West Palm Beach, with Mrs. David
W. Martin, also of West Palm Beach, second.
Engraved trophies were presented to the low
gross and low net winners, men and women, in
addition to the permanent trophies which are
retained one year. Two dozen golf balls for prizes
were presented by Eaton Laboratories and two
dozen by Pfizer Laboratories. In addition, a
stethoscope was presented by the Surgical Equip-
ment Co. of Miami. Additional prizes were in
the form of golfing merchandise, balls and shirts.
Ford Foundation 1956 Report
The Ford Foundation committed $602,000,000
in new grants and appropriations to its various
philanthropic interests during the last fiscal year,
according to its recently issued 1956 Annual Re-
port. The year 1956 was a significant milestone
in the development of the Foundation for in that
period this great philanthropic organization more
than doubled the dollar total of grants and ap-
propriations undertaken in all its preceding his-
tory. It increased 10 times over the number of
grantees which have received support.
In 1950, when the outline of its current pro-
gram was determined, grantees of the Foundation
were located in 28 communities of 16 states, and
in one foreign country. By October 1956, there
were Foundation grantees in some 2,500 com-
munities in all 48 states and three territories, as
well as in 54 foreign countries. Funds committed
by the Foundation for all purposes since its
establishment in 1936 totaled nearly $970,000,000
at the end of the 1956 fiscal year.
In the evolution and expansion of the Foun-
dation’s program, medical education has fared
well. Particularly in 1956, the Foundation faced
the question of what effective role it could essay
in this field of education which most concerns
the physical well-being of the nation but which
has proved over a period of many years to be the
most expensive.
“For the university administrator,” the An-
nual Report stated, “the medical school is not
only his costliest problem — on the average it
costs about four times as much to train a medical
student as a liberal arts student — but quite often
his toughest and touchiest. There are many rea-
sons for this. The medical school’s faculty is
large and its student body small. The courses are
long and the facilities and equipment expensive.
There is a constant problem in keeping teachers
from the lucrative attractions of private practice.
“To help prevent the impairment of the na-
tion's progress in medical science and to help meet
the ever-expanding requirements of the schools
upon which the people of the United States de-
pend so heavily for their health services, the
Foundation this year undertook two specific ac-
tions.”
The first action was to appropriate
$90,000,000 to be used as endowment grants to
help strengthen instruction in the nation’s 44
privately supported medical schools. As an ini-
tial disbursement under this appropriation, the
Foundation made grants totaling $22,000,000 to
these schools at the rate of $500,000 to each. For
a period of 10 years the grants are to be held as
invested endowment, with only the income to be
expended for instructional purposes. Construction
and research needs are specifically excluded from
purposes of the grants. After the 10 year period
has elapsed, the medical schools will be free to
use the principal sum. as well as endowment in-
come, for any academic purpose.
Entirely apart from the $90,000,000 endow-
ment program is the $10,000,000 for a program
of grants to assist the National Fund for Medi-
cal Education. Physicians are familiar with the
National Fund, which was established in 1949 to
campaign for funds, principally among corpora-
tions, to support medical education. These funds
are given for current operating expenses and are
distributed to each of the 81 accredited medical
schools of the United States, public and private.
Under the Foundation’s appropriation, grants will
be paid on a matching scale over a period of
five to 10 years, the duration of the program
depending upon the rate at which the National
Fund develops additional support. The sliding
formula of these grants is intended to give par-
ticular encouragement in the early y6ars of the
88
OTHERS ARE SAYING
Volume XLIV
Number 1
plan to increasing the contributions of existing
donors and to attracting new donors.
Of the Foundation’s several programs, H.
Rowan Gaither Jr., retiring president and now
chairman of the Board of Trustees of the Founda-
tion, said in his concluding review: “Education
emerges as the major strand that ties together
the purposes of almost our entire activity. ... In
the final analysis only the education of man — the
acquisition of new knowledge, dissemination of
accumulated knowledge and application of all
knowledge — will remove man’s own obstacles to
social progress. Foundation philanthropy serves
this end best when it serves as a radar detector,
helping men and institutions to reach beyond
man’s sight and touch to detect the obstacles in
his path.”
OTHERS ARE SAYING
Courtesy
In these turbulent times of rapidly changing
situations at home and abroad we are prone to
allow the press of activity to cause us to overlook
or forget the importance of a simple word com-
posed of eight letters — Courtesy. Courtesy is in
reality a habit. It is something which is in one
way or another bred into us by our parents and
teachers in the formative years of our childhood
and youth, and is a quality essential for success in
later years. It is a pattern which cannot be ac-
quired overnight, for no good habit can be de-
veloped within the matter of a few hours. It must
be exercised over and over, day after day, in order
to become a natural, spontaneous, genuine attri-
bute so necessary for success in dealing with other
people. If we pause to consider the Golden Rule.
“Do unto others as ye would they should do unto
you,” the need for courtesy is obvious. All of us
would prefer to be treated in a courteous manner
by others, and in turn it stands to reason that
others would prefer that we be courteous to them.
In the esteemed profession of Medicine noth-
ing is more important than the exhibition of cour-
tesy towards our patients and all those with whom
we come into contact. We are not judged by our
knowledge of medicine alone. Conversely, there
is much to indicate that the laity not only expects
but demands far more from the physician than a
simple prescription for medication. Patients fre-
quently want someone in which to confide their
troubles. Others may require sympathy. Some
have developed a morbid and overwhelming fear
of disease, be it imaginary or real, and need reas-
surance. Each patient feels that his individual
problem is the most important thing in the world,
and justly so. He would not consult the doctor
if his problem were not important to him. He not
infrequently comes to the office with the feeling
that only the doctor can help him, so it behooves
the physician to utilize every facility at his com-
mand to justify the faith of his patient.
If the doctor is courteous enough to listen
attentively to the story of the patient, he has
made the first and probably most important step
in gaining the confidence of that person. There
are times when the patient’s story will seem total-
ly unrelated to disease, but if the physician lis-
tens closely and appears genuinely interested, the
patient will feel at ease and it will be much easier
to establish proper rapport with him. Some have
had the unpleasant experience of hearing a pa-
tient say, “Doctor John Doe may be a good
doctor, but he tries to rush too much and won’t
listen to me. His main thought seems to be to
get me out of his office as soon as he can, and I
am never going to him again.” This connotes an
unhappy situation for it means that Dr. Doe
either was too busy or forgot to be courteous, con-
sequently losing a patient, plus the fact that the
patient will ultimately transfer some of his resent-
ment of the particular physician in question to
the medical profession as a whole, either con-
sciously or subconsciously. A prominent and
well-respected pediatrician practicing in Chicago
once made the statement, “I don’t want to be
known as the busiest doctor in town. I would
much rather be known as the best doctor in town.”
He qualified these words by explaining that a
satisfied patient usually feels that his doctor is
“the best doctor in town.” He further propounded
that in order to have a practice composed of satis-
fied patients a physican must be courteous, pa-
tient, and spend sufficient time with them. Cour-
tesy is one of the most solid stepping stones in
our quest for good public relations, and its im-
portance must be kept in the forefront at all
times.
It has become apparent in recent years that
increasing stress is being placed upon courtesy in
public relations. Many large organizations have
signs saying, “Courtesy is Contagious” displayed
at conspicuous places for the benefit of their em-
ployees and clientele. There is great truth in this
slogan, for it is difficult for the majority of peo-
ple to remain intractable in the face of an ap-
proach whose structure is sagely based upon un-
J. Florida. M.A.
July, 1957
89
BROAD ANTICHOLINERGIC BLOCKADE
Pro-Banthlne' Relieves Pain,
Accelerates Peptic Ulcer Healing
The efficiency of Pro-Banthlne (brand of
propantheline bromide) in inhibiting the
chemical substance which mediates para-
sympathetic gastric activity explains the
success of the drug in ulcer therapy. Pro-
Banthlne blocks acetylcholine at both the
ganglia and parasympathetic effector
sites. This dual action controls excess
neural stimulation of both gastric secre-
tion and motility.
The therapeutic benefits of this anti-
cholinergic blockade consist, as many
clinical investigators have noted, in
prompt relief of ulcer pain and pro-
nounced acceleration of ulcer healing.
The suggested initial dosage is one 1 5-
mg. tablet with meals and two tablets at
bedtime. Two or more tablets four times
a day may be indicated in severe manifes-
tations. G. D. Searle & Co., Chicago 80,
Illinois. Research in the Service of
Medicine.
90
Volume XLIV
Number 1
faltering courtesy. It often acts as a balm which
may be spread to sooth even the most ruffled
feelings.
These same principles are also applicable to
the receptionist, nurse, aide, or technician in the
office of the doctor. All employees should be
repeatedly impressed with the urgency for the use
of courtesy in dealing with the public This is
particularly true of the person assigned to an-
swer the office phone. The patient calling in for
an appointment or to talk to the doctor is fre-
quently very worried or upset, and may be dif-
ficult to manage. It is here that a little courtesy,
a kind word or two, and a little patience on the
part of the person taking the call will so often pay
great dividends in the form of satisfactory doctor-
patient relationships. The attitude of the office
staff frequently has much to do with the success
of the treatment. Hippocrates, the acknowledged
“Father of Medicine,” said in his Oath, “I will
prescribe regimen for the good of my patients ac-
cording to my ability and my judgment and never
do harm to anyone.” All physicians are sworn
to uphold the principles of this great vow, and
the place of courtesy in this regimen must be
recognized. Great harm can be done by failing to
do so. After all, a satisfied patient is the phy-
sician’s best and only means of advertisement.
R. C. P.
Monthly Bulletin
Duval County Medical Society
November 1956
Proceedings
Eighty-Third Annual Meeting
Florida Medical Association
The complete proceedings of the Eighty-Third
Annual Meeting of the Florida Medical Associa-
tion are published in this issue of The Journal.
The scientific papers delivered during the meeting
are scheduled to be published in subsequent issues.
PHYSICIANS AND PSYCHIATRISTS
FOR
CALIFORNIA
State Hospitals, correctional facilities and veterans
home. No written examination. Interview only . . .
Three salary groups:
$10,860 to $12,000
$11,400 to $12,600
$12,600 to $13,800
Salary increases being considered effective July 1957
U.S. citizenship and possession of, or eligibility for
California license required.
Write:
Medical Recruitment Unit, Box A, State Personnel
Board, 801 Capitol Ave., Sacramento, California
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Ahmann, Helen M., Deerfield Beach
Bailey, Jesse K., Miami
Blumenfeld, Irving H., Miami
Broadaway, Rufus, Miami
Caster, Milton P., Hollywood
Chenault, John W. (Col.), Bradenton
Chew, William, Orlando
Costanza, Louis C., Jacksonville
Crumbley, James J. Jr., Tampa
Cunningham. George A. Ill, West Palm Beach
Daurelle, George P., Miami
Douglas, Robert A., Homestead
Foertsch, Frederick E. Jr., Winter Park
Foster, L. Paul, Orlando
Fuerst, Howard J., Hollywood
Gastring, Joseph B., Valparaiso
Getz, Alvin M., North Miami Beach
Goodman, Julian J., West Palm Beach
Gowin, Thomas S., South Miami
Grosz, Eugene, Coral Gables
Harris, Robert D. Jr., St. Augustine
Koval, John M., South Miami
Lancaster, James W., Coral Gables
Lauth, Edward J. Jr., North Miami
McConnell, Bright Jr., Orlando
Maxwell, William, Miami Beach
Melvin, Hiram M., Milton
Millard. David R. Jr., Miami
Morris, Douglas C., Miami
Mullen, Sanford A., Jacksonville
Nelson. Harry C. Jr., Miami
Nesbitt, James III, Miami
Nogueiras. Humberto M., Miami
Ortega, Gimel, Miami
Page, William G., Orlando
Pearl, Morton, Miami Beach
Reiff, Max H., Hialeah
Sheehy, Paul L., Tampa
Simonson. Melvin. Coral Gables
Steinmetz, Rodney D.. Tampa
Tate, Charles F. Jr., Miami
Terragni, Manlio. Miami
Thompson, William W., Fort Walton Beach
Valentine, E. Henry Jr., Miami
Vanden Bosch, Jay H., Coral Gables
Wright, Henry L. Jr., Tampa
Zaydon. Thomas J., Coconut Grove
J. Florida, M.A.
July, 1957
91
Current Practices in Dietary Management of
Infant Allergies
Infants are not born hypersensitive but may develop
hypersensitivity to foodstuffs shortly after birth.
The earliest sensitizations are likely to be to milk,
wheat, eggs and orange juice, with which contact is
established early in life. Heredity is usually a domi-
nant factor in the tendency of infants to develop
allergy. Infants with a family history of both pater-
nal and maternal allergy tend to develop clinical
symptoms earlier than those with unilateral inherit-
ance. Both the allergen and the symptom in the
infant may be different from those of the father or
mother.
Allergic disorders of infants include gastrointestinal
disturbances, infantile eczema, urticaria and asthma.
Gastrointestinal allergy may be manifested by
vomiting, colicky abdominal pain and diarrhea.
Allergic dermatitis may be evidenced by wheal-like
cutaneous reactions which may develop into exuda-
tive lesions over the scalp, face and body. A systemic
food hypersensitivity may produce an asthmatic
response manifested by dyspnea and wheezing,
although infection is usually associated with this
type of response.
Common treatments include avoidance of the
allergen, desensitization, antihistaminics and, in the
presence of infection, antibiotics. Infants sensitive
to the proteins of cow’s milk whey may be fed
human, goat or mare’s milk reinforced with KARO®
Syrup. Casein-sensitive infants may be offered soy-
bean milk or amino acid mixtures reinforced with
KARO Syrup.
The same problems of infant feeding recur from
generation to generation, but solutions may differ
with each era. The carbohydrate requirement for
all infants is as completely fulfilled by KARO Syrup
today as a generation ago. Whatever the type of
milk adapted to the individual infant, KARO Syrup
may be added confidently because it is a balanced
mixture of low molecular weight sugars, readily
miscible, well tolerated, palliative, hypo-allergenic,
resistant to fermentation in the intestine, easily
digestible, readily absorbed and non-laxative.
KARO is readily available in all food stores.
MEDICAL DIVISION
CORN PRODUCTS REFINING CO.
17 Battery Place, New York 4, N. Y.
92
Volume XLIV
Number 1
STATE NEWS ITEMS
The annual meeting of the Southeastern Al-
lergy Association will be held November 1-2 in
the Fort Sumter Hotel at Charleston, S. C., ac-
cording to announcement by Dr. Clarence Bern-
stein, of Orlando, President. Reservations for
the meeting should be made early with Dr. Kath-
arine B. Maclnnis, Secretary-Treasurer, 818 Al-
bion Road, Columbia, S. C.
Dr. C. Ashley Bird of Jacksonville has re-
turned from St. Louis, Mo., where he was certified
a diplomat by the American Board of Neurologi-
cal Surgeons.
Dr. Ralph W. Jack of Miami was elected
president of the Continental Gynecologic Society
during the recent meeting held at Havana, Cuba,
and in Miami.
Dr. J. M. Ingram Jr. of Tampa was one of
the principal speakers on the program presented
at Havana. The title of his address was “Vaginal
Hysterectomy After Pelvic Surgery.”
Dr. James H. Ferguson of Miami, Professor
of Obstetrics and Gynecology at the University
of Miami School of Medicine, arranged and
presided at the program presented for the Society
at Miami in Jackson Memorial Hospital.
Dr. Jack acted as host and chairman of the
committee on local arrangements for the combined
meeting. Vancouver, British Columbia was se-
lected as the place for the next meeting.
Dr. Alvyn W. White of Pensacola has been
elected president of the recently organized Es-
cambia Pediatric Society. Serving with Dr. White
will be Dr. Joseph L. Rubel as vice president and
Dr. Reed Bell as secretary-treasurer. Regular
meetings are to be held every Tuesday which is
the fifth Tuesday in the month.
Dr. Meyer B. Marks of Miami Beach has been
certified in pediatric allergy by the Amercan
Board of Pediatrics.
Dr. I. Leo Fishbein of Miami Beach has re-
turned from Chicago where he attended a meeting
of the American Psychiatric Association.
The Second Annual Alpha Kappa Kappa Lec-
tureship sponsored by the Beta Chi Chapter at
the University of Miami School of Medicine was
presented to the students, faculty and staff at
the Jackson Memorial Hospital the middle of
May.
The lecture this year was entitled “Some
Practical Aspects of Nutrition” and was presented
by Dr. Garfield G. Duncan of Philadelphia. Dr.
Duncan is Clinical Professor of Medicine at Jef-
ferson Medical College and is head of the De-
partment of Nutrition and Metabolism at the
Pennsylvania Hospital in Philadelphia.
A Postgraduate Course in Pediatric Allergy
has been announced by the Division of Graduate
Studies, Department of Graduate Pediatrics, of
the New York Medical College. The course will
be held from November 6, 1957 to May 28, 1958
under the direction of Dr. Bret Ratner, Professor
of Clinical Pediatrics and Associate Professor of
Immunology. The fee is $300. Applicants for the
course must be certified in pediatrics or have the
requirements for certification. A limited number
of allergists practicing with adults may also apply.
Information may be obtained from: Office of the
Dean, New York Medical College, Fifth Avenue
at 106th Street, New York 29.
(State News Items are continued on page 94)
PERSPIRATION PROOF
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• Insole extension and wedge at inner corner of
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• The patented arch support construction is guaran-
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• Foot-so-Port lasts designed and the shoe construc-
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• We make more shoes for polio, club feet and dis-
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Write for free booklet on Foot-so-Port Shoes or
contact your local FOOT-SO-PORT Shoe Agency.
Refer to your Classified Telephone Directory.
Foot-so-Port Shoe Company, Oconomowot, Wis.
A Division of Musebeck Shoe Company
V J
J. Florida, M.A.
July, 1957
93
24-hour control
for the majority of diabetics
a clear solution
easy to measure accurately
Discovered by Reiner, Searle, and Lang
in The Wellcome Research Laboratories
BURROUGHS WELLCOME & CO. (U.S.A.) INC.
Tuckahoe 7, New York
94
Volume XT.IV
Number 1
( Continued jrom page 92 )
Drs. Alvan G. Foraker, Wilbur C. Sumner
and Sam W. Denham of Jacksonville have received
a grant of $5,708 from the National Cancer In-
stitute to be used to equip and furnish a special
research laboratory for cancer and other research.
Dr. Louis J. Polskin of Lakeland addressed
the Subsection of the American Chemical Society
meeting at the Lake Alfred Citrus Experiment
Station the middle of May on the biochemistry of
the “Mental Molecules.” Later, Dr. Polskin spoke
to the science classes of Kathleen High School
on the subject “Science as a Career.”
The American College of Gastroenterology an-
nounces that its annual course in postgraduate
gastroenterology will be given at The Somerset
in Boston, Mass., October 24-26.
The course will again be under the direction
and chairmanship of Dr. Owen H. Wangensteen,
Professor of Surgery, University of Minnesota
Medical School, and Dr. I. Snapper, Director of
Medical Education, Beth-El Hospital, Brooklyn.
For information and enrolment write to the
American College of Gastroenterology, 33 West
60th St., New York 23.
Dr. J. Ernest Ayre of Miami has been elected
president of the Pan American Cancer Cytology
Society which was formed during the First Pan
American ( ancer Cytology Congress held at Mi-
ami.
The Seventh Congress of the Pan-Pacific
Surgical Association is scheduled for November
14-22 at Honolulu, Hawaii. Information on the
Congress may be obtained from Dr. F. J. Pinker-
ton, Director General, Pan-Pacific Surgical As-
sociation, Room 230. Young Building, Honolulu.
Dr. Sherman B. Forbes of Tampa attended
the Interim Congress of the Pan-American Associ-
ation of Ophthalmology and the 1957 Conference
of the National Society for the Prevention of
Blindness held April 7-10 in the Hotel Statler,
New York City.
Dr. Frederick K. Herpel of West Palm Beach,
a past president of the Florida Medical Associa-
tion, left for California the last of May and plans
to be away for about two months. His itinerary
includes numerous clinics and hospitals.
The Ritter Examining and
Treatment Table enables
the physician to treat more
patients, more thoroughly
with less effort in less time
urotca
SUPPLY COMPANY
1050 W. Adams St.
I. B. SLADE, JR.
P. O. Box 2580
Jacksonville, Fla.
J. BEATTY WILLIAMS
Now... control both
the G.l. disorder
and
its
“emotional
overlay"
94
Volume XLIV
Numbek 1
(Continued, from page 92)
Alva | G. iForaker. Wjibur C.
_ p08 |oVye I.Joifi'
stitute to be used to equip and furnish a special
TeseaaTH!Xi>ratory for cancer and other research.
Dr. J. Ernest Ayre of Miami has been elected
Cancer Cytology
g the First Pan
ress held at Mi-
eland Aure.v
1 1 J 1 1 l: J I l'Iiemica| Soci
•til^^it flie red ^ffrus ftxflcrflnn
Station the middle of May on the biochemistry of
the “Mental Molecules.” Later, Dr. Polskin s|*ike
to the science classes of Kathleen High School
IcCfcject “Science as a Career.
The Sevejijh [Congress of the Pan-Pacific
irgifcj IT?iit7ln is scheduled for November
4-22^^Hln<|iilJ Hawaii Information on the
Congress may be obtained from Dr. F. J. Pinker-
ton. Director General. Pan-Pacific Surgical As-
sociation. Ro.un 2.50. Young Building. Honolulu.
gast*(
3tl
The American College of Gastroenterology an-
nounces that its annual course in postgraduate
gastroenterology will be given at The Somerset
l^oston, Mass., October 24-26.
he course will again be under the direction
fftd Chairmanship of Dr. Owen H. Wangensteen,
Professor of Surgery. University of Minnesota
Medical School, and Dr. I. Snapper, Director of
Medical Edw 1 Beth-El Hospital. Br o^vn.
>f10IT0m9
60th St., New York 23.
Dr. Sherman B. Forbes of Tampa attended
the Interim Congress of the Pan-American Associ-
ation of Ophthalmology and the 1957 Conference
of the National Society for the Prevention of
Blindness held April 7-10 in the Hotel Statler.
New York City.
Dr. Frederick K. Herpel of West Palm Beach,
a past president of the Florida Medical Associa-
tion. left for California the last of May and plans
to be away for about two months. His itinerary
includes numerous clinics and hospitals.
ie Ritter Examining and
Treatment Table enables
the physician to treat more
patients, more thoroughly
with less effort in less time
ASTA
urcnca
SUPPLY COMPANY
P. O. Box 2580
1050 W. Adams St.
T. B. SLADE, JR.
Jacksonville, Fla.
J. BEATTY WILLIAMS
is
. * I ... ..
I
SBi
PATH I BAM ATE
Meprobamate with Pathilon® LEDERLE
w gastrointestinal trad disorders and their emotional overlay
yy
• TRADE HA All % RKeilTCREO VRAOCMARK FOR TRIOINIIKTNVL IODIC! If Pf Alt
PATHIE
combines Meprobamate (400 mg.):
Widely prescribed tranquilizer-muscle relaxant. Effectiveness
in anxiety and tension states clinically demonstrated in millions of patients.
Meprobamate acts only on the central nervous system. Does not increase
gastric acid secretion. It has no known contraindications, can be used
over long periods of time.1-2'3
with Path i Ion (25 mg.y.
An anticholinergic noted for its extremely low toxicity and high
effectiveness in the treatment of G.I. tract disorders. In a comparative
evaluation of currently employed anticholinergic drugs,
Pathilon ranked high in clinical results, with few side effects,
minimal complications, and few recurrences.4
Now. . . with PATH I BAM ATE . . .you can control disorders of the
digestive tract and the “ emotional overlay'' so often associated with
their origin and perpetuation . . . without fear of barbiturate
loginess , hangover or addiction. A mong the conditions which have
shown dramatic response to PATH I BA MATE therapy:
DUODENAL ULCER • GASTRIC ULCER • INTESTINAL COLIC
SPASTIC AND IRRITABLE COLON • ILEITIS • ESOPHAGEAL SPASM
ANXIETY NEUROSIS WITH G.I. SYMPTOMS • GASTRIC HYPERMOTILITY
j fereilCeS'. 1. Borrus, J. C. : M. Clin. North America,
I )ress, 1957. 2. Gillette, H. E.: Internal. Rec. Med. & G. R
Ci. 169.453, 1956. 3. Pennington, V. M.: J.A.M.A.,
I >ress, 1957. 4. Cayer, D.: Prolonged Anticholinergic
1 -rapy of Duodenal Ulcer. Am. J. Dig. Dis. 1 : 301-309
( y) 1956. 5. McGlone, F. B.: Personal Communication to
Llerle Laboratories. 6. Texter, E. C., Jr.: Personal
C nmunication to Lederle Laboratories. 7. Bauer, H. G.
a McGavack, T. H.: Personal Communication
l( .ederle Laboratories.
i pplied: Bottles of 100 and 1000
/ ' ministration and Dosage: l tablet three times a day
anealtimes and 2 tablets at bedtime. Full
ii >rmation on PATHIBAMATE available on request,
c ;ee your local Lederle representative.
Comments on PATHIBAMATE from clinical investigators
I find it easy to keep patients using the drug
continuously and faithfully. I feel sure this is due
to the desirable effect of the tranquilizing drug.”5
• “The results in several people who were pre-
viously on belladonna-phenobarbital prepara-
tions are particularly interesting. Several people
volunteered that they felt a great deal better on
the present medication and noted less of the
loginess associated with barbiturate administra-
tion.’’6
• PATH 1 BAM ATE .. .“will favorably influence a
majority of subjects suffering from various forms
of gastrointestinal neurosis in which spasmodic
manifestations and nervous tension are major
clinical symptoms.”7
• “In the patients with functional disturbances of
the colon with a high emotional overlay, this has
been to date a most effective drug.”i * * * 5
^ c2 a/- .
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
98
Volume XLIV
Number 1
COMPONENT SOCIETY NOTES
Brevard
Dr. Samuel S. Wright, of Melbourne, and Dr.
Lewis A. Bean, of Cocoa, were principal speakers
at the May meeting of the Brevard County Medi-
cal Society held at the Rockledge Medical Center.
Dr. Wright discussed the role of antibiotics in
the treatment of pulmonary infections, and Dr.
Bean’s address was on certain physiological prob-
lems of pulmonary disease.
Collier
The Collier County Medical Society has paid
100 per cent of its state dues for 1957.
Columbia
The Columbia County Medical Society has
paid 100 per cent of its state dues for 1957.
Duval
A showing of the film “The Medical Witness”
and a discussion of the film by Judge Claude
Ogilvie, of Jacksonville, were features of the
June meeting of the Duval County Medical
Society. Members of the Jacksonville Bar Associa-
tion were invited guests.
Franklin-Gulf
1'he Franklin-Gulf County Medical Society
has paid 100 per cent of its state dues for 1957.
Hillsborough
Dr. Zack Russ Jr., of Tampa, was principal
speaker for the June meeting of the Hillsborough
County Medical Association. Dr. Russ discussed
“Current Trends in Electroshock Therapy.”
Lake
Dr. John Riepenhoft, of the Ohio State Uni-
versity College of Medicine at Columbus, ad-
dressed the members of the Lake County Medi-
cal Society at their May meeting. His subject
was convulsions as related to the practice of
pediatrics.
Manatee
The Manatee County Medical Society has
paid 100 per cent of its state dues for 1957.
Monroe
The Monroe County Medical Society has naid
100 per cent of its state dues for 1957.
Nassau
The Nassau County Medical Society has
paid 100 per cent of its state dues for 1957
( Continued on page 100 )
lOouJ
“PREMARINI’c MEPROBAMATE
Conjugated Estrogens (equine) with Meprobamate
It was inevitable that these two therapeutic agents— the
leading natural oral estrogen and the foremost, clinically
proven tranquilizer— should be combined for control of
the menopausal syndrome when unusual emotional stress
complicates the picture.
Ayerst Laboratories • New York, N. Y. • Montreal, Canada
5756
99
J. Florida, M.A.
July, 1957
Rauwiloid
A Better Antihypertensive
. . . because among all Rauwolfia preparations Rauwiloid
(alseroxylon) is maximally effective and maximally safe
. . . because least dosage adjustment is necessary . . .
because the incidence of depression is less , . . because
up to 80% of patients with mild labile hypertension and
many with more severe forms respond to Rauwiloid alone.
A Better Tranquilizer, too
. . . because Rauwiloid’s nonsoporific sedative action
relieves anxiety in a long list of unrelated diseases
not necessarily associated with hypertension . . . with-
out masking of symptoms . . . without impairing in-
tellectual or psychomotor efficiency.
Dosage: Simply two 2 mg. tablets at bedtime.
After full effect one tablet suffices.
Best first step when more potent drugs are needed
Rauwiloid is recognized as basal
medication in all grades and types
of hypertension. In combination with
more potent agents it proves syner-
gistic or potentiating, making smaller
dosage effective and freer from side
actions.
Rauwiloid +Veriloid®
In moderate to severe hypertension
this single-tablet combination per-
mits long-term therapy with depend-
ably stable response. Each tabletcon-
tainsl mg. Rauwiloid and 3 mg.Veri-
loid. Initial dose, 1 tablet t.i.d., p.c.
Rauwiloid +
Hexamethonium
In severe, otherwise intractable hy-
pertension this single-tablet com-
bination provides smoother, less
erratic response to hexamethonium.
Each tablet contains 1 mg. Rauwi-
loid and 250 mg. hexamethonium
chloride dihydrate. Initial dose, Yi
tablet q.i.d.
Riker
LOS ANGELES
100
Volume XLIV
Number 1
EVERY WOMAN
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
"premarin:
widely used
natural, oral
estrogen
( Continued from page 98 )
Pinellas
Dr. Walter H. Bailey, of St. Petersburg, dis-
cussed “Use and Misuse of Tranquilizers” at the
June meeting of the Pinellas County Medical
Society held at the Fort Harrison Hotel in Clear-
water.
Suwannee-Hamilton-Lafayette
The Suwannee-Hamilton-Lafayette County
Medical Society has paid 100 per cent of its state
dues for 1957.
St. Johns
The St. Johns County Medical Society has
paid 100 per cent of its state dues for 1957.
Washington-Holmes
The Washington-Holmes County Medical
Society has paid 100 per cent of its state dues for
1957.
Medical Officers Returned
Dr. Charles A. Schwarz, who entered military
service on July 1, 1954, was released from active
duty on Aug. 5, 1956, with the rank of major,
U. S. Army. His address is 1005 96th Street,
Miami Beach.
Dr. Russell V. Douglas, who entered military
service on May 8, 1955, was released from active
duty on May 7, 1957, with the rank of major,
U. S. Army. His address is 1500 Kuhl Avenue,
Orlando.
BIRTHS AND DEATHS
Births
Dr. and Mrs. Edward S. Lundell of Jacksonville an-
nounce the birth of twin sons, Ronald and Donald, on
April 19, 1957.
AYF.RST LABORATORIES
New York, N. Y. • Montreal, Canada
5645
Deaths — Member
Smith, James Alonzo, Sanford February’ 19, 1957
Trousdale, Theodore M., Sarasota April 16,1957
Deaths — Other Doctors
Young, Robert U., Tampa April 11, 1957
Blum, Leo J. Jr., Warner Robins, Ga Dec. 8, 1957
Fox, John W., St. Petersburg Feb. 7, 1957
McClure, Herbert A., Vernon, Ala March 21, 1957
Martin, Orel F., Coral Gables January’ 7, 1957
Sparks, Proctor, St. Petersburg January 16, 1957
Thompson, John James,
St. Petersburg January 2, 1957
Twomey, George Watson,
Fort Myers November 25, 1956
T. Florida, M.A.
July, 1957
101
FROM START TO FINISH
You can be assured that your guild optician uses only
the finest materials to compliment precision workmanship.
For the guild optician knows that skilled
craftsmanship must be combined with superior
materials. The result is the ultimate in precision eye wear.
Guild of Prescription Opticians of Florida
102
Volume XLIV
Number 1
Just Published!
A New Quick-Reference Text
Gius’
Fundamentals of
General Surgery
Ideal for all doctors of medicine who
feel the need for re-establishment of
background in surgical fundamentals
Stressing the pathophysiologic mechanisms of surgical
diseases, Dr. Gius describes in brief, easy-reading style
the essential facts and factors— short of actual operative
technic— surrounding the management (both diagnostic
and therapeutic) of the surgical patient.
Nor is this book confined only to the problems of
major surgery. Specific and useful guidance is also in-
cluded for application to conditions which frequently are
treated in the office of both the general practitioner and
the surgeon.
More than 20 years of surgical experience have gone
into the writing of this book ... private and university
hospital practice, extensive teaching at both undergradu-
ate and postgraduate levels, military practice, and clinical
research. Every one of the 31 chapters reflects this broad
background and the resulting capacity to separate the
wheat from the chaff.
Well illustrated, expertly written, thoroughly up-to-
date, this new book will indeed prove a boon to physi-
cians seeking refresher material. Professors of surgery
will quickly discover it to be the ideal text for instruct-
ing students in the basic elements of general surgery.
By JOHN ARMES GIUS, M.D., Professor of Surgery, College
of Medicine, State Lniversity of Iowa. 720 pages; 275
illustrations on 151 figures. $12.50
THE YEAR BOOK PUBLISHERS, INC.
200 East Illinois St., Chicago 11, Illinois
YearBook
PUBLISHERS
Please send the following for 10 days' examination. 1-7-7
n Gius’ Fundamental of General Surgery $12.50
Name Street...
City , Zone.... State
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
qualifications in writing. The Miami-Battle Creek,
Miami Springs, Fla.
INTERNIST WANTED: Established certified in-
ternist desires associate. Florida license, certified or
board eligible. Give full background in first letter.
Write 69-224, P. O. Box 2411, Jacksonville, Fla.
OBSTETRICIAN-GYNECOLOGIST: Completing
residency July 1957. Florida license. Family. Age
30. Category IV. Desires group practice or associa-
tion. Write 69-225, P. O. Box 2411, Jacksonville, Fla.
WANT TO BUY: Used binocular microscope suit-
able for medical student. Write 69-227, P. O. Box
2411, Jacksonville, Fla.
LOCUM TENENS: July 1, 1957 to January 1,
1958. General Practitioner to associate with same.
Suburban Jacksonville. To future association as
agreed. Write 69-229, P.O. Box 2411, Jacksonville,
Fla.
POSITION WANTED: British physician (Hun-
garian born). Permanent resident USA first papers,
1954. Wishes position in Florida pending admission
State Board. Experienced in medicine, surgery, gyne-
cology, research, medical journalism and languages.
Write P. O. Box 591, Miami, Fla.
WANTED: Specialist in Obstetrics and Gynecol-
ogy with Florida license to associate with group in
Dade-Broward area. Board man preferred. Write
age, training, chronology of medical experience, refer-
ences. Write 69-230, P. 0. Box 2411, Jacksonville,
Fla.
WANTED: Pediatrician or General Practitioner^
with special training in pediatrics to associate with
group in Dade-Broward area. Florida license neces-
sary. Write age, training, chronology of medical
experience, references. Write 69-231, P. O. Box 2411,
Jacksonville, Fla.
WANTED: General Practitioner to take over
practice in well-populated community 25 miles north
of Tampa. Hospital located nine miles away; open
staff. One other physician in community. Office
space under existing lease available August 1. Write
69-232, P. O. Box 2411, Jacksonville, Fla.
OBITUARIES
Louis J. Garcia
Dr. Louis J. Garcia of Tampa died suddenly
following a heart attack on Dec. 23, 1956. He
was 52 years of age.
A native of Cuba, Dr. Garcia was born in
Havana on Aug. 19, 1905, and received his pri-
mary schooling in a Catholic school in that city.
At the age of 12 years, he was sent to the United
States to attend high school and college in Bel-
mont, N. C. He received his professional train-
ing at Georgetown University School of Medicine
in Washington, D. C., where he was awarded the
degree of Doctor of Medicine in 1931. After
serving an internship in Georgetown Lniversity
( Continued on page 104)
J. Florida, M.A.
July, 1957
103
as well as his ‘stomach
peripheral level
ror duodenal ulcer • gastric ulcer • intestinal colic
spastic and irritable colon • ileitis • esophageal spasm
G.I. symptoms of anxiety states
controls gastrointestinal dysfunction
because it cares for the man
At the cerebral level
the tranquilizer Miltown in “Mil path controls the
psychogenic element in G. I. disturbances. ( Miltown
does not produce barbiturate loginess or hangover.)
At t
the anticholinergic, tridihexethyl iodide, in “Milpaf/i”
blocks vagal impulses to prevent hypermotility and
hypersecretion.
antichohnery-K
prescribe: §
1 tablet t.i.d. at II bb|
mealtime and II
2 at bedtime.
Formula:
Miltown® (meprobamate)
400 mg. (2 - methyl -2 -n -
propyl-1, 3-propanediol
dicarbamate)
U. S. Patent 2,724.720
tridihexethyl iodide 25 mg.
(3-diethylamino- 1 -cyclohexyl -
1 • phenyl - 1 - propanol-ethiodlde)
U. S. Patent 2,698.825.
WALLACE LABORATORIES New Brunswick, N. J. Literature and samples on request
HOW . . care of the man
rather than merely his stomach
WOLF &
WOLFF
HUMAN
GASTRIC
FUNCTION
104
Volume XLIV
Number 1
(Continued from page 102)
Hospital, he was granted a fellowship there in
internal medicine and later completed a residency
at the Tampa Municipal Hospital in Tampa.
In 1935, Dr. Garcia was appointed City Phy-
sician, Health Department of Tampa, and ac-
tively campaigned in the control and treatment
of tuberculosis. He pursued his studies in this
field and in 1938 took a course given by Dr.
Corillos on tuberculosis at Seaview and Bellevue
Hospitals in New York. In 1939, when the
Tuberculosis Hospital for Children was opened
in Tampa, Dr. Garcia took charge of this in-
stitution.
During World War II, Dr. Garcia served in
the United States Army. He was commissioned
a captain in 1942 and was separated from military
service in 1946 with the rank of major.
Upon his return to Tampa, Dr. Garcia re-
sumed his post with the Hillsborough County
Health Department and re-established his private
practice. Locally, he served on the staffs of St.
Joseph’s Hospital, Tampa Municipal Hospital.
Tampa Municipal Negro Hospital and the Centro
Asturiano Hospital. He engaged in numerous
civic activities. As a music lover, he helped to
foster the Little Theatre, the Symphony Orches-
tra, the Civic Ballet and other organizations. He
was treasurer of the Tampa Civic Ballet Asso-
ciation.
Dr. Garcia was a member of the Hillsborough
County Medical Association, the Florida Medical
Association, the American Medical Association,
the Pan American Medical Association and the
American College of Chest Physicians. He also
held membership in the American Trudeau So-
ciety and the Florida Trudeau Society.
Surviving are the widow, Mrs. Mary Josephine
Garcia; two daughters, Louisa and Sylvia Garcia,
of Tampa; the mother, Mrs. Mercedes Garcia, of
Cuba; three sisters, Mrs. Gloria Alfaro and Mrs.
Mercedes Garcia, of Panama, and Mrs Margot
Ferrer, of Cuba; and two brothers, Jose Antonio
and Alfredo Garcia, of Tampa.
Charles William Larrabee
Dr. Charles William Larrabee of Bradenton
died at his home on the grounds of the Bradenton
General Hospital on April 13, 1957, after a long
illness. He was 86 years of age.
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
551
CALL THE MEDICAL SUPPLY MAN!
HOSPITAL , PHYSICIANS and LABORATORY SUPPLIES t EQUIPMENT
EDICAL SUPPLY COMPANY
ot Jacksonville
Jacksonville
420 W. Monroe St.
Telephone EL 4-6661
Orlando
329 N. Orange Ave.
Telephone 5-3537
J. Florida, M.A.
July, 1957
105
IN S U P P L
Problem-eaters, the underweight, and generally below
par patients of all ages respond to incremin.
Incremin offers 1-Lysine for protein utilization, and es-
sential vitamins noted for outstanding ability to stimulate
appetite, overcome anorexia.
Specify incremin in either Drops (cherry flavor) or
Tablets (caramel flavor). Same formula. Tablets, highly
palatable, may be orally dissolved, chewed, or swallowed.
Drops, delicious, may be mixed with milk, milk formula,
or other liquid; offered in 15 cc. polyethylene dropper
bottle.
Each incremin Tablet
or each cc. of incremin Drops contains:
300 mg. Pyrldoxine (B«) 3 mg.
Vitamin Bi2 25 mcgm. (incremin Drops contain 1% al-
1 humine ( B] ) 10 mg. cohol)
R-8 U. S. Pal. OH.
only 1 INCREMIN TABLET or 10-20 INC REMIN
s daily.
106
Volume XLXV
Number 1
Born in 1870, Dr. Larrabee was a native of
Bath, Maine, and attended schools there. He re-
ceived his medical training at the Maryland Col-
lege of Eclectic Medicine and Surgery in Balti-
more, where he was awarded the degree of Doctor
of Medicine in 1913.
Dr. Larrabee practiced in Boston and Gaines-
ville, Ga., before locating in Florida. In 1921, he
and his wife, Mrs. Dovie Collins Larrabee, came
to Bradenton and established Larrabee Hospital,
later named Bradenton General Hospital, which
Mrs. Larrabee still directs. This institution was
the first hospital in Manatee County. As a char-
ter member of the Bradenton Elks Lodge and of
the Art League of Manatee County, and as a
member of the Bradenton Chamber of Commerce
this pioneer physician and surgeon was promi-
nently identified with many civic undertakings. He
was a founder of the Bradenton Yacht Club and
was a leader in conducting many regattas and oth-
er boating events. A past president of the former
Bradenton Optimist Club, he was also presi-
dent of the State of Maine Club during its entire
existence. He was of the Congregationalist faith.
For many years, Dr. Larrabee maintained a
home, Larrahurst, at Devil’s Elbow, a bend on the
upper Manatee River. During that period of his
life, the grounds and facilities were open to the
many friends of Dr. and Mrs. Larrabee and to
the general public for picnics and river sports.
Locally, Dr. Larrabee was a member of the
Manatee County Medical Society. For 31 years
he had been a member of the Florida Medical As-
sociation, holding honorary status in recent years.
Other professional affiliations included member-
ship in the Southern Medical Association and
honorary membership in the American Medical
Association.
In addition to the widow, Dr. Larrabee is
survived by a daughter, Mrs. Raymond L. Bond
Sr., of Jefferson, Maine; a sister, Mrs. Clara
Marson, of Booth Bay Harbor, Maine; a brother,
Albert Larrabee, of Auburn, Maine; one grandson
and six greatgrandchildren.
BOOKS RECEIVED
Vital Statistics of the United States 1954.
Volume I. Introduction and Summary Tables; Tables for
Alaska, Hawaii, Puerto Rico, and Virgin Islands; Mar-
riage, Divorce, Natality, Fetal Mortality and Infant Mor-
tality Data. U. S. Department of Health, Education, and
Welfare, Public Health Service, National Office of Vital |
Statistics. Prepared under the supervision of Halbert L.
Dunn, M.D., Chief, National Office of Vital Statistics.
Pp. 357. Price, $3.75. Washington, D. C., United States
Government Printing Office, 1956.
Gnderson Surgical Supply Go.
Established 1916
GOOD REPUT A TION
It takes years to build, but can be member
quickly destroyed.
It must be carefully guarded.
“A good name is rather to be chosen
than great riches.”
Distributors of Known Brands of Proven Duality
TELEPHONE 2-8504
MORGAN AT PLATT
P. O. BOX 1228
TAMPA 1, FLORIDA
TELEPHONE 5-4362
9th ST. & 6th AVE., SO.
ST. PETERSBURG, FLORIDA
J. Florida, M.A.
July, 1957
107
One donnagesic Extentab gives 10 to 12 hours of
steady, high-level codeine analgesia. Rebuilding
of effective analgesia with repeated doses is
avoided. Patient comfort is continuous.
There is more pain relief in donnagesic Extentabs
than in codeine alone — codeine analgesia is potentiated
by the phenobarbital present. In addition, phenobarbital
diminishes anxiety, lowering patient’s reactivity to pain.
DONNAGESIC is safer, too, for codeine side effects are
minimized by the peripheral action of the belladonna
alkaloids.
extended action — The intensity of effects smoothly
sustained all-day or all-night by each DONNAGESIC
Extentab is equivalent to, or greater than, the maximum
which would be provided by q. 4h. administration of one-
third the active ingredients.
Donnagesic
Extentabs*
extended action tablets of CODEINE with DONNATAL&
One* every 10-12 hours
and
for all codeine uses
DONNAGESIC No. 1 (pink)
DONNAGESIC No. 2 (rod)
CODEINE Phosphate . .
Hyoscyamine Sulfate . .
Atropine Sulfate . . . .
Ilyoscine Hydrobromide
Phenobarbital
. 48.6 mg. (Vegr.) .
. . . 0.3111 mg. .
. . . 0.0582 mg. .
. . . 0.0195 mg. .
. 48.6 mg. (Vegr.) .
.. 97.2 mg. (1V4 grj
0.3111 mg.
0.0582 mg.
0.0195 mg.
. . . 48 6 mg. (Va gr.)
A. H. ROBINS CO., INC., RICHMOND, VIRGINIA Ethical Pharmaceuticals of Merit Since 1878
’Rea U. S. Pat. Off., Pat. applied tor.
108
Volume XLIV
Number 1
Tfcxlfisieictice PtofiAylaxui.
I PREVENTION + DEFENSE -f
PROPER PROTECTION AGAINST LOSS
Sfreccalifed Service
oka. eCocian. &a£en.
THEj
MEDICAXPROTECTIVEf COMPANY
FoRT.TVayWE; Indiana
Professional Protection Exclusively
since 1899
This is one of two volumes presenting final vital sta-
tistics for the United States, its Territories, and two pos-
sessions for the year 1954. Their subject matter con-
sists of vital events that occurred in these areas during
the year — marriages, divorces, births, fetal deaths, infant
deaths, and deaths among the general population. The
contents of the present volume are described in the title.
The second volume of the annual report will contain mor-
tality data for the United States and each state.
Vital Statistics of the United States 1954.
Volume II. Mortality Data. U. S. Department of Health,
Education, and Welfare, Public Health Service, National
Office of Vital Statistics. Prepared under the supervision
of Halbert L. Dunn, M.D., Chief, National Office of Vital
Statistics. Pp. 505. Price, $4.00. Washington, D. C.,
United States Government Printing Office, 1956.
This is the second of two volumes presenting final
vital statistics for the United States, its Territories, and
two possessions for the year 1954. It contains mortality
data for the United States and each state.
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. 84-2703
A Doctor’s Marital Guide for Patients.
By Bernard R. Greenblat, B.S., M.D. Pp. 88. Price,
$1.50. Chicago, The Budlong Press, 1956.
This nontechnical and well illustrated book is extreme-
ly practical in that it clearly presents the best known
information about sex and marriage which patients fre-
quently find hard to discuss with anyone but their doc-
tor. It is written for those who are married or are about
to be married and offers common sense advice for both
husband and wife to help them attain a normal and ad-
justed sex life. Available only through physicians, it is
printed in two editions: Regular and Catholic. The
latter eliminates the chapter on birth control and instead
discusses the Catholic viewpoint toward family spacing
and related matters. Sample copies will be mailed to
physicians upon request.
Surgery in World War II. Volume II. Gen-
eral Surgery. Editor in Chief, Colonel John Boyd
Coates, Jr., MC; Editor for General Surgery, Michael E.
DeBakey, M. D. Pp. 417. Washington, D. C., Office of
the Surgeon General, Department of the Army, 1955.
Volume II on general surgery (volume I will appear
later) is set apart from other volumes of the history of
the Medical Department of the United States Army in
World War II by several special considerations. It is a
story not only of surgery performed in forward Army
medical units, but of extremely urgent surgery. It also
records the performance of an auxiliary surgical group,
and as such is typical of the outstanding work done in
all theaters of operations by the medical officers assigned
to similar units, as well as by medical officers organically
assigned to frontline hospitals in which surgical teams
from auxiliary surgical groups were employed.
The 3,154 abdominal injuries upon which this story
is chiefly based were all the result of the violence of war,
and undoubtedly comprise the largest series to be ana-
lyzed in such detail. The policy of prompt surgical inter-
vention in abdominal injuries was made practical and
possible because of another concept new in World War II,
the practice of prewperative resuscitation, which is also
described in this volume. Other important departures
from previous medicomilitary practices include the man-
agement of wounds of the rectum and large bowel by ,
colostomy with or without exteriorization of the damaged
segment, surgical treatment of wounds of the liver, and
the transdiaphragmatic approach to thoracoabdominal
wounds.
This book should have particular interest for military
and civilian surgeons and also medical students who antic-
ipate military service. It is not alone a record of past
events but also a source of potential usefulness at this
time and for the future in a world not yet at peace.
j
I Allen’s Invalid Home
S MILLEDGEVILLE, GA.
: Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
! Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department jor Men
II I). Allen, M.D., Department for Women
Terms Reasonable
J. Florida, M.A.
July, 1957
109
Surgery in World War II. Orthopedic Sur-
gery in the European Theater of Operations.
Editor in Chief, Colonel John Boyd Coates, Jr., MC;
Editor for Orthopedic Surgery, Mather Cleveland, M.D.
Pp. 397. Washington, D. C., Office of the Surgeon Gen-
eral, Department of the Army, 1956.
This is the first of three planned volumes on ortho-
pedic surgery to be included in the history of the United
States Army Medical Department in World War II. In
that war the European theater was the largest single
theater. Casualties were heavy, and, as in all theaters,
battle injuries of the extremities, including bones and
joints, comprised the largest single group, approximately
two thirds of the 381,350 wounded and injured in action
in Europe.
The orthopedic care of this enormous number of
wounded was a task of the first magnitude, brilliantly
planned and accomplished. This record, therefore, of
that remarkable feat will be of great interest to all medi-
cal officers who served in this country and overseas,
whether they have returned to civilian life or are still in
the Army. It will also be of interest to the medical offi-
cers who served in Korea and will be a source of informa-
tion and inspiration to students now in medical school
who face a term of service after graduation in one of the
medical services of the Armed Forces.
SUN RAY PARK
HEALTH RESORT
SANITARIUM IN MIAMI
Medical Hospital American Plan
Hotel for Patients and their families.
REST, CONVALESCENCE, ACUTE and
CHRONIC MEDICAL CASES. Elderly
People and Invalids. FREE Booklet!
Acres Tropical Grounds, Delicious Meals,
Res. Physician, Grad. Nurses, Dietitian.
125 S.W. 30TH COURT, MIAMI, FLORIDA
Under New Medical
Direction and Man-
agement.
MEMBER, AMERICAN HOSPITAL ASSOCIATION
MEMBER, FLORIDA HOSPITAL ASSOCIATION
Q&OOOOQQOQQQQQQtXtOGQQOQOQOQOOOOOOOOOGQ&QGOOQOOOGOOQOGOOOOO&OOOOOOOOOOOOtt
1 HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
Asheville, North Carolina
AFFILIATED WITH DUKE UNIVERSITY
A non-profit psychiatric institution, offering
modern diagnostic and treatment procedures —
insulin, electroshock, psychotherapy, occupa-
tional and recreational therapy — for nervous and
mental disorders.
The Hospital is located in a 75-acre park, amid
the scenic beauties of the Smoky Mountain
Range of Western North Carolina, affording ex-
ceptional opportunity for physical and nervous
rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic
services and therapeutic treatment for selected
cases desiring non-resident care.
R. CHARMAN CARROLL, M IX
Dipiomate in Psychiatry
Medical Director
ROBT. L. CRAIG, M.D.
Dipiomate in Neurology and Psychiatry
Associate Medical Director
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOGOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOCfOOd
110
Volume XI.IV
Number 1
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff PAUL v- ANDERSON, M.D., President
REX BLANKIN'SHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request - P. 0. Box 1514 - Phone 5-3245
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1151
J. Florida, M.A.
July, 1957
INDEX TO ADVERTISERS
111
• Allen’s Invalid Home 108
• American Meat 12
• Ames Co., Inc. . Third Cover
• Anclote Manor 116
• Anderson Surgical Supply Co. 106
• Appalachian Hall 117
• Ayerst Laboratories 98, 100
• Ballast Point Manor 111
• Bayer Co. . 16
• Brawner’s Sanitarium 117
• Brayten Pharmaceutical Co. 13
• Burroughs Wellcome & Co. 93
• California Personnel Board 90
• Convention Press , 116
• Corn Products Refining Co. 91
• Drug Specialties, Inc. 1 1
• Foot-So-Port 92
• Fort Lauderdale Beach Hospital 112
• Geigv Pharmaceuticals 14
• Guild of Prescription Opticians 101
• Highland Hospital, Inc. 109
• Hill Crest Sanitarium 110
• Lakeside Laboratories 5
• Lederle Laboratories 7, 60, 61, 94a, 94b, 95,
96, 97, 105
• Lewal Pharmaceutical Co. 8
• Eli Lilly & Co. 18
• Medical Protective Co. 108
• Medical Supply Co. 104
• Miami Medical Center 113
• Parke-Davis & Co. Second Cover, 3
• Pfizer Laboratories ... 15
• Riker Laboratories, Inc. 99
• A. H. Robins Co. 107
• Roerig & Co. 9
• Schering Corp. 10a, 10b, 17
• G. D. Searle Company 89
• Smith, Kline & French Labs. Back Cover
• E. R. Squibb & Sons 10
• Sun Ray Park Health Resort 109
• Surgical Supply Co. 94
• Tucker Hospital, Inc. 112
• Wallace Laboratories 102a, 102b, 103
• Westbrook Sanatorium 110
• Winthrop Laboratories, Inc. 6
• Yearbook Publishers, Inc. 102
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
522S Nichol St.
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9, Florida
112
Volume XL1V
Number 1
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond. Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
FORT LAUDERDALE BEACH HOSPITAL
125 N. Birch Rd., Ft. Lauderdale, Florida
GERIATRICS
(care of the aging)
REHABILITATION. . . .
CONVALESCENT CARE
A private hospital especially
planned for the medical care
and rehabilitation of the
CHRONICALLY ILL, the
AGED, and the HANDICAP-
PED.
Departments of Medicine, Ra-
diology, Laboratory, Dietary,
Dentistry, Rehabilitation, Oc-
cupational and Physiotherapy.
Patients accepted for long or
short term care under direction
of private physician.
MEDICAL RESIDENT STAFF
For information write
Medical Director
Louis L. Amato, M.D.
SCHEDULE OF MEETINGS
113
JoRIDA, M.A.
H, 1957
ORGANIZATION
I da Medical Association
I da Medical Districts
Northwest
Northeast
Southwest
•Southeast
1 da Specialty Societies
demy of General Practice
1 gy Society
i thesiologists, Soc. of
i t Phys., Am. Coll., Fla. Chap,
it n. and Syph., Assn of
i th Officers’ Society
i strial and Railway Surgeons
rology and Psychiatry
1 and Gynec. Society
jthal. & Otol., Soc. of.
i opedic Society
s ologists, Society of
e itric Society
1 :ic & Reconstructive Surgery
r tologic Society
i ological Society
u eons, Am. Coll., Fla. Chapter
logical Society
Iida —
isic Science Exam. Board
ood Banks, Association
ue Cross of Florida, Inc
ue Shield of Florida, Inc
ncer Council
abetes Assn
ntal Society, State
■art Association
>spital Association
idical Examining Board
edical Postgraduate Course
irse Anesthetists, Fla. Assn
irses Association, State
armaceutical Assoc., State
blic Health Association
udeau Society
berculosis & Health Assn
iman’s Auxiliary
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Joel V. McCall Jr., Daytona Beach
Geo. W. Robertson III, Miami
George Williams Jr., Miami
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
James J. Griffitts, Miami
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
Edward R. Smith, Jacksonville
Coleman T. Brown, D.D.S., Tampa
William P. Hixon, Pensacola
Mr. Robert B. Eleazer Jr., Jax.
Eramus B. Hardee, Vero Beach
Turner Z. Cason, Jacksonville
Miss Dorothy Jackson, C. Gables
Martha Wolfe R.N., Coral Gables
Wesley D. Owens, Jacksonville
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson M. Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
Ivan C. Schmidt, W. Palm Beach
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Burns A. Dobbins Jr., Ft. L’d’dale
Bernard L. N. Morgan, Jax
Sam Sulman, Orlando
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mr. J. M. Potts, Miami
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Joseph J. Lowenthal, Jacksonville
Wallace C. Mayo, D.D.S., Pensa.
Sidney Davidson, Lake Worth
Mr. Steve F. McCrimmon, C. Gbls.
Homer L. Pearson Jr., Miami ....
Chairman
Mrs. Lulla F. Bryan, Miami
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Clarence L. Brumback, W. P. B
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Panama City, Oct. 28, ’57
Orlando, Oct. 30, ’57
Clearwater, Oct. 29, ’57
Fort Pierce, Oct. 31, ’57
St. Petersburg, Nov. 1-2, ’57
Nov. 30-Dec. 1, ’57
Jan. 58
Nov. ’57
Gainesville, Oct. ’57
Ft. Lauderdale Oct. 31-Nov. 2, ’5'.
» » f) ff
Miami Beach, May 10-14, ’58
t dean Medical Association
M.A. Clinical Session
) hern Medical Association
I ama Medical Association
( gia. Medical Assn, of
. Hospital Conference
iheastern Allergy Assn.
iheastern, Am. Urological Assn.
> heastern Surgical Congress
i Coast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schafer, Tocoa
Mr. D. O. McClusky Jr
Tuscaloosa, Ala.
Clarence Bernstein, Orlando
Sidney Smith, Raleigh, N. C
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Mr. Pat Groner, Pensacola
Kath. B. Maclnnis, Columbia, S.C.
Robert F. Sharp, New Orleans
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala.
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Miami Beach, Nov. 11-14, ’57
Macon, April 27-30, ’58
Charleston, S.C., Nov. 1-2, ’57
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin, Electroshock, Hydrotherapy.
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
.Memoer American Hospital Association
114
Volume XLIV
Number 1
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
BLUE SHIELD LIAISON
WILLIAM C. ROBERTS, M.D., President Panama City
JERE W. ANNIS, M.D., Pres. -Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D..
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . Jacksonville
SHALER RICHARDSON, M.D., Editor. .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
HENRY J. HABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A-58 Tallahassee
JOHN J. CHELEDEN, M.D. B-58 Daytona beach
JOHN M. II U TCI II It, M.D. ( 58 Sarasota
PAUL G. SHELL, M.D. D-58 Tort Lauderdale
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
III MO L. HARRELL, M.D IS 59 Ocala
JAMES It. BOULWARE JR., M.D. ( 59 lakeland
RALPH M. OVERSTREET JR., M.D. D 59 W. Palm beach
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
ROBERT E. ZELLNER, M.D. B 60 Orlando
WHITMAN C. McCONNELL, M.D. C-60 St. Petersburg
RAI I’ll s SAPI’I NI II I D, M.D. 1) 60 Miami
HAROLD I WAGER, M.D. A 61 Panama City
CHARLES F. McCRORY, M.D. B 61 Jacksonville
JOHN S. STEWART, M.D. C-61 Tort Myers
DONALD F. MARION, M.D. 1) 61 Miami
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR.. M.D... AL-58 Ocala
GEORGE S. PALMER, M.D. ..A-58 Tallahassee
CLYDE O. ANDERSON, M.D...C-59 St. Pete, shiny
REUBEN B. CHRISMAN JR., M.D.. D-60. Coral Cables
MEREDITH MALLORY, M.D.. .B-61 Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D...PP-59 St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio Jacksonville
EDWARD JELKS, M.D. (Public Relations) Jacksonville
HERBERT L. BRYANS, M.D. . . S.B.H.-58 Pensacola
ERNEST R. GIBSON (Advisory) Jacksonville
S ubconi mittees
1. Veterans Care
FREDERICK II. BOWEN, M.D.
GEORGE M. STUBBS, M.D.
DOUGLAS D. MARTIN, M.D.
RICHARD A. MILLS. M.D
JAMES L. BRADLEY', M.D
LOUIS M. ORR, M.D. (Advisory)
2. blue Shield
RUSSELL B. CARSON, M.D.
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm. AL-58 Brooksville
First— ALPHEUS T. KENNEDY, M.D 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D 3-58 Jacksonville
Fourth — DON C. ROBERTSON, M.D 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D. 6-58 Daytona Beach
Seventh— RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON M. ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
TOR PHYSICIANS AND ALLIED SPECIALISTS
J. ItOCHER CHAPPELL, M.D., Chm. Orlando
THOMAS II. BATES, M.D. “A” Lake City
FRANK L. FORT, M.D “B” Jacksonville
ALVIN L. MILLS, M.D “C” St. Petersburg
JOHN D. MILTON, M.D “D” Miami
Jacksonville
Jacksonville
„..T am pa
Tort Lauderdale
Tort Myers
Orlando
Tt. Lauderdale
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
SAMUEL B. D. RHEA, M.D. A 59 Pensacola
\l FONSO I. MASSARO, M.D. C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D. B 61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm D-58 Coral Gables
WILLIAM F. HUMPHREYS !R., M.D. AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D. A 60 Tallahassee
J. K. DAVID JR., M.D. B 61 Jacksonville
CONSERVATION OF VISION
CARL S. McLF.MORE, M.D., Chm. AL-58 Orlando
HUGH E. PARSONS, M.D. C-58 Tampa
CHARLES C. GRACE, M.D. B 59 St. Augustine
ALAN E. BELL, M.D. A-60 Pensacola
LAURIE R. TFASDALE, M.D. D 61 W. Palm Beach
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm. Orlando
WALTER C. PAYNE JR.. M.D. "A” Pensacola
W. DEAN STEW ARD, M.D. "B” Orlando
WILLIAM W. TRICE JR., M.D. "C” Tampa
JOHN V. HANDYY7ERKER JR., M.D. “D” Miami
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm
FRANCIS II. LANGLEY, M.D.
JOHN 1). MILTON, M.D.
DUNCAN T. McEWAN, M.D.
ROBERT B. McIVER, M.D.
W. Palm Beach
St. Petersburg
Miami
Orlando
Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D. AL-58 Tort Lauderdale
EDWARD JELKS, M.D. B-58 Jacksonville
CECIL M. PEEK, M.D. D 60 W. Palm Beach
GEORGE H. GARMANY, M.D. A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY', M.D. (Ex Officio) Jacksonville
BLOOD
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
LEO E. REILLY, M.D. AL-58 Panama City
ROBERT B. McIVER, M.D B-58 Jacksonville
GRETCHEN V. SQUIRES, M.D A-59 Pensacola
DONALD W. SMITH, M.D. D-60 Miami
MATERNAL WELFARE
E. FRANK McCALL, M.D., Chm. B-60 Jacksonville
WILLIAM C. FONTAINE, M.D. AL-58 Panama City
J. LLOYD MASSEY M.D A-58 Quincy
RICHARD F. STOVER, M.D. ...D-59 _ .....Miami
S. L. WATSON, M.D C-61 lakeland
J. Florida, M.A.
July, 1957
115
MEDICAL ECONOMICS
NURSING
ROBERT E. ZELLNER, M.D., Chm AL.58 Orlando
DEWITT C. DAUGHTRY, M.D D 58 Miami
S. CARNES HARVARD, M.D. C-59 Brooksville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
THOMAS C. KENASTON, M.D., Chm.
CARL M. HERBERT, M.D. AL-58
HERBERT L. BRYANS, M.D. A-58
NORVAL M. MARR SR., M.D. C-60
JAMES R. SORY, M.D. D-61
B-59 Cocoa
Gainesville
Pensacola
St. Petersburg
W. Palm Beach
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
PAUL J. COUGHLIN, M.D AL-58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. B-60 Gainesville
RAYMOND B. SQUIRES, M.D... A-61 Pensacola
Subcommittee
1. Medical Schools Liaison
POLIOMYELITIS medical advisory
RICHARD G. SKINNER JR., M.D., Chm.
JOHN J. BENTON, M.D AL-58
GEORGE S. PALMER, M.D. A-58
EDWARD W. CULLIPHER, M.D. D 60
FRANK H. LINDEMAN JR., M.D. C-61
B-59 Jacksonville
Panama City
Tallahassee
Miami
Tampa
REPRESENT AT IVES TO INDUSTRIAL COUNCIL
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D B-58 Gainesville
JAMES N. PATTERSON, M.D. C-61 Tampa
EDWARD W. CULLIPHER, M.D. D-59 Miami
HOMER F. MARSH JR., Ph.D Univ. of Miami
School of Medicine 1961 , Miami
GEORGE T. HARRELL JR., M.D. Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
PASCAL G. BATSON JR., M.D., Chm. A-60
WILLIAM J. HUTCHISON, M.D. AL-58
CHAS. L. FARRINGTON, M.D. C-58
THOMAS N. RYON, M.D. D-59
RAYMOND R. KILLINGER, M.I). B-61
Pensacola
Tallahassee
St. Petersburg
Miami
Jacksonville
Special Assignment
1. Industrial Health
SCIENTIFIC WORK
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm. B-59 Jacksonville
LEO M. WACHTEL, M.D. AL-58 Jacksonville
C. FRANK CHUNN, M.D C-58 Tampa
WILLIAM D. CAWTHON, M.D. A-60 DeFuniak Springs
V. MARKIIN JOHNSON, M.D. D-61 W. Palm Beach
GEORGE T. HARRELL JR., M.D. Chm.
FRANZ H. STEWART, M.D. AL-58
DONALD F. MARION, M.D. D-58
RICHARD REESF.R JR., M.D. C 59
CRETCHEN V. SQUIRES, M.D. A 61
B-60 Gainesville
Miami
Miami
St. Petersburg
Pensacola
STATE CONTROLLED MEDICAL INSTITUTIONS
MEDICARE FEE SCHEDULE COMMITTEE
WILLIAM D. ROGERS, MD„ Chm. A-60
NELSON II. KRAEFT, M.D. AL-58
WILLIAM L. MUSSER, M.D. B-58
whitman h. McConnell, m.d. c-59
DONALD W. SMITH, M.D. D-61
Chattahoochee
Tallahassee
Winter Park
St. Petersburg
Miami
Medicine
DONALD F. MARION, M.D., Gen. Chm. D-60 Miami
W. DEAN STEWARD, M.D., Sec. Chm. B-61 Orlando
H. PHILLIP HAMPTON, M.D C-58 Tampa
S urgery
GEORGE W. MORSE, M.D., Sec. Chm. A-58 Pensacola
PAUL F. WALLACE, M.D. C-60 St. Petesburg
REUBEN B. CHRISMAN JR., M.D D-59 Coral Gables
Radiology
FREDERICK K. HERPEL, M.D.,
Sec. Chm D-58 W. Palm Beach
C. ROBERT D> ARMAS. M.D. B-59 Daytona Beach
JOHN P. FERRELL, M.D C-61 St. Petersburg
Pathology
GRETCHEN V. SQUIRES, M.D., Sec Chm. A-60 Pensacola
W. ANSELL DERRICK, M.D B-58 Orlando
JAMES N. PATTERSON, M.D C-59 Tampa
General Practice
JAMES T. COOK JR., M.D., Sec Chm A-59 Marianna
LEO M. WACHTEL, M.D. B-60 Jacksonville
JOHN V. HANDWERKER JR., M.D D-61 Miami
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm B-61 _ Jacksonville
WILLIAM M. C. WILHOrr, M.D AL-58 Pensacola
J. LLOYD MASSEY, M.D. A-58 Quincy
W. TRACY HAVERFIELD, M.D D-59 Miami
MASON TRUPP, M.D C-60 I am pa
NECROLOGY
J. BASIL HALL, M.D., Chm AL-58 Tavares
WALTER W. SACKETT JIL, M.D. 1)58 Miami
LEO M. WACHTEL, M.D. B-59 Jacksonville
ALVIN L. STEBBINS, M.D A 60 Pensacola
RAYMOND H. CENTER, M.D. C-61 Clearwater
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. B-61 Jacksonville
HENRY I. LANGSTON, M.D. AI.-58 Marianna
JOHN G. CHESNEY, M.D. D-58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD 11. CANNING, M.I). A-60 Wewahitchka
Special Assignment
1 . Diabetes Control
VENEREAL DISEASE CONTROL
C W. SHACKELFORD, M.D., Chm. A-61 Panama City
FRANK V. CHAPPELL, M.D. AL-58 Tampa
A. BUIST L£TTERER, M.D. D-58 Miami
LINUS W. HEWIT, M.D C-59 Tampa
LORENZO L. PARKS, M.D B-60 Jacksonville
WOMAN'S AUXILIARY ADVISORY
MERRITT II. CLEMENTS, M.D., Chm. A-60 Tallahassee
JOHN II. TERRY, M.D. AL-58 Jacksonville
WILEY M. SAMS, M.D. I) 58 Miami
G. DEKLE TAYLOR, M.D B-59 Jacksonville
CHARLES McC. GRAY, M.D. C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate.™ Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
(Board of Past Presidents on Next Page)
116
Volume XLIV
Number 1
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
JOHN S. McEWAN, M.D., 1925 Orlando
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 . Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 19 V) Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. McIVER, M.D., 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
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MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO,
M.D.
ZACK RUSS, Jr., M.D.
Consultants in Psychiatry
ARTURO G.
GONZALEZ,
M.D.
SAMUEL G. WARSON,
M.D.
ROGER E. PHILLIPS, M.D.
WALTER
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TARPON
SPRINGS •
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• ON THE GULF OF MEXICO •
PH. VICTOR
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J. Flohida, M.A.
July, 1957
117
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association of
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D. ALBERT F. BRAWNER, MP,
Medical Director Assistant Director
P. O. Box 218
Phone 5-4486
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or cn
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
County Medical Societies of Florida
118
Volume XLIV
Number 1
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, . a calmative effect . . . superior to anything we
had previously seen with the new drugs.”*
true calmative
nostyn
Ectylurea, Ames
(2-ethyl-ch-crotonylurea)
the power of gentleness
allays anxiety and tension
without depression, droivsiness, motor incoordination
Nostyn is a calmative— not a hypnotic-sedative— unrelated to any available
chemopsychotherapeutic agent • no evidence of cumulation or habituation • does
not increase gastric acidity or motility • unusually wide margin of safety
— no significant side effects
dosage : 1 50-300 mg. (Vi to 1 tablet) three or four times daily,
supplied : 300 mg. scored tablets, bottles of 48 and 500.
*Ferguson, J. T., and Linn, F. V. Z.: Antibiotic Med. & Clin. Therapy 3: 329, 1956.
AMES COMPANY, INC • ELKHART, INDIANA :so57
AMES COMPANY OF CANADA, LTD., TORONTO
2
Nt;V YORK ACADEMY OF
MED I C I NE
2 E
NEW
I 0 3RD ST
Yr0tU N Y
By changing the attitude of the
emotional dermatologic patient, ‘Thorazine’
facilitates the management of the patient and the treatment
of skin disorders. The patient becomes less insistent
and frantic, and accepts her affliction philosophically.
‘Thorazine’ does not cure skin diseases but, according to
Cornbleet and Barsky,1 is a “most useful adjuvant to
dermatologic therapy” in patients with an emotional background
of tension, apprehension, excitement, anxiety and agitation.
THORAZINE*
“can be to the dermatologist what the
anesthetist is to the surgeon.”1
Smith , Kline & French Laboratories , Philadelphia
1. Cornbleet, T., and Barsky, S.: The Role of the Tranquilizing
Drugs in Dermatology, presented at 1 1 5th Annual Meeting of
Illinois State Medical Society, May 19, 1 955-
*T.M. Reg. U.S. Pat. Off. for chlorpromazine, S.K.F.
Vol. XLIV
AUGUST, 1957
.
RESISTANCE
IS
LESS OF A PROBLEI
SENSITIVITY OF 100 STRAINS
OF HEMOLYTIC STAPHYLOCOCCUS AUREUS
TO CHLOROMYCETIN
AND OTHER IMPORTANT ANTIBIOTIC AGENTS*
100
90
80
70
60
50
40
30
20
10
0
CHLOROMYCETIN
89%
ANTIBIOTIC A
70%
ANTIBIOTIC B
46%
ANTIBIOTIC C
22%
ANTIBIOTIC D
20%
ANTIBIOTIC E
18%
ANTIBI
13'
*This graph is adapted from Kempe.1 The single bar
designated as “Antibiotics F” represents three widely used, chemically related agents
grouped together by the investigator in his study.
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
The striking consistency with which CHLOROMYCETIN (chloramphenicol,
Parke-Davis) acts against staphylococci is well-documented.1'10 Continued
sensitivity of these problem pathogens to CHLOROMYCETIN accounts for
clinical effectiveness of this antibiotic, often where other antimicrobial
agents fail. Whereas most strains of staphylococci isolated by Kempe over
a period of one year were not inhibited by commonly used antibiotics,
“...only 11 per cent were chloramphenicol-resistant.”1 CHLOROMYCETIN
also retains its potency against the significant gram-negative pathogens.6'11*15
CHLOROMYCETIN is a potent therapeutic agent and, because certain blood
dyscrasias have been associated with its administration, it should not be used
indiscriminately or for minor infections. Furthermore, as with certain other drugs,
adequate blood studies should be made when the patient requires prolonged or
intermittent therapy.
REFERENCES
(1) Kempe, C. H.: California Med. 84:242, 1956. (2) Petersdorf, R. G.; Bennett, I. L., Jr., & Rose, M. C.:
Bull. Johns Hopkins Hosp. 100:1, 1957. (3) Spink, W. W.: Ann. New York Acad. Sc. 65:175, 1956.
(4) Yow, E. M.: CP 15:102, 1957. (5) Altemeier, W. A., in Welch, II., & Marti-Ibanez, E: Anti-
biotics Annual 1956-1957, New York, Medical Encyclopedia, Inc., 1957, p. 629. (6) Rantz, L. A.,
& Rantz, H. H.: Arch. Int. Med. 97:694, 1956. (7) Wise, R. I.; Cranny, C., & Spink, W. W.:
Am. J. Med. 20:176, 1956. (8) Smith, R. T.; Platou, E. S., & Good, R. A.: Pediatrics 17:549, 1956.
(9) Cohen, S.: Postgrad. Med. 20:483, 1956. (10) Royer, A.: Scientific Exhibit, 89th Ann. Conv.
Canad. M. A. Quebec City, Quebec, June 11-15, 1956. (11) Bennett, I. L., Jr.: West Virginia M. J.
53:55, 1957. (12) Altemeier, W. A.: Postgrad. Med. 20:319, 1956. (13) Felix, N. S.: Pcdiat. Clin.
North America 3:317, 1956. (14) Metzger, W. I., & Jenkins, C. J., Jr.: Pediatrics 18:929, 1956.
(15) Woolington, S. S.; Adler, S. J., & Bower, A. G., in Welch, H., & Marti-Ibanez, E: Antibiotics
Annual 1956-1957, New York, Medical Encyclopedia, Inc., 1957, p. 365.
PARKE, DAVIS & COMPANY • DETROIT 32, MICHIGAN
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
C 0 N T E N T S
Scientific Articles
The Evaluation of Procedures Used in the Diagnosis
of Hemorrhagic Diseases, L. W. Diggs, M.D. 139
Anileridine as an Anesthetic Agent. John T. Stage, M.D. 143
Progressive Synergistic Bacterial Gangrene of the Skin,
Edward R. Annis, M.D., Banning G. Lary, M.D., Alma
Trappolini, M.D., and Wayne B. Martin, M.D. 146
Cost of Administration of Salk Vaccine Program, Joseph
M. Bistowish, M.D., and Warren T. Weathington, M.D. 150
Skin Reactions to a Nicotinic Acid Ester in Tuberculosis,
Milton S. Saslaw, M.D., and Murray M. Streitfeld. Ph.D. 152
Abstracts
Drs. Clifford C. Snyder. J. Ernest Ayre, Alvan G. Foraker, R. Sam Mosley,
Leonard G. Rowntree. Robert J. Boucek and Wayne S. Rogers 158
Editorials and Commentaries
Actions of the Florida Legislature 1957 Session 161
Florida Medicine and the Future 163
‘ Heedless Horsepower” 163
Graduate Medical Education
Hematology Seminar and Short Course Held. Gainesville, June 20-22 166
Report of Florida Delegates to American Medical Association
1957 Annual Meeting 167
Registration of Florida Medical Association Members
Attending AMA 1957 Annual Meeting 170
Southern Medical Association Builds Permanent Headquarters 171
Postgraduate Obstetric Seminar. Daytona Beach, Sept. 9-1 1 1957 171
State Board of Health — A New Strain of Influenza 172
General Features
President’s Page 160
Others Are Saying 174
Births, Marriages and Deaths 176
State News Items 176
Classified 190
New Members 191
Woman’s Auxiliary 192
Books Received 196
Schedule of Meetings 201
Florida Medical Association Officers and Committees 202
County Medical Societies of Florida 206
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price $5.00 a year: single numbers. 50 cents. Address Journal of Florida
Medical Association. P.O. Box 2411. 735 Riverside Ave., Jacksonville 3, Fla. Telephone EL 6-1571. Accepted for mail-
ing at special rate of postage provided for in Section 1103. Act of Congress of October 3. 1917; authorized October 16.
1918. Entered as second-class matter under Act of Congress of March 3. 1879. at the post office at Jacksonville,-
Florida, October 23, 1924.
J. Florida, M. A.
August, 1957
125
YOUR PATIENT NEEDS AN ORGANO MERCURIAL
Practicing physicians know that many years of clinical and laboratory experience
with any medication are the only real test of its efficacy and safety.
Among available, effective diuretics, the organomercurials have behind them over
three decades of successful clinical use. Their clinical background and thousands of
reports in the literature testify to the value of the organomercurial diuretics.
TABLET
NEOHYDRIN
BRAND OF CHLORM ERODR I N (is.a mg. of j-chloromcrcuri-i-methoxy-propylurca
EQUIVALENT TO lO MG. OF NON-IONIC MERCURY IN EACH TABLET)
a standard for initial control of severe failure
MERCUHYDRIN8 SODIUM
D E BRAND OF M ERALLURIDE INJECTION
oxim
FOR OVER
YEARS
HASKELL’S
NOW
IN
CONVENIENT DOSAGE FORMS
’
I’henobarbital
Belladonna
Alkaloids
Supplied
BELBARB No. 1
per tablet
Vi gr.
hyoscyamine,
atropine,
Bottles of 100, 500
and 1,000 tablets
2 BELBARB No. 2
per tablet
V-2 gr.
and
scopolamine
Bottles of 100, 500
and 1,000 tablets
3 BELBARB-B
with B Complex Supplement*
Vi gr.
in fixed
proportion,
approximately
equivalent to
Tr. Belladonna,
8 min.
Bottles of 100, 500
and 1,000 tablets
4 BELBARB Elixir
per fluidrachm (4 cc)
Vi gr.
Bottles containing
1 pt. and 1 gal.
3 BELBARB Trisules
1 Trisule is equivalent to
3 Belbarb tablets
Bottles of 30 and 100
Trisules
•Thiamine Hydrochloride — 5 mg., Riboflavin — 2 mg., Calcium Pantothenate — 2.5 mg., Pyridoxine
Hydrochloride — 0.5 mg., Niacinamide — 10 mg.. Vitamin B12 Activity — 2 meg.
Send for free samples and literature.
CHARLES C. HASKELL & CO., INC., Richmond, Virginia
J. Florida. M. A.
August, 1957
127
•Reg. U. S. Pat Off.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER, N. Y.
mm
128
Volume XLIV
Number 2
\
A natural
biochemical treatment
for your problem
of PRURITUS ANI-
HYDROLAMINS*
TOPICAL AMINO ACID THERAPY
Immediate and prolonged relief . . . Inherent safety
98% Effective1 and Why —
Recent observations on the pruritogenic
effects of proteolytic enzymes- have focused
new interest on the value of proteins and
amino acids in pruritus ani.
Using selected amino acids — Hydrolamins
— Bodkin and Ferguson1 obtained relief in
98% of pruritus ani cases. McGivney:<
states that practically all his patients have
had immediate relief.
Hydrolamins offers a protective stainless
biochemical barrier to irritating enzymes
and also neutralizes alkaline irritants
seeping from the anal canal.
100%, Safe and Why —
Being biochemical in character and having
a pH of around 6, Hydrolamins harmo-
nizes with the skin, does not — unlike the
"caines” and steroids — tend to cause
treatment dermatitis or sensitization — in
a word is SAFE.
Hydrolamins is, therefore, indicated in the topical treatment of —
Pruritus Ani et Vulvae • Fissures • Diaper Rash • Anal Irritations and
Erythemas • Pinworm Pruritus • Ileostomy and Colostomy Irritations
SUPPLIED ; 1 oz. and 2.5 oz. tubes.
Pharmaceutical Company
Chicago 14, Illinois
1. Bodkin, L. G., and Ferguson. E. A., Jr.: Am. J. Digest. Dis. 11:59 (Feb.) 1951. 2. Arthur, R. P., and Shelley,
W. 8.: J. Invest. Derm. 25.341 (Nov.) 1955. 3. MeGivney, J.: Texas J. Med. 47.770 (Nov.) 1951.
J. Florida, M. A
August, ly57
129
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or Vfe teaspoonful
contains:
Pentylenetetrazol .100 mg.
Nicotinic Acid 50 mg.
1. Levy, S„ JAMA.. 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J., 15:596. 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
ORUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
130
Volume XU V
Number 2
kids really like ...
SQUIBB IRON, B COMPLEX AND Bis VITAMINS ELIXIR
■ to correct many common anemias
■ to correct mild B complex deficiency states
■ to aid in promotion of growth and stimulation of appetite in poorly nourished children
Each teaspoonful (5 cc.) supplies:
Elemental Iron 38 mg.
(as ferric ammonium citrate and colloidal iron)
(equivalent to 130 mg. ferrous sulfate exsiccated)
©Vitamin B12 activity concentrate 4 meg.
Thiamine mononitrate 1.0 mg.
Riboflavin 1.0 mg.
Squihh Quality- Niacinamide 5 mg.
the Priceless Ingredient Pantothenic acid (Panthenol) 1.5 mg.
Pyridoxine hydrochloride 0.5 mg.
Alcohol content: 12 per cent
Dosage: 1 or 2 teaspoonfuls t.i.d.
Supply: Bottles of 8 ounces and 1 pint.
'BOBRATON'Q fft A SQUIBB TRADEMARK
J. Florida. M. A
August, 1957
131
anticholinergic
Miltown®
now . . care of the man
rather than merely his stomach”1
Miltown® i j anticholinergic
controls
gastrointestinal dysfunction
at cerebral and peripheral levels
tranquilization without
barbiturate ioginess
spasmolysis without
belladonna-like side effects
for duodena f ulcer • gastric ulcer • intestinal colic
spastic and irritable colon • ileitis • esophageal spasm
6. I. symptoms of anxiety states
prescribe
1 tablet t.i.d. at
mealtime and
2 at bedtime.
U. S. Patent 2,724,720
sethyl iodide 25 mg.
( 3 - diethylamino - 1 - cyclohexyl -
1 - phenyl - 1 - propanol-ethiodide)
WALLACE LABORATORIES New Brunswick, N. J.
|. Wolf & Wolff, Human Gastric Function
Literature, samples, and
personally imprinted peptic vlccf
did booklets on request.
132
Volume XLIV
Number 2
nTz
Foi, HAY FEVER
1
NASAL SPRAY
20 cc.
" nTz . . . singularly effective for nasal congestion due to
either allergic or infectious causes."
Levin, S.J.: Pedlat. Clin. North America 1:975, Nov., 1954.
~Act& unfJiub Aeconda -ctecongeAti/Hb &ZAtA f<yo Jiouaa
Balanced combination of three
proved intranasal medications —
N eo-Synephrine® HCI, 0.5%
— dependable vasoconstrictor
and decongestant
T henfadil® HCI, 0.1%
— potent topical antihistaminic
Z ephiran® Cl, 1 :5000
—antibacterial wetting agent
and preservative
• NO IRRITATION, SEDATION, EXCITATION
• SANITARY, CONVENIENT, EFFECTIVE
The NTz plastic squeeze
bottle is pocket size,
unbreakable and leakproof
sprays a -fine, even mist.
nTz permits the patient to breathe again,
promoting aeration and proper sinus drainage. There
is usually no congestive rebound — virtually no side effects.
Patients may use it repeatedly without loss of effect.
NTZ, Neo-Synephrine (brand of phenylephrine),
Thenfadil (brand of thenyldiamine)
and Zephiran (brand of benzalkonium, as chloride,
refined), trademarks reg. U. S. Pat. Off.
Rapidly Effective
Prolonged Relief
LABORATORIES
NEW YORK 18. N Y
J. Florida, M. A.
August, 1957
133
unique
derivative of
Rauwolfia
canescens
Harmonyl*
combines the full effectiveness of the rauwolfias
with a new degree of freedom from side effects
Harmonyl makes rauwolfia more useful in
your everyday practice. Two years of clinical
evaluation have shown this new alkaloid ex-
hibits significantly fewer and milder side ef-
fects than reser pine. Yet, Harmonyl compares
to the most potent forms of rauwolfia in
effectiveness.
Most significant: Harmonyl causes less
mental and physical depression — and far less
of the lethargy seen with many rauwolfia
preparations.
Patients became more lucid and alert, for
example, in a study1 of chronically ill, agi-
tated senile cases treated with Harmonyl.
And these patients were completely free from
side effects — although a group on reserpine
developed such symptoms as anorexia,
headache, bizarre dreams, shakes, nausea.
Harmonyl has also demonstrated its po-
tency and relative freedom from side effects
in hypertension. In a study comparing vari-
ous forms of rauwolfia'-, the investigators
reported deserpidine “an affective agent in
reducing the blood pressure of the hyper-
tensive patient both in the mild to moderate,
as well as the severe form of hypertension.”
They also noted that side reactions were
“less annoying and somewhat less frequent”
with this new alkaloid. Other studies con-
firm that few cases of giddiness, vertigo or
sense of detached existence or disturbed sleep
are seen with Harmonyl.
Professional literature on this unique rau-
wolfia derivative is available upon request.
Harmonyl is supplied in 0.1-mg., /l pn
0.25-mg. and 1-mg. tablets. vAuuOll
References: 1. Communication to Abbott
Laboratories, 1956. 2. Moyer, J. H. et al:
Deserpidine for the Treatment of Hyperten-
sion. Southern Medical J., 50:499, April,
1957.
• Trademark for Deserpidine, Abbott
134
Volume XUV
Number 2
simple, well-tolerated routine for "sluggish' older patients
one tablet t.i.d.
DECHOLIN'
“therapeutic bile”
Establishes free drainage of biliary system — effectively combats bile stasis and
improves intestinal function.
Corrects constipation without catharsis — copious, free-flowing bile overcomes tendency
to hard, dry stools and provides the natural stimulant to peristalsis.
Relieves certain G.I. complaints — improved biliary and intestinal function enhance
medical regimens in hepatobiliary disorders.
Decholin Tablets: (dehydrocholic acid, Ames) 3% gr.
j W 13757
AMES COMPANY, INC • ELKHART, INDIANA • AmesCompany of Canada, Ltd., Toronto
ddition of neomycin to the
e active Donnagel formula assures
m more certain control of most
f the common forms of diarrhea.
Neomycin is an ideal antibiotic
fteric use: it is effectively
b.teriostatic against neomycin-
siptible pathogens; and it is
latively non-absorbable.
The secret of Donnagel with Neomycin’s clinical dependability
lies in the comprehensive approach of its rational formula:
Rgbins
Informational
literature
available
upon request.
COMPONENT
in each 30 cc. (1 fl. oz.)
ACTION
BENEFIT
Neomycin base (210.0 mg.)
(as neomycin sulfate U.S.P.)
antibiotic
Affords effective intestinal bacte-
riostasis.
Kaolin (90 gr.)
adsorbent,
demulcent
Binds toxic and irritating substan-
ces. Provides protective coating
for irritated intestinal mucosa.
Pectin (2 gr.)
protective,
demulcent
Supplements action of kaolin as
an intestinal detoxifying and
demulcent agent.
Dihydroxyaluminum
aminoacetate (0.25 Gm.)
antacid,
demulcent
Enhances demulcent and detoxi-
fying action of the kaolin-pectin
suspension.
Natural belladonna alkaloids: anti-
hyoscyamine sulfate (0.1037 mg.) spasmodic
atropine sulfate (0.0194 mg.)
hyoscine hydrobromide (0.0065 mg.)
Relieves intestinal hypermotility
and hypertonicity.
Phenobarbital (% gr.)
sedative
Diminishes nervousness, stress
and apprehension.
INDICATIONS: Donnagel with Neomycin
is specifically indicated in diarrheas or
dysentery caused by neomycin-suscep-
tible organisms: in diarrheas not yet
proven to be of bacterial origin, priorto de-
finitive diagnosis. Also useful in enteritis,
even though diarrhea may not be present.
SUPPLIED: Bottles of 6 fl. oz. At all pre-
scription pharmacies.
DOSAGE: Adults: 1 to 2 tablespoonfuls (15
to 30 cc.) every 4 hours. Children over 1
year: 1 to 2 teaspoonfuls every 4 hours.
Children under 1 year: y2 to 1 teaspoon-
ful every 4 hours.
ALSO AVAILABLE: Donnagel, the original
formula, for use when an antibiotic is not
indicated.
A. H. ROBINS CO., INC., RICHMOND 20, VA. •
136
Volume XLI
Number 2
j
an important
first step
in the care
of the
infant’s skin
DESITIN
OINTMENT
No other product is more effective in healing the baby’s
skin and keeping it clear, smooth, supple, and free from
diaper rash • dermatitis • intertrigo
heat rash • chafing • irritation • excoriation
Soothing, protective, healing1-5 Desitin Ointment — rich in cod
liver oil — is the most widely used ethical specialty for the over-all
care of the infant’s skin.
May we send samples and literature?
DESITIN CHEMICAL COMPANY, Providence, R. I.
1. Grayzel, H. G., Heimer, C. B., and Grayzel, R.W.: New York St. J. Med. 53:2233, 1953. 2. Heimer,
C. B., Grayzel, H. G., and Kramer, B.: Archives of Pediatrics 68:382, 1951. 3. Behrman, H. T.,
Combes, F. C., Bobroff, A., and Leviticus, R.: Ind. Med. & Surgery 18:512, 1949. 4. Sobel,
A. E.: Scientific Exhibit, A.M.A. Meet. 1955. 5. Marks, M. M.: Missouri Med. 52:187, 1955.
*
m
4
Tubes of 1 oz„
2oz.,4oz.,and
1 lb. jars.
each in 10 Gm. tubes
Meti-Derm,* brand of prednisolone topical.
Meticortelone,® brand of prednisolone.
allergic
eczemas
Meti-Derm cream 0.5%
water washable — stainless (Meticortelone, free alcohol)
Meti-Derm ointment 0.5%
5 mg. Meticortelone and 5 mg. Neomycin Sulfate with Neomycin
for comprehensive topical therapy
138
Volume XL1 V
N UMBER 2
from allergic effects of pollen
CO-PYRONIL
(Pyrrobutamine Compound, Lilly)
— with minimal side-effects
Each Pulvule ‘ Co-Pyronil’
provides:
‘Pyronil’ 15 mg.
( Pyrrobutamine , Lilly)
‘HistadyV 25 mg.
( Thenylpyramine , Lilly)
‘ Clopane
Hydrochloride’ 12.5 mg.
( Cyclopentamine
Hydrochloride , Lilly)
This is the season when we all yearn for escape from every-
day life, to “commune with nature.” But, to the one allergic
to pollen, this craving is usually easier to endure than the
penalty of exposure to pollen.
Such a patient is grateful for the relief and protection
provided by ‘Co-Pyronil.’ Frequently, only two or three
pulvules daily afford maximal beneficial effects.
‘Co-Pyronil’ combines the complementary actions of a
rapid-acting antihistaminic, a long-acting antihistaminic,
and a sympathomimetic.
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A
758021
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, August, 1957 No. 2
The Evaluation of Procedures Used in
The Diagnosis of Hemorrhagic Diseases
L. W. Diggs, M.D.
MEMPHIS, TENN.
It is discouraging for the average physician
who desires information about developments in
in the field of blood coagulation to be confronted
with so much that is unfamiliar and so much that
he cannot understand. So many new terms, new
diseases and new tests have been introduced that
the current medical literature regarding blood
coagulation appears to be written in a foreign
language. As additional factors are discovered,
new theories of blood coagulation are spun and
complicated “snakes-by-the-tail” diagrams are
presented. Orientation is needed in order to eval-
uate the relative importance of procedures used
in the diagnosis and management of hemorrhagic
diseases.
Research in blood coagulation and related
i problems may be compared with the investigations
of the corona of the sun when the sun is in total
eclipse. The study of the gases and flames which
extend as tenuous and fleeting streaks into the
outer darkness gives us essential information
about the chemistry of the sun and about the
solar mechanisms which cannot be obtained in
any other way. On the other hand, the major
light and energy of the sun do not come from the
relatively thin and luminous envelope that sur-
rounds the sun, but from the central mass. In a
like manner, we are dependent for advance of
knowledge concerning the factors involved in
blood coagulation on investigations of a highly
technical nature at the nebulous peripheral zone
which separates the known and the unknown.
The procedures which are of greatest value in
everyday practice are the time-honored history,
physical examination, screening laboratory tests
and the more simple tests.
Professor of Medicine, University of Tennessee College of
Medicine, and Director, Department of Medical Laboratories,
University of Tennessee — City of Memphis Hospitals, Memphis,
Tenn.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 6, 1957.
It is the purpose of this paper to discuss some
of the more practical procedures and laboratory
tests.
History
The personal and family history is more im-
portant than all of the laboratory tests in the
diagnosis of diseases characterized by abnormal
bleeding. Every individual is daily exposed to
tests of trauma. We bump into objects, wear
tight clothing, brush our teeth and shave. Cuts,
operations, extraction of teeth, menstruation and
childbirth reveal the presence of hemorrhagic
disease, if it is present. The pattern of many of
the hereditary diseases is so characteristic that
the diagnosis can be made often from the history
alone.
The history should begin at the time of birth
and include infancy, preschool, school and adult
years as well as recent events. There should be
a review of all symptoms with specific questions
asked about epistaxis, gingival bleeding, bruises,
petechiae, hemoptysis, vomiting of blood, rectal
bleeding, hematuria, hemarthrosis and abnormal
uterine bleeding. Specific questions should be
asked concerning allergy, diet, drugs and exposure
to chemicals and poisons. Information about the
degree and manner of bleeding and response to
various forms of therapy are essential.
Physical Examination
The physical examination gives many leads
concerning the diagnosis of hemorrhagic disease.
Enlarged lymph nodes and splenomegaly suggest
leukemia and other primary diseases of the hem-
atopoietic system. Jaundice, hepatomegaly and
spider nevi suggest liver disease. Eyeground
changes may suggest bacterial endocarditis or
miliary tuberculosis, which may be characterized
by hemorrhage as a presenting sign. Puffiness of
the eyes, pallor and hypertension suggest ne-
140
DIGGS: PROCEDURES IN DIAGNOSIS OF HEMORRHAGIC DISEASES
Volume XLIV
Number 2
phritis, which is a common cause of hemorrhagic
phenomena. A lump in the breast, a pigmented
mole or a prostatic mass may be indicative of a
tumor, which in its metastasis may be the expla-
nation for thrombocytopenic purpura or fibrino-
genopenia.
The distribution of the hemorrhagic lesions is
often of diagnostic value. In the majority of
patients with purpura of the vascular type the
pigmented lesions involve the lower legs and are
maximal over the extensor surfaces and pressure
points. In purpura of the Henoch-Schbnlein type,
the lesions are more likely to be over the face,
elbows, buttocks and shins, with relatively few
lesions on the flexor surfaces and trunk. Senile
purpura is characterized by superficial hemor-
rhages over the backs of the hands and pretibial
areas. The petechiae of fat embolism are more
numerous over the lateral thorax and shoulder
areas. Patients with hemophilia and related dis-
eases have ecchymoses limited to the sites of most
recent trauma. In this disease the muscles and
joints are often involved, causing deformity and
disability.
The type of hemorrhagic lesion is also of aid
in diagnosis. In thrombocytopenic purpura there
are small hemorrhages without peripheral edema
or erythema. In allergic purpuras there is likely
to be a zone of erythema and edema around the
central hemorrhage. A hemorrhagic lesion with a
pale center suggests embolic disease. An area of
hemorrhagic necrosis which does not bleed or a
skin discoloration of the stocking and glove type
suggests occlusive vascular disease. A red spot
which partially blanches on pressure is character-
istic of telangiectasia. Pigmented and hemor-
rhagic lesions which itch and have linear scratch
marks are indicative of an allergic state.
Black-and-blue areas of the arms and legs
of women who bruise easily, in the absence of
other signs of abnormal bleeding, are indicative
of hereditary purpura simplex. The condition is
called by some “the Devil’s Nips” because the
wife has to have someone to blame when the
husband demands to know how she was pinched
in such unusual places.
Children with hemophilia and related diseases
have elastic tissues which hold the blood from
ruptured superficial vessels in tight compartments,
giving localized tumor-like lesions. In adults with
hemophilia the blood extravasates widely and may
involve a large area and deeper structures.
Petechiae limited to the face, neck, shoulders
and arms suggest increased capillary fragility
caused by breath holding or severe coughing. An-
nular bands of purpura or purpuric lesions limited
to distal areas may be explained on the basis of
foundation garments, arm bands or garters. Pecul-
iar hemorrhagic lesions limited to the anterior
surfaces of the arms and legs suggest self-induced
lesions (purpura factitia) and should lead to
close inspection for tooth or fingernail marks or
evidences of skin puncture.
Laboratory Tests
The blood smear is the most important of the
laboratory tests, for it may reveal the presence
of leukemia, aplastic anemia or thrombocytopenia.
Enumeration of platelets in 100 oil immersion
fields at the thin end of an ordinary blood smear,
stained with Wright’s stain, is considered to be
the most reliable of the platelet counting methods
in the hands of the average technologist. No
platelet counting methods are accurate. The smear
method has an error of more than 100 per cent
when the platelet count is normal or increased,
but becomes more accurate and reproducible as
the thrombocyte count decreases. The normal
count is 300 or more per 100 oil immersion fields.
A count below 100 per 100 oil immersion fields is
significantly low. In thrombocytopenic states
there are often less than 50 and sometimes there
is less than 1 per 100 fields.
The bleeding time by the Ivy method is in-
formative as a screening test for hemorrhagic
disease. In this procedure venous stasis is pro-
duced by a blood pressure cuff above the elbow
inflated to 40 mm. Hg. The skin of the forearm
is punctured to a depth of 4 mm. with a “Hem-
olet” lancet or equivalent. It is preferable to
make two puncture wounds instead of one, for
there is considerable variation in the blood flow
from different wounds. The drops of blood are
collected on filter paper at 30 second intervals
until the flow ceases. The technologist should
save the filter paper on which the drops of blood
are absorbed so that the physician can evaluate
the adequacy of the test. The normal bleeding
time by the Ivy method is two to six minutes. A
bleeding time of six to 10 minutes is equivocal.
A bleeding time longer than 10 minutes is signif-
icant. Continuance of the test beyond 15 minutes
is not recommended.
Routine preoperative tests in order to pre-
dict the tendency to bleed at the time of surgerj
J. Florida, M. A.
August, 1957
DIGGS: PROCEDURES IN DIAGNOSIS OF HEMORRHAGIC DISEASES
141
are not necessary, provided the physician obtains
a history, examines the patient, and orders the
usual hematocrit determination, white blood cell
count, smear examination and urinalysis. Tests
for hemorrhagic tendency on all surgical patients
are not required by standardizing agencies. A
surgeon would not be considered as negligent if
he did not perform tests for hemorrhagic disease
on all of his patients. Many surgeons, however,
prefer to perform preoperative tests routinely.
In this case, the tests of choice would be the
thrombocyte count by the smear method and
the bleeding time by the Ivy method. The bleed-
ing time from a puncture wound of the finger
tip is not reliable and should not be accepted as
a standard procedure.
The coagulation time by any method is of
limited value in the detection of bleeding tend-
ency, for the test may reveal no abnormality in
mild hemophilia and other related diseases. The
coagulation time of capillary blood by the capil-
lary tube or other micro methods is worthless.
If the history or physical examination or screen-
ing laboratory procedures furnish evidence of
hemorrhagic disease or of conditions commonly
associated with hemorrhagic tendency, a battery
of preoperative tests should be performed which
include the bleeding time, tourniquet test, test
tube coagulation time, observation of the clot,
and serum and plasma prothrombin activity.
The coagulation test recommended is the
four tube method, using venous blood. Care
should be taken to withdraw the blood and to
place it in the tubes so that frothing or foaming
of the blood does not occur. If there is difficulty
in venipuncture, the test is unreliable, for ad-
mixture of blood with tissue thromboplastin will
shorten the clotting time and will mask a de-
ficiency of plasma components. The clotting time
of normal blood by the multiple tube method is
15 to 25 minutes. A coagulation time greater
than 30 minutes is significant. Many efforts
have been made to increase the sensitivity of the
coagulation time by dilution, the use of plastic
tubes and the coating of tubes with various non-
wettable substances, but the clotting times ob-
tained with these methods have been erratic and
unpredictable and have not proved to be of clini-
cal significances.
After the clotting time has been performed,
the clots should be saved for observation of de-
gree of clot retraction, the volume of red cells
which escape from the clot and the character of
the clot. In order to measure the volume of ex-
pressed serum, it is recommended that 3 to 5
ml. of blood be placed in a graduated, conical
test tube. A wooden applicator is inserted and
the blood allowed to clot. After four hours
at room temperature, the tube is tilted and the
clot, attached to the applicator stick, gently re-
moved. The amount of serum expressed from the
clot is measured and reported in terms of per
cent of original volume. A normal clot on re-
traction will squeeze out 40 per cent or more of
original volume as serum. A defective clot, on the
contrary, will not retract as well and will there-
fore yield less than 40 per cent of serum.
In order to measure the amount of serum re-
maining on the clot, the volume of the clot is
determined. By subtracting the hematocrit value
from the volume of the clot the extracorpuscular
clot volume is obtained. The normal clot will be
relatively dry and will contain 0 to 20 per cent
of serum. Values above 20 per cent are indicative
of a defective clot.
In obstetric or surgical emergencies in which
there is suspicion of fibrinogenopenia and/or
fibrinolysis, the observation of the clot character
at intervals during the treatment procedure will
give valuable information about the condition of
the patient and the need for fibrinogen therapy
(table 1).
Table 1. — Fibrinogen Deficiency
(Defibrination and Fibrinolysis)
Clinical Signs
Excessive bleeding from uterus or surgical wound
Bleeding through packs
Spontaneous bleeding from mucous membranes
Bleeding from needle puncture wounds
Ecchymoses of skin
Laboratory Signs
Prolonged coagulation time
Escape of red cells from clot
Small clot
Lysis of clot
An absence of a clot means complete afibrinogene-
mia or fibrinolysis (fig. 1). A small clot from
which a large volume of red cells has escaped is
indicative of fibrinogenopenia, whereas a relatively
large clot from which few red cells have escaped is
indicative of normal fibrinogen.
The tourniquet test is one of the most sensi-
tive and least informative of the standard so-
called “hemorrhagic tests,” for a few patients with
no demonstrable hemorrhagic disease may have
petechiae under conditions of venous stasis and
hypoxia. A positive tourniquet test (capillary
fragility test) in the absence of a history of bleed-
142
DIGGS: PROCEDURES IN DIAGNOSIS OF HEMORRHAGIC DISEASES
Volume XLIV
Number 2
CLOT OBSERVATION TEST
NO POOR GOOD
V
Fig. 1. — The character of the clot and the amount of
red cells that escape from the clot are of value in detect-
ing a defect in fibrinogen and in evaluating the response
to therapy.
ing and physical signs of abnormality is not a
contraindication to surgery. On the other hand,
the tourniquet test may be the only sign of ab-
normality as revealed by the special laboratory
tests. In the presence of a history of abnormal
bleeding or spontaneous bleeding, the tourniquet
test is to be given consideration.
The plasma prothrombin activity test by the
one stage method of Quick should be included as
a part of the hemorrhagic study on patients with
symptoms and signs of bleeding, for this test is
of great value in separating the diseases in which
there is defective thromboplastin formation (first
stage of coagulation) from the second stage of
prothrombin conversion (table 2).
Table 2. — One Stage Prothrombin Time
(Thromboplastin + Ca + Plasma)
Normal
Prolonged
Hemophilia
P.T.C. Deficiency
P.T.A. Deficiency
Thrombasthenia
Prothrombin Deficiency
Labile Factor Deficiency
Stable Factor Deficiency
Fibrinogen Deficiency
Increased Anticoagulants
The serum prothrombin activity test has now
been used for a sufficiently long time to prove its
value in the detection of hemorrhagic diseases
which may not be revealed by the platelet count,
bleeding time, coagulation time and observation
of the clot. The serum prothrombin activity test
should be available and employed in selected
cases in every general hospital laboratory and
diagnostic center.
The thromboplastin generation test and tests
for accelerator factors and anticoagulants are not
practical in the average hospital and should not
be attempted unless special facilities are available.
These tests require the services of one or more
skilled technologists in the preparation of reagents
and in the performance of control tests. They
also require interpretation by a clinical pathol-
ogist with special training in blood coagulation
problems. If the physician has a patient with an
hereditary hemorrhagic anomaly or a bleeding
tendency which cannot be diagnosed by the more
simple tests, he should refer this patient to a
research or medical center for the performance
of the more complicated tests. A patient with
hereditary disease has the condition for a lifetime.
It would be more economical to have a thorough
examination on one occasion by an expert coagu-
lationist than to have incomplete tests performed
by untrained technicians on multiple occasions.
Summary
The most important diagnostic procedures are:
A. History
B. Physical examination
C. Screening laboratory procedures
1. Blood smear examination, including
thrombocyte count
2. Hematocrit reading
3. Leukocyte count
4. Urinalysis
The standard hemorrhagic tests recommended
are:
A. Thrombocyte count
B. Bleeding time (Ivy method)
C. Tourniquet test
D. Coagulation time (4 tube method)
E. Observation of the clot
F. Plasma prothrombin activity test (one
stage method, Quick)
G. Serum prothrombin activity test
The thromboplastin generation and other spe-
cial tests are necessary in selected patients, but
these tests are too complicated to be performed
in the average hospital.
J. Florida. M. A.
August. 1957
143
Anileridine as an Anesthetic Agent
John T. Stage, M.D.
JACKSONVILLE
Anileridine* (ethyl l-(4-aminophenethyl)-4-
phenylisonipecotate dihydrochloride; anileridine)1
. is a new narcotic agent with an analgesic potency
approaching that of morphine and several times
. greater than than of meperidine. The analgesic
effect begins within 15 to 30 minutes after ad-
ministration and lasts from five to six hours. In
dogs, subcutaneous administration of 8 mg. of
anileridine per kilogram of body weight produces
strong analgesia lasting for over six hours. Un-
like morphine, anileridine has shown no emetic
action in dogs. The compound is also effective
orally. Nalorphinet reverses the action of anileri-
dine, antagonizing both the analgesic effect and
the mild respiratory depression produced by the
drug.
Because of these properties, anileridine ap-
peared suitable for trial as a primary anesthetic
agent.
Narcotics are not newcomers to the field of
anesthesiology. In former years, when nitrous
oxide held sway as a primary anesthetic agent,
the use of heavy premedication was common, since
it had been discovered that a satisfactory course
under this gas could be more easily obtained if
large doses of premedicating agents were given.
The intravenous administration of meperidine
and scopolamine in combination has become a
well established form of premedication for laryn-
: goscopic, bronchoscopic, esophagoscopic, gastro-
scopic and cystoscopic procedures, providing
greater relaxation and freedom from pain than or-
al or subcutaneous premedication.
Anesthesiologists who had occasionally used
the intravenous route for preoperative medication
realized some years ago that narcotics were po-
ont tential anesthetic agents. In the past few years,
various combinations employing a narcotic as the
primary analgesic agent have been suggested in
the literature, the additional agents generally con-
si* listing of nitrous oxide, thiopental sodium and
but 1 .
[flltt From the Department of Anesthesiology, Rivedside Hospital,
Jacksonville.
Head before the Florida Society of Anesthesiologists, Jack-
sonville, Nov. 17, 1956.
Through the courtesy of Dr. S. Clyde Strickland, Merck &
Co., Inc., supplied the anileridine for this study.
Trademark adopted by Merck & Co., Inc., for anileridine is
Leritine.
tTrademark of Merck & Co., Inc., for its brand of nalorphine
hydrochloride is Nalline.
curare. The narcotic was either injected in single
intermittent doses or administered as an intrave-
nous drip. Introduction of the narcotic was ob-
viously an attempt to substitute an analgesic agent
for an ultra-short-acting barbiturate, the latter
having proved unsatisfactory not only because
of its lack of analgesic effect but also because of
the confusion and prolonged sleep following its
use.
Method of Study
To familiarize myself with the method, I chose
to combine meperidine hydrochloride with nitrous
oxide, thiopental sodium and d-tubocurarine, pro-
posing to use this combination on all patients
unless some contraindication existed. Any patient
with an easily obtainable intravenous route and
a free airway was a suitable candidate. The series
consisted of 300 patients, all of whom were sched-
uled to receive some narcotic in drip form. The
method of premedication in established use at
Riverside Hospital was retained: a barbiturate
at bedtime, a barbiturate one and one-half hours
preoperatively, and meperidine hydrochloride and
scopolamine one hour preoperatively. The dose
of these drugs varied according to the patient’s
age and weight.
The usual course of anesthesia with thiopental
sodium, nitrous oxide and curare proceeds ac-
cording to the following schedule: Induction be-
gins with the intravenous injection of from 5 to
10 cc. of a 2.5 per cent solution of thiopental
sodium. The agent is continued as a dilute in-
travenous drip (0.2 per cent solution), with tlY
flow adjusted to maintain the anesthetic lev"’
Nitrous oxide and oxygen are given in a 75’ i5
ratio by the semiclosed method in a total volu ne
ranging between 5 and 7 liters per minute. This
excess flow of gas aids in the removal of nitrogen
expired by the patient. d-Tubocurarine is added
intravenously in intermittent doses, with an initial
injection of from 3 to 6 cc., followed by smaller
volumes when necessary to ensure relaxation. The
patient’s respiratory efforts are supplemented by
pressure on the breathing bag during inspiration
for the entire course of the anesthesia, ensuring
adequate oxygenation and rapid loss of carbon
dioxide.
144
STAGE: ANILERIDINE AS AN ANESTHETIC AGENT
Volume XLIV
Numiiek 2
This method was continued with the addition
of meperidine hydrochloride. Intermittent use of
the drug was first attempted. Once the anesthetic
course had been in progress for five to 10 minutes,
the narcotic was administered intravenously. It
was soon discovered that doses above 25 mg.
produced apnea and hypotension. The depressant
effects of thiopental sodium on the respiratory
and circulatory centers necessitated smaller doses
than would ordinarily be given to a conscious pa-
tient. Additional doses of from 6 to 12 mg. of
meperidine hydrochloride were injected as re-
quired: that is, when increased respiratory rate,
quickening pulse, or increasing muscle rigidity
led me to believe that further analgesia was neces-
sary.
As experience with this method was acquired,
various modifications were tried. First, an attempt
was made to reduce the preoperative dose of me-
peridine. This did not prove wholly successful
since reduction of the preoperative dose was ap-
parently reflected by a need for additional drug
during surgery. The next step was to discontinue
the dilute thiopental sodium solution when the
surgical procedure had been in progress for 10
minutes, keeping the vein open with a 5 per cent
solution of glucose and water in order to provide
a means of giving further injections of meperidine
hydrochloride or d-tubocurarine. It must be kept
in mind that at this stage one is controlling an-
esthesia by means of an analgesic agent, a paraly-
zing agent and a not too potent gas. If the patient
is not observed closely, it is possible either to over-
dose with the narcotic or, conversely, to produce
inadequate anesthesia by excessive use of the re-
laxant drug.
Discontinuance of thiopental sodium early in
the surgical course permitted rapid recovery. It
was apparent that careful manipulation of the
drugs might render the patient capable of moving
and opening his eyes before being taken from the
operating table. This early recovery promised
certain advantages: a rapid return of reflexes
would reduce immediate postoperative morbidity
and would present fewer problems to personnel in
the recovery room.
Next, the method of Ausherman, Nowill and
Stephen2 was instituted. Meperidine hydrochlo-
ride was given in a dilute intravenous drip (0.5
mg. per milliliter), either continuously or inter-
mittently as required. As before, thiopental sodium
solution was discontinued as soon as adequate
anesthesia was established. An average of 75 mg.
of meperidine was required, less meperidine being
necessary for each succeeding hour of operative
time. Far less hypotension and respiratory de-
pression were encountered with this method than
with the intermittent single dose method. The
gradual decrease in respiratory rate provided a
highly sensitive index for decreasing the rate of
the injection.
Clinical Trial of Anileridine
Once experience had been gained, anileridine
was substituted for meperidine. It was believed
that the use of this agent in a dilute drip would
be the most satisfactory method. The single small
dose method was tried in enough cases to check
the potency of the compound, and then the dilute
drip method was employed. For this study, anileri-
dine was tried in 100 cases.
Because of the stated potency of anileridine.
an initial dose of from 6 to 12 mg. was elected.
At no time was 25 mg. exceeded as a single dose.
Because of the difference between the hydrogen
ion concentration of thiopental sodium and the
analgesic, flocculation occurred when these two
drugs were mixed, even with the dilute (0.2 per
cent) solution of thiopental sodium. Flocculation
was severe enough to block the intravenous tubing
and needle. Mild respiratory depression occurred
even with a dose as small as 12 mg.
Using the concentration of the meperidine drip
0.5 mg. per milliliter) as a basis, a solution of
anileridine was prepared in a concentration of 0.3
mg. per milliliter. As with meperidine, the con-
tinuous drip method proved more satisfactory than
intermittent single dose administration. Thio-
pental sodium could usually be discontinued as
soon as the patient was asleep. The respiratory
depression and bouts of mild hypotension occur-
ring with intermittent injections were not as pro-
nounced, despite the rather rapid rate at which
the dilute solution was run in during the early pe-
riod of anesthesia. Study of this series of cases
suggests that from 30 to 60 mg. of anileridine is
utilized per hour, the amount varying with the
type of surgical procedure. The average dose for
procedures one and one-half to two hours in length
was 35 to 50 mg., as compared with the average
dose of 75 mg. of meperidine. The dilute solution
can be so titrated that the great majority of pa-
tients can be awakened on the table. Discontinu-
ance of the anileridine solution five to 10 minute'
prior to the completion of the operation makes h
possible to time awakening to coincide with the
removal of the mask. It is noteworthy that pair
J. Florida, M. A.
August, 1957
STAGE: ANILERIDINE AS AN ANESTHETIC AGENT
145
does not return immediately, postoperative anal-
gesia enduring for as long as two or three hours.
Excitement during the awakening appears to be
less after anileridine than after thiopental sodium.
Discussion
A sufficient number of endotracheal intuba-
tions were performed in completing this series to
establish that narcotic agents either in single doses
or in continuous drip solution obtund the laryn-
geal reflexes. Smaller quantities of curare and
thiopental sodium were required for smooth un-
hurried intubation. Less “bucking” occurred fol-
lowing introduction of the endotracheal tube.
The cases in which anileridine was used rep-
resented the general run of surgical procedures.
Two mitral commissurotomies and one ligation
of a patent ductus arteriosus were successfully
completed. Two thoracic procedures — a lobectomy
and a pneumonectomy — and one craniotomy were
among the other operations of particular intere.-t.
No difficulty for which this narcotic agent could
be held responsible was encountered.
In the more satisfactory cases r.f the series
adequate time was the common denominator.
Enough time should be allowed at the beginning of
the operation to ensure an adequate level of nar-
cotic in the blood stream and a concomitant flush-
ing-out of nitrogen by the semiclosed method.
The required level of narcotic can be attained by
a more rapid drip at the beginning of the opera-
tion. Liberation of nitrogen requires adequate
volume flow of gases per minute and open ex-
haust valves in the machine.
In conclusion, it may be said that narcotics
are now clinically recognized as primary anesthetic
agents. Anileridine, a new narcotic, has proved to
be adaptable to this particular method. The rea-
son for substituting a narcotic for an ultra-short-
acting barbiturate is to provide analgesia rather
than sedation; the value of this substitution lies
in the possibility for a smoother anesthetic course
and a more easily controllable awakening time.
This method is not one for the occasional anes-
thetist.- It requires breath-by-breath supervision
and should be attempted only by those willing to
devote the necessary time.
Summary
In a series of 100 cases in which various sur-
gical procedures were performed, anileridine was
administered in place of meperidine as a primary
anesthetic agent, in conjunction with nitrous oxide,
thiopental sodium and d-tubocurarine. Initial
trials with single intermittent doses were later
abandoned in favor of the continuous drip method.
The drug appeared to be more potent than
meperidine, and with the drip method no signifi-
cant apnea or hypotension occurred. Patients
responded to command before leaving the operat-
ing table, and manifested little excitement on
awakening. Analgesia appeared to persist up to
three hours postoperatively.
The new narcotic appears to be a safe and
satisfactory compound for use as a primary anes-
thetic agent. The combination of anileridine with
nitrous oxide, thiopental sodium and d-tubocura-
rine provides an adequate, controllable, nonex-
plosive mixture.
References
1. Weijlard, J.; Orahavats, P. D.; Sullivan, A. P. Jr.; Purdue,
G.; Heath, F. K., and Pfister, K., 3rd: New Synthetic Anal-
gesic. J. Am. Chem. Soc. 78:2342-2343 (May 20) 1956.
2. Ausherman, H. M.; Nowill, W. K., and Stephen, C. R.:
Contrdlled Analgesia with Continuous Drip Meperidine,
Analysis of One Thousand Cases, J. A. M. A. 160:175*179
(Jan. 21) 1956.
Riverside Hospital.
“Doctors at Work”
New Cover Series Begins
On the cover of The Journal this month is the first in a series of pictures show-
ing doctors at work. This series replaces the picture of the Association’s headquar-
ters which has been shown on the cover, with one exception, since November 1956.
Believing that an attractive cover encourages reader interest, it is hoped that
subscribers to The Journal will find the new cover pictures not only interesting
but a source of inspiration.
An attempt will be made to portray as many phases of medical activities as
possible, limited by the availability of appropriate photographs.
146
Volume XLIV
Number 2
Progressive Synergistic Bacterial
Gangrene of the Skin
Edward R. Annis, M.D.
Alma Trappolini, M.D.
Banning G. Lary, M.D
MIAMI
AND
Wayne B. Martin, M.D.
CORAL GABLES
Progressive synergistic bacterial gangrene of
the skin is a formidable clinical entity character-
ized by uncommonly severe pain at the site of a
progressive necrosis of the skin. The lesion has a
characteristic appearance arising from its three
separate and distinct zones (fig. 1). The outer
erythematous zone or halo ranges from 0.5 to 4
cm. and fades gradually into the surrounding skin.
The middle or necrotic zone is blue-black and
elevated sharply 0.5 to 1 cm. above the surround-
ing halo. The inner or granulating zone consists
of necrotic skin, usually gray, resembling suede
leather floating unattached on granulations. Cul-
len1 is credited with publishing the first case re-
port in 1924. Brewer and Meleney2 in 1926 estab-
lished the essential bacteria. Since Cullen's report
there have been over 100 reports of typical cases.
In 1945 Stewart-Wallace3 reviewed 37 cases then
in the literature. Dodd, Heekes and Geiser4 add-
ed 49 cases up to 1939. Since then marry others
have contributed to the knowledge of this dis-
ease.5-24 Brewer and Meleney2 showed the bac-
teria in the erythematous halo to be predominant-
ly a microaerophilic nonhemolytic streptococcus
associated synergistically with hemolytic Staphylo-
coccus aureus in the middle or gangrenous zone.
The lesion was reproduced in animals by Me-
leney21 only by injection of the two organisms in
the identical area of the tissue, thus justifying the
name “progressive bacterial synergistic gangrene.”
He found that if the sites of injection of the or-
ganisms were 1 cm. apart, the lesion failed to
develop. The streptococcus is believed to invade
the tissue (erythematous halo) and prepare it for
destruction by the staphylococcus, which produces
the middle or gangrenous zone. Tension sutures
and drainage tubes have frequently been the site
of origin of this lesion, but apparently it may
begin in any infected lesion of the skin.
The microscopic pathology is usually described
as acute and chronic, nonspecific inflammatory
ulcer of the skin. Gangrene of the tissue is super-
ficial, but inflammatory changes usually occur
down to or through the muscle fascia. The
changes are primarily perivascular infiltration of
inflammatory cells. Only one author reported
thrombophletitis in the subcutaneous tissue and
cited this as the cause of the necrosis of the skin.
The lesion is noncontagious.
The most characteristic symptom is extremely
severe pain at the site of a superficial ulcer of the
skin having a characteristic appearance. Anorexia,
exhaustion and mental depression, as well as
hypoproteinemia, anemia, and electrolyte imbal-
ance, appear as the lesion progresses.
Treatment
Many kinds of therapy have been used in-
cluding quartz light, hypertonic saline, immunized
blood transfusion, maggots, roentgen therapy, vari-
ous antiseptics and vitamins, minerals, salvarsan
and vaccine, without satisfactory results. The cur-
rent therapy of choice consists of immediate bac-
terial analysis with determination of antibiotic
sensitivity followed by intensive treatment with
drug or drugs of choice.
If a reasonable period of treatment fails to halt
the progress of the lesion, excision of the ulcer
en bloc with application of zinc peroxide dress-
ings should proceed without further delay. The
excision should include 3 cm. of skin beyond the
erythematous halo and all of the subcutaneous
tissue to the deep fascia. Immediate grafting
would appear to be in order; however, there is
some danger of spreading the lesion to the graft
site. It may be preferable to maintain dressings
saturated with zinc peroxide solution on the de-
nuded area for seven to 10 days until a recurrence
seems unlikely before attempting grafting. The
conscientious application of zinc peroxide paste
dressings frequently enough to keep the dressings
constantly moist is essential to the destruction of
J. Florida. M. A.
August, 1957
ANNIS, LARY, TRAPPOLINI AND MARTIN: GANGRENE OF THE SKIN
147
Fig. 1. — Photograph of edge of ulcer demonstrating
the three zones.
the microaerophilic streptococcus that contami-
nates the surface of the area after excision. Peni-
cillin-4 and bacitracin25 have been curative, ob-
viating surgery in some cases. Side contaminants
such as Escherichia coli and Pseudomonas pyo-
cyanea may produce penicillinase and thus make
it ineffective.25
Many fatalities have occurred as the result of
this entity, but with the use of the plan of treat-
ment described deaths should be rare.
Report of Case
On April 1, 1955, the patient was first seen with cel-
lulitis and lymphadenitis of considerable degree on the
left side of the neck following extraction of a tooth. She
elected, for financial reasons, not to be hospitalized and
was given 300,000 units of Wycillin intramuscularly and
advised to use local heat at home. On the next day her
condition was unchanged, and Terramycin, 250 mg. four
times a day orally, was prescribed. A sample ampoule
of Tetracyn was given intramuscularly in the upper outer
quadrant of the left gluteal area.
By April 7 the inflammatory process had completely
subsided except for residual palpable nodes in the anterior
cervical triangle, but there was an area of cellulitis 5 cm.
in diameter at the site of the Tetracyn injection in the
left gluteal area. Heat to this area was advised, and on
April 9 several small blisters with serous content were
noted in the center of the erythematous gluteal area.
This area was uncommonly painful, causing loss of sleep
and much difficulty in walking, but there was still no
fluctuation. Heat was continued at home, and two days
later the patient reported that a small amount of drain-
age had escaped. On April 15 it was noted that there
was no deep draining sinus, rather a superficial ulceration
of the skin 3 cm. in diameter with a bluish black, 2 mm.
margin of skin surrounded by an erythematous halo
measuring 2 cm. On April 18 the ulceration measured
4.5 cm.; the black margin of skin was slightly elevated
and 0.5 cm. wide with the red halo of erythema un-
changed. It then was recognized that this was probably
progressive synergistic bacterial gangrene of the skin, and
the patient was admitted to St. Francis Hospital in Mi-
ami Beach.
On admission, laboratory work was as follows: Urin-
alysis revealed a faint trace of albumen, 2 plus acetone
and 4 to 6 white blood cells. Blood analysis showed
4,340,000 red blood cells with a hemoglobin estimation
of 12.3 Gm. and 15,500 white blood cells with 94 per
cent polymorphonuclear cells and 6 per cent lymphocytes.
The VDRL reaction was negative.
Panmycin, 500 mg. every six hours, was given intra-
muscularly with hot packs locally to the lesion until April
Fig. 2.- — Twenty-nine days after injection the ulcer
was large and was excised the next day.
21 when culture revealed Staph, aureus sensitive to Fura-
dantin, Chloromycetin and bacitracin. Chloromycetin, 100
mg. every four hours, with local hot packs was given
until April 26 with no effect on progress of the lesion.
At this point 20,000 units of bacitracin intramuscularly
every eight hours and 2,000,000 units of intravenous
crystalline penicillin every 24 hours with local application
of bacitracin to the ulcer were started. The temperature
to April 21 had not exceeded 99 F. On April 30 baci-
tracin was increased to 25,000 units every six hours.
It was obvious on May 1 that the ulcer was progress-
ing steadily (fig. 2), and on the next day excision of the
ulcer was carried out. A 2 cm. margin of normal skin
beyond the border of the erythema was included along
with all subcutaneous tissue down to the fascia. The
pathologic report was an acute and chronic inflammation
of the skin, nonspecific, the specimen measuring 21 by
20 by 3.5 cm. Grafting of the defect was not attempted
at this time, and a dressing saturated with 40 per cent
aqueous solution of medicinal zinc peroxide was applied.
From April 22 to April 25 the temperature spiked progres-
sively daily until on May 3, the day following excision,
it reached 104 F. Thereafter it fluctuated between 99 and
100 F. until June 9 when it dropped to normal for the
remainder of the hospital stay. The high temperature on
May 3 was believed to be the result of a pelvic cellulitis
accompanying a spontaneous abortion.
Fig. 3. — Recurrence is seen on left margin of area
excised nine days preceding this picture.
148
ANNIS, LARY, TRAPPOLINI AND MARTIN: GANGRENE OF THE SKIN
Volume XUV
Number 2
Fig. 4. — Dorsal view of defect after grafting. Epi-
thelialization is complete. On May 1, 1956 no scar con-
tractures had developed.
After excision the bacitracin and penicillin were dis-
continued, and Panmycin, 250 mg. every six hours, with
continuous local wet dressings of a solution of 300,000
units of penicillin per liter were used. Daily urinalysis
during this period revealed only faint traces of albumin
with occasional cells.
On May 11 three marginal recurrences were observed
(fig. 3). Split thickness grafts were taken from the right
thigh, and after this area was dressed to prevent con-
tamination, the recurring lesions were excised with a
margin of 2 cm. of normal skin. Grafts were placed and
Aureomycin-impregnated gauze with zinc peroxide solu-
tion about the periphery of the excision was placed in a
pressure dressing. The pathologic report was acute and
chronic inflammation of the skin with ulceration, the
three specimens of skin and subcutaneous tissue measur-
ing 15 by 15 by 2 cm., 5 by 3 by 2 cm., and 3.5 by 1.8
by 1.5 cm. Thereafter, the Aureomycin gauze was used
to dress graft, and zinc peroxide solution was used on the
skin margins daily.
By May 19 two recurrences were noted on the margins
of the lesion and these areas were excised with the taking
of 3 cm. of normal skin beyond the edge of the erythe-
matous halo. At this time the graft site was dressed
for the first time, and three typical ulcers were noted on
the donor area. These were excised, with the taking of
as wide an area of normal skin as described previously.
The pathologic report was acute and chronic inflamma-
tion of the skin and multiple skin ulcers, the six speci-
mens measuring 2.3 by 2 by 2.1 cm., 7.5 by 4.2 by 1.2
cm., 5 by 5.5 by 3 cm., 6 by 3.2 by 3 cm., 3.1 by 2.8 by
1 cm. and 3 by 3.3 by 2 cm. The excised areas of the thigh
and of the parent lesion were flooded with zinc peroxide
solution and after 24 hours these areas were flooded with
this excellent medication every 24 hours. On May 21 the
total protein was 5.7 Gm. with 3.3 Gm. of albumin and
2.4 Gm. of globulin. The gamma globulin fraction was
.85 Gm. per hundred cubic centimeters. The granulating
areas (only 70 per cent of the graft “took”) remained
clean, and by June 14 only small areas remained un-
epithelialized. The application of zinc peroxide was con-
tinued up to June 10.
Blood and electrolyte solutions were given as necessary
throughout the period of hospitalization. Altogether four
cultures were made with the use of anaerobic technic each
time, but the streptococcus was never isolated.
It was almost impossible to persuade the patient to
eat. Her caloric intake was much below minimum re-
quirement, and she lost 22 pounds while hospitalized.
Forced feeding through an indwelling tube was not tol-
erated by the patient. Vitamin C, 1,000 mg. along with
multivitamins, was given daily, orally after the first ex-
cision. Liberal doses of narcotics were necessary to con-
trol the pain of the lesion, particularly from April 18 to
the time of the first excision on May 2. After the last
excision the narcotic consumption precipitously declined,
and the anorexia and malaise improved remarkably. On
August 30 the photograph shown in figure 4 was taken in
the office, revealing great loss of tissue, but showing the
lesion completely epithelialized and asymptomatic. She
has gained 18 pounds in two months and feels she has
completely recovered.
Discussion
Although great pains were taken to culture the
organisms (including cultures from the cut sur-
faces of tissue in the halo zone), the nonhemolytic
streptococcus was never cultured. Perhaps the
antibiotics used prior to culture interfered. Care-
ful anaerobic methods are necessary to grow the
streptococcus.-6
The literature leads one to the conclusion that
any infected wound may become the site of this
lesion. The pH of Tetracyn is 3.5, and we ob-
served for one month another case of fat necrosis
resulting from intramuscular injection of this drug
that was suspected of being a “Meleney’s ulcer.”
There is no intention to incriminate Tetracyn as
the cause of this lesion. It seems likely, however,
that an area of fat necrosis produced by the injec-
tion of Tetracyn was the lesion that became in-
fected to produce the progressive synergistic bac-
terial gangrene of the skin.
The ability of this ulcer to spread to other
areas of the body — in this case the donor site —
is emphasized by this case. Fortunately wide ex-
cision and intensive zinc peroxide therapy cured
these lesions promptly.
It is difficult to overemphasize the extreme pain
associated with the lesion. Even while the lesion
was small (5 cm. in diameter), the patient found
it difficult to walk and almost impossible to sleep.
Her absolute refusal to recline on other areas than
the opposite hip demanded a maximum effort by
the nursing staff to prevent a decubitous ulcer of
this area. Needless to say, the constant and ef-
ficient nursing care from this standpoint and that
of nutrition was largely responsible for her recov-
ery.
Since no recurrence followed the most zealous
postexcision application of zinc peroxide paste, it
seems reasonable to conclude that it was essential
to the successful outcome of this case, which failed
to respond to the antibiotics. Meleney27 has
urged its use in such cases. Medicinal zinc perox-
ide should be sterilized in an oven for four hours
at 140° centigrade. Water suspension is best, but
it may be used in Carbowax (polyethylene gly-
col), a water-soluble base in areas difficult to keep
moist. Its end products are zinc oxide and zinc
hydroxide and these are harmless chemicals to the
tissue. It is obviously important that the zinc
peroxide be activated, and there is a simple test
to determine its activation.27
J. Florida, M. A.
August, 1957
ANNIS, LARY, TRAPPOLINI AND MARTIN: GANGRENE OF THE SKIN
149
Conclusion
A case of progressive synergistic bacterial gan-
grene of the skin resistant to antibiotic therapy is
presented. It required three separate surgical at-
tacks on recurrences and spread to other areas of
the body (donor site) before it finally was con-
trolled.
The appearance of a black middle zone in any
spreading ulcer of the skin demands consideration
of progressive synergistic bacterial gangrene of
the skin in the differential diagnosis. Expeditous
culture and antibiotic sensitivity studies followed
by intensive antibiotic therapy are imperative. If
the lesion continues to progress after reasonable
trial on the proper antibiotics, wide excision is
mandatory in order to prevent considerable de-
formity resulting from tissue loss and/or death.
Zinc peroxide is essential in the treatment of those
lesions requiring excision.
References
1. Cullen, T. S.: Progressively Enlarging Ulcer of Abdominal
Wall Involving Skin and Fat, Following Drainage of Ab-
dominal Abscess Apparently of Appendiceal Origin. Suig.,
Gynec. & Obst. 38:579-582 (May) 1924.
2. Brewer, G. E., and Meleney, F. L. : Progressive Gangrenous
Infection of Skin and Subcutaneous Tissue Following Oper-
ation for Acute Perforative Appendicitis; Study in Sym-
biosis, Ann. Surg. 84:438-450 (Sept.) 1926.
3. Stewart-Wallace, A. M.: Progressive Post-Operative Gan-
grene of Skin, Brit. J. Surg. 22: 642-656 (April) 1935.
4. Dodd, H.; Heekes, J. W., and Geiser, H.: Progressive Post-
Operative Gangrene of Skin, Arch. Surg. 42:983-1002
(June) 1941.
5. Pergola and Rosenfeld: Progressive Cutaneous Gangrene
Following Hartmann Operation for Rectosigmoid Cancer:
Case, Mem. Acad, de chir. 64:1177-1188 (Nov. 9) 1938.
6. Hulten, O. : Danger of New Operation After Progressive
Post-Operative Gangrene of Skin, Nord. med. (Hygeia)
1:775-776 (March 18) 1939.
7. Ducrey, E. : Progressive Post-Operative Cutaneous Necrosis,
Beitr. z. klin. chir. 169:650-662, 1939.
8. Touraine, A., and Duperrat, R.: Progressive Post-Operative
Gangrene of Skin of Abdomen and Thorax, Presse med.
47:131-132 (Jan. 25) 1939; id., Progressive Post-Operative
Gangrene. Ann de Dermat. et Syph. 10:257-285 (April)
1939.
9. Antomoh, G. M. : Cutaneous Gangrene After Appendec-
tomy; Clinical and Therapeutic Study of Case, Gazz. d.
osp. 61:99-104 (Feb. 4) 1940.
10. Brodie, I. H., and Bouek, C. : Progressive Post-Operative
Gangrene of Skin, Canad. M. A. J. 43:133-135 (Aug.) 1940.
11. Constantinescu, M. M., and Vasiliu, A.: Progressive Post-
Operative Gangrene of Skin, Rev. de Chir. Bucuresti
43:747-762 (Nov. -Dec.) 1940; id, : U oer Fortschreitenue
Hautnekrose Nach 1 ntramuskularer Iniektion, Zentralbl.
f. Chir. 67:859-861 (May 11) 1940.
12. Mester, A.: Progressive Postoperative Gangrene of Skin;
Report of Case, Am. J. Surg. 47:660-665 (March) 1940.
13. V ier, H. J.: Progressive Postoperative Gangrene of Ab-
dominal Wall, With Case Report, Surgery 7:334-341
(March) 1940.
14. Lichtenstein, M. E : Progressive Bacterial Synergistic
Gangrene; Involvement of Abdominal Wall; Report of Un-
usual Case, Arch Surg. 42:719-729 (April) 1941.
15. Gurruchaga, J. V.. and Manzoni, A. R.: Post-Operative
Cutaneous Gangrene With Report of Case Following Ap-
pendectomy, Bol. Soc. de cir. de Rosario 9:73-82 (May)
1942.
16. Paulino, F. : Progressive Post-Operative Gangrene of Skin;
Case, Rev. med. munic. 4:195-199 (Aug.) 1942.
17. Vara-Lopez, R.: Case of Progressive Gangrene of Skin,
Differentiation of Acute Subcutaneous Gangrene, Rev.
clin. espan. 4:245-251 (Feb. 28) 1942.
18. Neary, E. P. and Rankine, J. A.: Chronic Progressive
Postoperative Gangrene of Skin and Subcutaneous Tissues
(Report of Case). Canad. M. A. J. 49:517-519 (Dec.) 1943.
19. Davison, M. ; Sarnat, B. G., and Lampert, E. : Post-Oper-
ative Chronic Progressive Gangrene of Abdominal Wall,
Ann. Surg. 119:796-800 (May) 1944.
20. Leonard, D. W. : Progressive Gangrene in Operative
Wound, Arch. Surg. 48:457-464 (June) 1944.
21. Meleney, F. L. : Bacterial Synergism in Disease Processes
with Confirmation of Synergistic Bacterial Etiology of
Certain Type of Progressive Gangrene of Abdominal Wall,
Ann. Surg. 94:961-9bl tDec. 31) 1931.
22. Marcus, R. : Progressive Bacterial Synergistic Gangrene of
Legs, British M. J. 1:1230-1231 (June 7) 1952.
23. Brown, R. W.; Carlisle, J. D., and Monroe, C. W. : Pro-
gressive Bacterial Synergistic Gangrene; Case Report, Sur-
gery 33:407-416 (March) 1953.
24. Meleney, F. L. ; Friedman, S. T., and Harvey D. H.:
Treatment of Progressive Bacterial Synergistic Gangrene
with Penicillin, Surgery 18:423-435 (Oct.) 1945.
25. Meleney, F. L. ; Shambaugh, P., and Millen, R. S.: Sys-
temic Bacitracin in Treatment of Progressive Bacterial
Synergistic Gangrene, Ann. Surg. 131:129-144 (Feb.) 1950.
26. Meleney, F. L. : Differential Diagnosis Between Certain
Types of Infectious Gangrene of Skin, With Particular
Reference to Haemolytic Streptococcus Gangrene and
Bacterial Svnergistic Gangrene, Surg., Gynec. & Obst.
56:847-867 (May) 1933.
27. Meleney, F. L. : Present Role of Zinc Peroxide in Treat-
ment of Surgical Infection, J. A. M. A. 149:1450-1453
(Aug. 16) 1952.
/300 Biscayne Boulevard (Dr. Annis).
1502 Milan Avenue (Dr. Martin).
150
Volume XLI V
Number 2
Cost of Administration
Of Salk Vaccine Program
Joseph M. Bistowish, M.D.*
TALLAHASSEE
AND
Warren T. Weathington, M.D.|
APPALACHICOLA
The Federal Polio Act of 1955 allotted $780,-
000 to Florida for a program of vaccination
against poliomyelitis. According to the plan, Flor-
ida was allowed to use $564,000 of this amount
for the purchase of vaccine and $216,000 for its
administration. It was necessary, however, that all
money used for purposes other than for the pur-
chase of vaccine be validated in some manner con-
sistent with the accounting principle of the U. S.
Public Health Service.
In some states, in order to validate these
funds, every employee, both state and local, de-
voting any time to the program, was being re-
quired to keep a strict time record of all appro-
priate activities. The Florida State Board of
Health and its Poliomyelitis Advisory Commit-
tee, however, realized that such a procedure would
burden an unnecessarily large number of people
and might, in some of the more understaffed coun-
ties, result in decreased efficiency in carrying out
the immunization.
It was, therefore, decided that in this state,
three jurisdictions, as nearly as possible represen-
tative of the state as a whole, would be selected
to make the validation time and cost studies. For
this purpose were chosen Orange County, Leon
County, and the tricounty unit encompassing
Franklin, Gulf, and Wakulla counties. Orange
County was considered to be representative of a
large county, an urban area, and a locality in
which most of the immunizations would be given
by private physicians. Leon County, on the other
hand, was believed to be a rather typical county
of average size with mostly urban population
where the immunization program would be car-
ried out almost entirely by the Health Depart-
ment. The tricounty jurisdiction was chosen to
represent small rural counties in which most of
the immunizations, by necessity, are given by the
Health Department.
* Director, Leon County Health Department.
t Director for Franklin, Gulf and Wakulla Counties.
'<ead before the Florida Health Officers Society, Eleventh
Annual Meeting, Miami Beach, May 13, 1956.
The School of Public Administration of Flor-
ida State University** was most helpful by assist-
ing in the planning of the time and cost study it-
self, and the necessary forms were prepared by
that school. The basic form was an “Individual
Daily Time and Travel Sheet,” which was com-
pleted daily by every person taking part in the
polio vaccination program. On this sheet, the time
consumed in each of 1 1 categories was noted.
These activities were: planning of the program;
administration of program — records, reports, con-
sent slips; distribution of vaccine; advance prep-
aration of vaccine, syringes, and other supplies;
administering injections; educational activity —
lectures, publicity, evaluation of the program; in-
vestigation of reactions, cases and suspected cases;
collection of laboratory specimens; giving of in-
formation on the telephone or in person, and mis-
cellaneous activities not covered in any of the
other 10 categories. The number of miles traveled
in the performance of these various activities was
also recorded.
Each county, on a monthly basis, compiled
the total time and miles devoted to the vaccina-
tion program by worker and by type of activity.
These figures with the hourly wage of each worker
make possible a determination of the total cost of
the program, the cost of each worker’s contribu-
tion, and the cost by activity. It was thought
that the counties selected for the study were suf-
ficiently representative of the state as a whole to
warrant using the average cost in these counties
to estimate the cost of the statewide program.
Thus, the total cost to the state could be obtained
by multiplying the average cost per injection by
the total number of injections given in the state
and adding the costs of the State Board of
Health's part in the over-all program.
Of the $216,000 designated for administration
of the program, $171,000 was assigned to county
**James A. Norton, Ph.D., Associate Professor, School of
Public Administration; John E. Swanson, Ph.D., Director,
Bureau of Governmental Research and Service; and Penrose
B. Jackson, Acting Director of the Bureau of Governmental
Research and Service, Florida State University.
J. Florida. M. A.
August, 1957
BISTOWISH AND WEATHINGTON: SALK VACCINE PROGRAM
151
health departments, and $45,000 was reserved to
defray the costs of the program to the State Board
of Health. Through March 31, 1956, $16,910.51
of this amount had been expended for such items
as: travel and expenses of the State Advisory
Committee, the purchase of health education ma-
terials, publicity, personnel and equipment to
carry out statistical procedures, salaries of a pro-
gram director and his stenographer, and the cost
of personnel and equipment to carry out a viro-
logical diagnostic service.
Table 1. — Cost of a Program for Administering
Poliomyelitis Vaccine in Selected Florida Coun-
ties, August 12, 1955 through March 31, 1956
Total
Number
Cost
County
Populatio
n Local
Cost
of per
Injections Injection
Orange
176,402
$5,065.08
18,819
$0,269
Leon
Franklin
59,995
3,012.97
11,025
0.273
Gulf
Wakulla
19,818
2,876.20
2,925
0.983
Totals
256,215
$10,954.25
32,769
$0,334
From table 1, one learns that Orange County
gave 18,819 injections of poliomyelitis vaccine at
a total cost of $5,065.08 or $0,269 per injection.
In Leon County, 11,025 injections were given at a
total cost of $3,012.97 or $0,273 per injection.
The tricounty area, including Franklin, Gulf, and
Wakulla counties, gave 2,925 injections for $2,-
876.20, which makes the cost per injection $0,983.
In the study area as a whole, the total cost for
giving 32,769 injections was $10,954.25, or $0,334
per injection.
In the three areas studied, only the rural area
had costs out of line with the average of the three
jurisdictions. It was thought, therefore, that un-
less the proportion of rural to urban in the study
area approached that proportion for the state as
a whole, the bias would be too great to permit
using the simple arithmetic average cost per in-
jection in the study and to determine the state-
wide cost. It was determined that in the state as
a whole, 9.2 per cent of the population lives in
counties having a population of less than 20.000.
In the study area, this proportion was found to
be 7.8 per cent.
If the average cost per injection ($0,334) in
the study area is multiplied by the total number
>f injections (404,470) given throughout the state,
t is found that the total cost of the vaccination
irogram to the counties was $135,092.98.
Average Local Total Injections Total Local Cost
Tost per Injection in State in State
$0,334 404,470 $135,092.98
I
If the expenditures of the State Board of
Health ($16,910.51) are added to the local cost,
the total cost of the program is found to be
$152,003.49. This figure does not take into con-
sideration a large number of minor and incidental
expenses such as the proportionate share of the
costs of utilities, telephone, rent, stationary and
other office and clinic supplies. An estimate of
5 per cent of the total cost of the program is
thought to be a reasonable allowance for these
expenses. Thus the total cost of the program to
the taxpayers from August 12, 1955 through
March 31, 1956 was $159,603.66, or $0,395 per
injection.
Total Local State Total Cost
Cost Expenditures of Program
$135,092.98 $16,910.51 $152,003.49
Total Adjusted
Total Cost Estimated 5 Per Cent Cost to Taxpayer
of Program for Miscellaneous for 404,470
Expenses Injections
$152,003.49 $7,600.17 $159,603.66
($0,395 per injection)
Explanations
While statistics are available which would en-
able one to determine the cost of the various
phases of the immunization program, it was the
purpose of this report to give only the over-all
costs. A more complete report will be made when
the study is completed.
Because of the time lag in obtaining from
private physicians reports on immunizations com-
pleted, the use of reported immunizations in com-
puting the cost of the program would be mis-
leading in that Orange County, in which most of
the immunizations are given by private physicians,
would have an unusually high cost. The amor t
of vaccine distributed was therefore used rather
than the number of injections reported. This is
justifiable since the expenses under consideration
are ended when the vaccine has been distributed
to the private physician.
Conclusions
Several tentative conclusions oi observations
can be made from this incomplete Time-Cost
Study. Chief among them are:
1. That the probable cost to administer
404.470 doses of poliomyelitis vaccine to Florida's
children was $159,600 or $0,395 per dose. This
figure does not include the cost of the vaccine or
fees paid to private physicians by individuals.
2. That the cost of a county program of dis-
tribution of vaccine to private physicians with the
152
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
Volume XLIV
Number 2
necessary collection of reports and other suppor-
tive activities was essentially the same as for a
county program in which practically all immuniza-
tions were given by the health department.
3. That the cost of the immunization program
in the rural counties was more than twice the cost
found for either urban county. This is additional
proof that the cost of rural public health is high.
It is realized that a study of this sort is subject
to a great many sources of error. The counties
selected as the sample may not be typical or rep-
resentative of the state as a whole. There could
also be great variability in the daily accounting of
time by the individual workers. It is believed,
however, that the study was sufficiently well con-
trolled to determine roughly the cost of adminis-
tering the vaccine. It should also be emphasized
that this is an interim report and that the costs
found at this time may not be the same as those
computed when the study is completed.
P. O. Box 1117 (Dr. Bistowish).
Skin Reactions to a Nicotinic Acid Ester
In Tuberculosis
Studies with Tetrahydrofurfuryl Ester of Nicotinic Acid
Milton S. Saslaw, M.D.
AND
Murray M. Streitfeld, Ph.D.
MIAMI
The use of nicotinic acid derivatives in the
treatment of tuberculosis led us to study the pos-
sible effects of such therapy on a skin test devel-
oped as a diagnostic aid in active rheumatic
fever. 7-1H We described an atypical response to
the topical application of an ointment containing
the tetrahydrofurfuryl ester of nicotinic acid* in
patients with active rheumatic fever. This reac-
tion differed from the erythematous andor
edematous response observed in normal persons
and patients with inactive rheumatic disease. It
was characterized by failure of the skin to redden
or by actual blanching at the site of application
of the ointment. The mechanism of this reaction
in rheumatic fever may be related to altered
metabolism of nicotinic acid or its precursors.
Disturbances in metabolism of the precursors of
nicotinic acid have also been reported in tubercu-
losis.4 This and certain other similarities between
the two diseases appeared to warrant the investi-
Read before the American College of Chest Physicians,
Interim Session, Boston, Mass., Nov. 28, 1955.
From the Departnient of Medical Research. National Chil-
dren’s Cardiac Hospital, and the University of Miami School
of Medicine, Miami.
Supported in part by a research grant from Ciba Pharma-
ceutical Products, Inc., Summit, N. T.
"Trafuril (Ciba)
gation of the skin responses to tetrahydrofurfuryl
ester of nicotinic acid of patients with tuberculo-
sis. Both tuberculosis and rheumatic fever are
characterized by chronic activity and debilitating
effects. Bacterial hypersensitivity may be impli-
cated in the pathogenesis of each disease (to
Mycobacterium tuberculosis in tuberculosis, and
to Streptococcus pyogenes in rheumatic fever).
In view of these similarities, a study of the
influence of tuberculosis and of isonicotinic acid
hydrazide therapy on the cutaneous response to
the tetrahydrofurfuryl ester of nicotinic acid pro-
vided a logical approach to obtain further infor-
mation on the mechanism and specificity of the
skin test. This is a report and discussion of our
findings in a series of 166 patients suffering from
tuberculosis.
Material and Method
The skin response to topical application of a
Vaseline-lanolin ointment containing 5 per cent
tetrahydrofurfuryl ester of nicotinic acid was de-
termined in 166 patients with pulmonary tubercu-
losis at the Southeast Florida Tuberculosis Hos-
pital at Lantana. The patients ranged in age from
17 to 81 years; there were 88 males and 78 fe-
males; 76 were white, and 90 were Negro. Other
diseases complicated the tuberculosis in 44 pa-
tients. Mycobacterium tuberculosis was recovered
from the sputum of all the patients immediately
prior to hospitalization; 91 patients had a positive
J. Florida, M. A.
August, 1957
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
153
sputum at least once during the six month period
prior to skin testing. Symptoms and signs on
admission varied from mild to severe. At the
time the skin tests were performed, clinical and
roentgenologic evaluations by the physicians and
consultants in charge revealed that in 146 pa-
tients the disease was considered definitely active.
In the remaining 20, it was indeterminate or
quiescent.
Fifty-three patients were receiving isonicotinic
acid hydrazide or other isonicotinic acid deriva-
tives, in varying dosages. Other forms of therapy
also were used in these 53 patients, as well as in
all of the remaining patients. Such treatment in-
cluded para-aminosalicylic acid, streptomycin and
other antibiotics, multivitamins, and surgery. No
tests were performed during the immediate post-
operative period. The method of skin testing was
the same as previously described.7-10 An oint-
ment of 5 per cent tetrahydrofurfuryl ester of
nicotinic acid in Vaseline-lanolin base was rubbed
into the volar aspect of the forearm of each pa-
tient. A second ointment, consisting of the same
base, but without the nicotinic acid ester, was ap-
plied in the same manner to another portion of
the forearm. The normal response was a hyper-
emia and/or edema occurring within 30 minutes.
Responses were recorded as typical, borderline
typical, borderline nontypical or nontypical, as
outlined in table 1.
All skin tests were performed and interpreted
“blindly” by us without knowledge of the clinical
status of activity of the disease in any patient,
nor were the clinicians aware of the test results.
As controls for evaluation of the specificity of
the skin test, 74 healthy persons were studied.
Table 1. — Method of Reading Tetrahydrofurfuryl Nicotinic Acid Ester
Inunction Test
Erythema in
Edema
Type of Reaction
Ointment
Spread
Zone
Zone
Typical
(normal)
1.
+
— to -f
- to +
or 2.
— to +
— to +
~h
or 3.
Hr
+ > Va"
—
Borderline typical
(normal?)
1.
±>Va"
—
or
+>/4"
and <
Borderline nontypical
(abnormal?)
1.
>±
fading
within
30 min.
—
—
or 2.
+ <%"
—
or
±>Ya"
Nontypical
(abnormal)
1.
0 or —
0 or —
or 2.
—
fading
within
.
30 min.
or 3.
—
+ <lA"
—
or
±<lA"
KEY: 3. ± — Barely perceptible erythema
1. 0= Blanching without edema 4. + = Perceptible erythema and/or edema
2. — = No visible erythema, no edema NOTE: Edema is never present in a nontypieal response.
154
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
Volume XLIV
Number 2
Results
Skin responses to the tetrahydrofurfuryl ester
of nicotinic acid were observed in 166 patients
with tuberculosis (table 2). Normal (typical or
borderline typical) reactions were noted in 148
patients (90.2 per cent); abnormal (nontypical
or borderline nontypical) reactions, in 16 patients
(9.8 per cent); and nonreadable reactions, in two
patients.
Table 3 indicates that 38 (88.4 per cent) of
43 patients with other conditions complicating
the tuberculosis had typical or borderline typical
reactions. Five patients (11.6 per cent of the 43)
had nontypical or borderline nontypical responses.
There was one reaction which could not be read.
Of 91 patients (table 4) with positive sputums
some time during the six months immediately
prior to the skin testing. 89 per cent responded
normally, while 1 1 per cent responded abnor-
mally.
Among the 53 patients receiving therapy with
one of the isonicotinic acid derivatives (table 5),
Table 2. — Skin Responses of 166 Patients with
Tuberculosis to Tetrahydrofurfuryl Ester of
Nicotinic Acid
Type of Skin Response
Patients
Number
Per Cent
Typical
144
Borderline typical
4
Total normal
148
90.2
Nontypical
9
Borderline nontypical
7
Total abnormal
16
9.8
Total
164
100.0
Nonreadable
2
—
Table 3. — Skin Responses of 44 Patients with Tuberculosis Complicated by Other
Diseases to Tetrahydrofurfuryl Ester of Nicotinic Acid
Type of Skin Response
and Complication
Patients
Number
Per Cent
Typical response
Treated syphilis
19
Diabetes
5
Pregnancy
3
Hypertensive heart disease
3
Arteriosclerotic heart disease
3
Congenital heart disease
2
Peptic ulcer
1
Myasthenia gravis
1
Total typical
37
86.1
Borderline typical response
Treated syphilis and alcoholic cirrhosis
1
Total borderline typical
1
2.3
Total Normal
38
88.4
Nontypical response
Asthma
1
Diabetes
1
Renal lithiasis
1
Total nontypical
3
7.0
Borderline nontypical response
Peptic ulcer
1
Epilepsy, alcoholism and latent syphilis
1
Total borderline nontvpical
2
4.6
Total abnormal
5
11.6
Nonreadable (diabetes)
1
—
J. Florida, M. A.
August, 1957
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
155
Table 4. — Skin Responses of 91 Patients with Sputums Positive for Tubercle
Bacilli to Tetrahydrofurfuryl Ester of Nicotinic Acid
Patients
Type of Skin Response
Number
Per Cent
Typical
79
Borderline typical
2
Total normal
81
89.0
Nontypical
3
Borderline nontypical
7
Total abnormal
10
11.0
Total
91
100.0
50 (94.4 per cent) reacted normally, while only
three (5.6 per cent) gave abnormal responses.
Of the 74 control subjects, only three (4.1
per cent) showed no erythema or edema in re-
sponse to the skin test.
Table 6 summarizes the responses with refer-
ence to all the factors studied. The presence of
a complicating disease, or the finding of a posi-
tive sputum, increased, though only slightly, the
percentage of abnormal skin responses. Isonico-
tinic acid hydrazide therapy, on the other hand,
decreased the percentage of abnormal responses
to 5.6 per cent — toward the control figure of 4.1
per cent.
Discussion
Patients with active tuberculosis do not re-
spond to skin testing with the tetrahydrofurfuryl
ester of nicotinic acid in the same way as do pa-
tients with active rheumatic fever. Despite the
similarities of the two diseases as regards ten-
dency to chronic activity, debilitating effects, and
implication of a hypersensitivity mechanism in
their etiology, of 60 patients (table 7) with active
rheumatic fever, 87 per cent gave abnormal re-
sponses11 as against only 9.8 per cent of 164 tu-
berculous subjects (table 2).
These findings are substantially in accord with
those reported by Weiss,13 who found that 3 per
cent of 33 patients with active tuberculosis gave
abnormal skin test responses. The higher number
of atypical reactions (9.8 per cent) observed by
us may be attributable to purely statistical differ-
ences, to other factors such as therapeutic agents
employed in each individual patient, or to slight
differences in criteria for interpreting the skin
response. Atypical reactions were observed in on-
ly 4.1 per cent of our 74 healthy controls. Be-
cause the number of subjects in control, rheu-
matic and tuberculous groups is small, differences
in percentages of abnormal responses cannot be
definitely evaluated. It has been reported1 that
in tuberculosis, there is an abnormality in the
catabolism of tryptophan to nicotinic acid, as in-
dicated by increased urinary excretion of 3-hydro-
xyanthranilic acid. Abnormal tryptophan metab-
olism also has been observed11 following the
administration of isonicotinic acid hydrazide to
Table 5. — Skin Responses of 53 Patients on Isonicotinic Acid Hydrazide Therapy
to Tetrahydrofurfuryl Ester of Nicotinic Acid
Type of Skin Response
Patien
s
Number
Per Cent
Typical
48
Borderline typical
2
Total normal
so
94.4
Nontypical
1
Borderline nontypical
2
Total abnormal
3
S.6
Total
S3
100.0
156
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
Volume XLI V
N U M BER 2
Table 6. — Summary of Skin Responses of 166 Tuberculous Patients to Tetrahydro-
furfuryl Ester of Nicotinic Acid
Patients
Status of Tuberculosis
Total
Per Cent Abnor-
Number
mal Responses
Complicated by other diseases
43
11.6
Uncomplicated
121
9.1
Positive sputum within 6 mos. of test
91
11.0
Negative sputum within 6 mos. of test
73
8.2
On isonicotinic acid hydrazide therapy
S3
5.6
Not on isonicotinic acid hydrazide therapy
111
11.7
Controls (no tuberculosis)
74
4.1
tuberculous subjects. We therefore considered the
skin test responses to tetrahydrofurfuryl ester of
nicotinic acid worthy of analysis from the stand-
point of the relationship of the test to the tryp-
tophan-nicotinic acid series, for “considerable
evidence has been adduced from work in animals
and microorganisms to show that nicotinic acid
may be formed from tryptophane (sic).”2 Fig-
ure 1, based on established data,3 * shows reported
relationships between various diseases and abnor-
malities in tryptophan catabolism.
The possibility that isonicotinic acid hydra-
zide therapy may interfere with normal metabo-
lism of some of the vitamin B complex compo-
nents (nicotinic acid, pantothenic acid, pyridox-
ine) in tuberculosis has been postulated.5- 0 Pe-
gum6 first described the “burning feet” syndrome
resulting from isonicotinic acid hydrazide therapy
and suggested that either pantothenic or nico-
tinic acid deficiency might be responsible. Mc-
Connell and Cheetham5 noted that pellagra
developed in a tuberculous patient after iso-
nicotinic acid hydrazide therapy; the pellagra
was cured by the administration of vitamin
B complex. Biehl and Vilter1 noted peripheral
neuritis in 40 per cent of their patients receiving
isonicotinic acid hydrazide therapy, but not in
those patients receiving pyridoxine in addition to
the hydrazide. These investigators demonstrated
increased excretion of xanthurenic acid following
the administration of test doses of isonicotinic
acid hydrazide to tuberculous patients; the rise
in xanthurenic acid excretion was proportional to
the dosage of isonicotinic acid hydrazide. The
urinary excretion of N’-methylnicotinamide, prod-
uct of nicotinic acid metabolism, was not affected.
Possible sources of nicotinic acid in these tu-
berculous patients may be from: (1) diet and
vitamin therapy (all of the patients in the pres-
ent investigation received supplemental vitamin
therapy), (2) reserves of coenzymes I and II,
(3) other metabolic systems, and (4) increased
tryptophan catabolism. We may speculate that
most tuberculous patients maintain normal nico-
tinic acid supplies from one or more of these
sources, and that normal skin test responses de-
pend on an adequate skin concentration of the
acid itself, some closely related substance, or
some compound of which it is a component (such
as coenzyme I or II). Only occasionally, in tu-
berculosis, will the available supply of the requisite
skin test factor be diminished sufficiently to re-
Table 7. — Comparison of Abnormal Skin Responses in Tuberculosis, Rheumatic
Fever and Health
Disease
Number Tested
Per Cent Abnormal
Active rheumatic fever
60
87.0
Tuberculosis + sputum*
91
11.0
Tuberculosis — sputum*
73
8.2
Healthy controls
74
4.1
#Sputum positive or negative during six months prior to skin t esting.
J. Florida, M. A.
August, 1957
SASLAW AND STREITFELD: NICOTINIC ACID ESTER IN TUBERCULOSIS
157
TRYPTOPHAN > SEROTONIN* f (MALIGNANT CARCINOID8)
I
KYNURENINE f(MALIGNANCY9)
j(RIBOFLAVIN)
3-HYDRQXYKYNURENINE > XANTHURENIC ACID f (PYRIDOXINE
I DEFICIENCY1; FOLLOWING INAH IN TBC1)
(PYRIDOXINE)
3-HYDROXYANTHRANILIC ACID f (TUBERCULOSIS4)
1
QUINOLINIC ACID
NICOTINIC ACID > NICOTINAMIDE > N 'METHYLNICOTINAJUIOE
1
COENZYME I OR II
t = increased, in urine.
*t = increased, in blood and tumor; increased urinary excretion
of 5-hydroxyindole acetic acid.
Fig. 1. — Tryptophan Catabolism.
suit in an abnormal skin response.
In our series of tuberculous patients who were
on long term isonicotinic acid hydrazide therapy,
there was a lower percentage of abnormal skin
responses (5.6 per cent) than in those patients
who did not get this drug (11.7 per cent). Sev-
eral hypotheses may be offered to explain this
apparent effect of therapy. Patients on isonico-
tinic acid hydrazide therapy may approach nor-
mal health, reflected in normal nicotinic acid
metabolism, and therefore display normal skin
reactions. Isonicotinic acid hydrazide, in tuber-
culous patients who show abnormal skin re-
sponses, may replace a deficiency in the tissues or
capillary walls of the skin of nicotinic acid, of
one of its metabolites, or of some compound con-
taining nicotinic acid or its amide. There may be
other mechanisms, as yet undescribed, which are
responsible for the higher rate of normal skin
responses in patients on isonicotinic acid hydra-
zide treatment. The effect of single doses of iso-
nicotinic acid hydrazide was observed by Weiss,13
who administered 100 mg. of isoniazid to each of
14 normal subjects, and noted an atypical skin
reaction in two instances. On the other hand,
when he gave 200 or 300 mg. to 28 additional
persons, no abnormal skin response ensued.
We suggested7 that altered nicotinic acid
metabolism might explain the tendency of pa-
tients with acute rheumatic fever to respond ab-
normally to the skin test. Recently, this con-
cept has been investigated further by Weiss.12
He observed atypical skin responses in patients
with acute tonsillitis. Of 14 such patients fed
nicotinamide (800 mg. per day), 13 gave a nor-
mal skin test by the fifth day, while only six of
14 tonsillitis controls responded with a normal
skin reaction in the same period of time. He was
unable to demonstrate correlation of blood levels
of nicotinic acid with the type of skin reaction
observed, although “serial determinations sug-
gested that in patients with acute infections, the
blood concentration of nicotinic acid tends to
rise within the normal range as the disease sub-
sides.”14
Further investigation of the tryptophan-nico-
tinic acid catabolic series and its relationship to
the tetrahydrofurfuryl ester of nicotinic acid skin
test is in progress in our laboratory.
Summary
Skin responses to inunction with an ointment
containing 5 per cent tetrahydrofurfuryl ester of
nicotinic acid were observed in 166 patients hos-
pitalized because of active tuberculosis, and were
compared with those seen in 60 patients with
active rheumatic fever and in 74 healthy control
subjects.
In the tuberculous group, 148 patients (90.2
per cent) gave normal responses, while 16 (9.8
per cent) gave abnormal reactions; two patients
gave nonreadable reactions. These results were
in contrast to those observed in active rheumatic
fever, where 87 per cent of the patients gave
abnormal responses. Abnormal reactions occurred
in 4.1 per cent of the healthy controls.
Isonicotinic acid hydrazide therapy seemed
to lower the percentage of abnormal reactions
(5.6 per cent) when compared with the percent-
age (11.7 per cent) in the group of patients not
receiving this medication. No definite conclusion,
however, can be drawn as to the effect of such
therapy because of the small number of patients
in each category.
The abnormal cutaneous response observed in
patients with active tuberculosis could be linked
neither to the chronicity of the disease, nor to
activity as indicated by the presence of tubercle
bacilli in the sputums at some time during the six
months prior to skin testing, nor to the effects of
any particular form of therapy, including para-
aminosalicylic acid and streptomycin, other than
isonicotinic acid hydrazide.
The relationship of skin testing with tetra-
hydrofurfuryl ester of nicotinic acid to tubercu-
losis, isonicotinic acid hydrazide therapy, rheu-
matic fever and the metabolism of tryptophan
and nicotinic acid have been discussed.
158
ABSTRACTS
Volume XLI V
Number 2
We acknowledge, with thanks, the cooperation of Dr.
W. L. Potts, medical director, and the staff of the South-
east Florida Tuberculosis Hospital, Lantana.
Bibliography
1. Biehl, J. P., and Vilter, R. W. : Effect of Isoniazid on
Vitamin Bn Metabolism; Its Possible Significance in Pro-
ducing Isoniazid Neuritis, Proc. Soc. Exper. Biol. 85:389-
392 (March) 1954.
2. Bodansky, M., and Bodansky, O. : Biochemistry of Dis-
ease, ed. 2, revised by Oscar Bodansky, New York, The
Macmillan Company, 1952, p. 984.
3. Cantarow, A., and Schepartz, B. : Biochemistry, W. B.
Saunders Company, Philadelphia, 1954, pp. 192 and 544-
5 19.
4. Musajo, L. ; Spada, A., and Coppini, I).: Isolation of 3-
Hydroxyanthranilic Acid from Pathological Human Urine
After Administration of 1-Tryptophan, J. Biol. Chem.
196:185-188 (May) 1952.
5. McConnell. R. B., and Cheetham, II. I).: Acute Pellagra
During Isoniazid Therapy, Lancet 2:959-960 (Nov. 15)
1952.
6. Pegum, J. S.: Nicotinic Acid and Burning Feet, lancet
263:536 (Sept. 13) 1952.
7. Saslaw, M. S., and Streitfeld, M. M.: Skin Response to
Trafuril: Possible Test for Rheumatic Activity, J. Florida
M. A. 41:21-25 (July) 1954.
8. Sjoerdsma, A.; Mattingly, T. W., and Udenfriend, S.:
Cardiovascular Disease and Abnormal Tryptophan Metab-
olism Associated with Malignant Carcinoid, Proceedings of
28th Annual Scientific Session of the American Heart As-
sociation, October 22-24, 1955, p. 110.
9. Spacek, M.: Kynurenine in Disease, with Particular Refer-
ence to Cancer, Canad. M. A. J. 73:198-201 (Aug. 1 ) 1955.
10. Streitfeld, M. M., and Saslaw, M. S.: Cutaneous Test for
Rheumatic Activity in Children, Proc. Soc. Exper. Biol. &
Med. 84:628-631 (Dec.) 1953.
11. Streitfeld, M. M.; Zurich, A., and Saslaw, M. S. : Unpub-
lished data.
12. Weiss, W.: Skin Reaction to Nicotinic Acid Ester Oint-
ment in Tuberculosis and Effect of Isoniazid, abst. Tr.
14th VA-Army-Navy Conference on Chemotherapy of
Tuberculosis, 1955.
13. Weiss, W.: Skin Response to Nicotinic Acid Ester: Acute
Phase Reaction, Am. J. M. Sc. 231-13-19 (Jan.) 1956.
14. Weiss, W.: Nicotinic Acid Blood Levels in Relation to
Skin Response to Nicotinic Acid Ester Ointment, Am. J.
M. Sc. 23 1-20-25 (Jan.) 1956.
4250 West Flagler Street (Dr. Saslaw).
ABSTRACTS
Bilateral Facial Agenesia (Treacher Col-
lins Syndrome). By Clifford C. Snyder, M.D.
Am. J. Surg. 92:81-87 (July) 1956.
The purpose of this paper is to focus attention
on a group of congenital facial anomalies which,
when assembled, present a definite clinical entity.
The author notes that other authors have de-
scribed various parts of this syndrome with the
sincere impression that they have added some-
thing new to the literature and adds that al-
though it is the consensus of many that this
complicated anomaly is a rare disease, it has been
found to be more common than previously be-
lieved. He regards this misunderstanding as
possibly due to the various names attached to the
syndrome. He describes the complex clinical pic-
ture of bilateral facial agenesia and various cor-
rective surgical procedures. Patients with the
deformities associated with this syndrome ha^e
normal intelligence and deserve the surgical re-
construction which he advocates.
Cervical Cancer: Chronic Inflammation,
Stress and Adaptation Factors. By J. Ernest
Ayre, M.D. Acta Union Internationale Contre
Le Cancer 12:20-26, 1956.
In the quest for an understandable concept of
carcinogenesis there has long been speculation re-
garding the role of chronic inflammation in the
production of carcinoma of the cervix. The clini-
cal and epidemiologic factors here presented sub-
stantiate the concept that chronic cervicitis and
cancer are related. An hypothesis is introduced
suggesting that Selye’s stress and adaptation syn-
drome may fit into the picture of cervical car-
cinogenesis. The leukorrhea of chronic cervicitis,
the presence of an estrogen in cervical mucus, and
hypoxia resulting from the fibrotic changes of
chronic inflammation are presented as “links” in
a “chain reaction” of cancergenesis. A promis-
ing avenue for further research into this complex
problem is suggested.
Nuclear Size and Nuclear: Cytoplasmic
Ratio in the Delineation of Atypical Hyper-
plasia of the Uterine Cervix. By Alvan G.
Foraker, M.D., and James W. Reagan, M.D.
Cancer 9:470-479 (May-June) 1956.
The present study is an attempt to orient
atypical hyperplasia as regards nuclear size and
nuclear: cytoplasmic ratio with respect to obvious-
ly innocuous squamous metaplasia and to intraepi-
thelial carcinoma. Nuclear size and nuclear:cyto-
plasmic ratio in atypical hyperplasia and intraepi-
thelial carcinoma of the uterine cervix were sub-
jected to measurement and comparison. Nuclear
measurements on normal and abnormal epithelium
from 20 cases each of intraepithelial carcinoma,
atypical hyperplasia, and squamous metaplasia
were prepared. The results showed ( 1 ) little dif-
ference in nuclear measurement properties of nor-
mal epithelium from all three types of cases; (2)
similar mean nuclear size in all epithelial layers,
and similar nuclear: cytoplasmic ratio in the basal
layers of intraepithelial carcinoma and atypical
hyperplasia; (3) progressively higher nuclear cy-
toplasmic ratio in the middle layer of epithelium
in metaplasia, atypical hyperplasia, and intraepi-
thelial carcinoma; and (4) evidence of more cell
J. Florida, M. A.
August, 1957
ABSTRACTS
159
maturation through the layers of atypical hyper-
plasia than in those of intraepithelial carcinoma.
With respect to the sum of these nuclear
measurement properties, atypical hyperplasia oc-
cupied an intermediate position between meta-
plasia and intraepithelial carcinoma. This inter-
mediate position corresponds to the relationships
of the general microscopic pattern of these three
entities, as well as to their apparent biologic sig-
nificance in the production of invasive squamous
carcinoma of the uterine cervix.
Squamous Cell Carcinoma of the Anus:
A Case Report. By R. Sam Mosely, M.D.
South. M. J. 49:1006-1010 (Sept.) 1956.
Squamous cell carcinoma of the anus rep-
resents less than 2 per cent of the tumors of the
intestinal tract. In this article the literature is
reviewed, and a case is reported. This lesion is
insidious in onset and, as in the case here describ-
ed, may be asymptomatic for several years. The
author suggests that all tumor masses in the anal
area should be suspected and subjected to biopsy.
Extension is usually by contiguity, but there may
be spread through the lymphatic pathways and
rarely through the blood stream. Less than 10
per cent of the reported cases had spread to the
inguinal lymph nodes. Whereas irradiation used
to have a prominent place in the treatment of
these lesions, most of the surgeons in the larger
medical centers now are of the opinion that early
radical surgery is better. Irradiation may cause
the loss of valuable time in the treatment of this
tumor. The combined abdominoperineal resection
is considered the operation of choice, and only
rarely is local excision indicated. Routine excision
of the inguinal glands is of doubtful value. Al-
though the present five year survival rate for
this tumor compares favorably with that of adeno-
carcinoma of the rectum, this should be improved
with a greater use of radical surgery.
Anomalous Type of Salt and Water Re-
tention with Persistent Edema; Report of a
Case. By Leonard G. Rowntree, M.D., Robert
J. Boucek, M.D., and Nancy L. Noble, Ph.D.
J. A. M. A. 161:877-879 (June 30) 1956.
The effect of the central nervous system upon
salt and water metabolism is being noted more
frequently, particularly as a postoperative neuro-
surgical complication. For three years the authors
have had the opportunity of studying a case of
apparent postencephalitic involvement of the
central nervous system affecting salt and water
metabolism, presumably through the neurohy-
pophysis. It is the purpose of this report to re-
view the pertinent features of the clinical and lab-
oratory records of this patient and the record of
the diuretic response to various agents and to sug-
gest the possible mechanism of the salt and water
retention. The patient has an anomalous type of
edema that developed six months after a second
attack of encephalitis, has persisted over seven
years in spite of dietary salt restriction, and re-
quires weekly use of diuretics. The red blood
cells reveal an exaggerated sodium and potassium
response to augmented sodium intake and to
diuretics. The authors presume that the syn-
drome is neurohormonal in origin and may rep-
resent the antithesis of diabetes insipidus — and
possibly a form of “hyperpitressinism.”
Value of Cytology in the Accidents of
Early Pregnancy: Preliminary Report. By
Wayne S. Rogers, M.D., J. Ernest Ay-re, M.D.,
and Kola M. Kennedy. Obst. & Gynec. 8:437-
443 (Oct.) 1956.
In a series of 122 consecutive patients, routine
cytologic examination was made during their first
antepartum visit in an attempt to detect endo-
crine dysfunction. Of those experiencing clinically
normal pregnancies, 1 1 per cent showed an en-
docrine deficiency, and of those with clinically
threatened abortion, 54.8 per cent had evidence
of a deficiency. Those patients who were clinically
normal and whose cytologic examination revealed
an endocrine dysfunction were placed in cate-
gories of cytologic threatened abortions and cyto-
logic missed abortions.
It was suggested that the cytologic findings
may be used as a method of standardization of
the patients for the evaluation of the various
methods of treatment. It was also observed that
the question of pathologic ova may be better
evaluated when the response to therapy is studied
in those patients showing minimal deficiencies.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
160
Volume XL IV
Number 2
P?eAi(ient .& paye
Hopeful Procrastination
Are we in a state of hopeful procrastination? Yes, I am afraid we are. As I sit
here in the wee hours of the morning on well developed gluteus maximus muscles,
I am perfectly content to wait out the process of childbirth, an attitude which is con-
sidered one attribute of a good obstetrician. Waiting for nature to take its course
without having to use but little more brains and skill than the average good midwife
is nothing more than hopeful procrastination.
Awake and alert, I am aiding nature when I can and should, like a well trained
obstetrician is expected to do, even if there is need for nothing more than boosting
morale and allaying fear. I am like too many of our doctors in the Florida Medical
Association, just willing to let nature take its course with the hope that all will be
well when the contest is finished. Should something go wrong with nature, however,
and it begins to play tricks on me and my patient, then I am expected to be willing
and able to cope with its wrongdoings.
Likewise, with all kinds of unnatural tricks from many unnatural sources being
forced upon organized medicine today, too many of us are willing to resort to
Hopeful Procrastination. Doing nothing individually or collectively toward combat-
ing the evil forces that beset us. in the hope they will reconcile themselves, is really
abusing the old glutei. It is high time we gave them a rest and used our brains and
skill to decompose, dissolve, destroy or deter those tricks, trades and tyrants that
seek to decompose, dissolve, or deter our freedom and our way of life as doctors of
medicine.
Yes, it is time for real thinking and action individually and collectively, for hope-
ful procrastination is not going to reconcile or protect our freedom or our profession.
Our holding action against these vipers must be turned into a potent and powerful
offensive force, for to continue to retreat, appease and pacify is not good medicine,
the kind it will not do to practice.
Your House of Delegates at the recent convention of the Association took a
stand. The doctors of Florida have stopped retreating. Now we must get on the
offensive with real bulldog tenacity and let the rest of the country know we are
potent and mean business. The eyes of the nation are now on Florida in many
respects, but particularly on the Florida Medical Association.
Our most potent weapon is our state Association, and our Association’s most
potent weapon is the county medical societies, and the county medical societies’
most potent weapon is the individual members. All these must be tightly organized.
We cannot be sick, weak and disorganized; instead, we must be strong, healthy
and tightly organized. The only way we will fail is to be divided among ourselves.
This must never be.
Let us get off our glutei, attend our society meetings and take an active part.
Let us speak our mind, lest our thinking and actions go astray and we wonder
WHO DONE IT. Let us not be victims of Hopeful Procrastination.
J. Florida. M. A.
August, 1957
161
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON. M.D.. Editor
STAFF
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
Committee on Publication
Shaler Richardson, M.D., Chairman ... .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Managing Editor
Ernest R. Gibson
Assistant Managing Editor
Thomas R. Jarvis
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder. M.D Jacksonville
C \rlos P. Lamar. M.D Miami
Walter C. Payne Sr.. M.D Pensacola
George T. Harrell Jr.. M.D Gainesville
Dean, College of Medicine. University of Florida
Homer F. Marsh. Ph.D Miami
Dean. School of Medicine, University of Miami
Editorial Consultant
Mrs. Edith B. Hill
Actions of the Florida Legislature
1957 Session
The legislative program of the Florida Medi-
cal Association for the 1957 session of the Flor-
ida legislature fared well. Its major objectives
met a large measure of success, justifying the
vast amount of time spent in determining and
coordinating a sound, constructive over-all pro-
gram. It was necessary to follow 65 bills intro-
duced on a wide variety of subjects which in some
way pertained to the medical profession of the
state and its role in protecting the health and
welfare of the public.
Naturopathy
Support of the recommendations of Governor
LeRoy Collins to abolish the practice of naturop-
athy in Florida was the primary objective of
the Association’s program. After introduction of
the original bill to outlaw the practice of naturop-
athy in the state, the supporters of this measure
deemed it advisable to accept a committee sub-
stitute which accomplished the following:
1. — Redefined naturopathy by excluding
phytotherapy and biochemistry from the
list of authorized means of practicing na-
turopathy and specifically prohibited a
naturopath from prescribing or administer-
ing any drugs.
2. — Abolished the Board of Naturopathic
Examiners and placed all their present au-
thority under the State Board of Health.
3. — Revoked all nonresident licenses and
allowed only those naturopaths to continue
who had been in active practice in the
State of Florida for two years.
4. — Provided that all naturopaths who are
authorized to continue to practice be re-
certified by the State Board of Health.
This bill passed the House without amend-
ments, but was amended in the Senate to ex-
clude those naturopaths who had been practicing
for 15 years in Florida and permit them to ad-
minister narcotics in cases of emergency justify-
ing their use. The House concurred in the Senate
amendment, and the Governor signed the bill into
law on May 16, 1957. It becomes effective on
October 1 of this year.
162
EDITORIALS AND COMMENTARIES
Volume. XLIV
Number 2
A bill to allow veterans of military service or
those receiving their training under the G. I.
bill to be considered as having practiced naturop-
athy in Florida for 15 years, thereby qualifying
them for drug privileges, was introduced and
supported by the naturopaths. This bill was
amended to provide that they must have served
in the Armed Forces during World War II as
naturopathic physicians or must have received
their naturopathic training under the G. I. bill.
Passed by both Houses, the bill was vetoed by
the Governor on June 28, 1957, and therefore did
not become law.
“I am confident,” said Governor Collins, com-
menting on the naturopathy legislation, ‘‘that this
new law will prove of great public benefit. For
many years and for many sessions, efforts have
been made in Florida to eliminate abuses in this
field, but this is the first time that substantial
progress has been made.”
Indigent Hospitalization Program
A second major objective of the Association
was to support the budget request of the State
Board of Health for $4,000,000 for the 1957-1959
biennium for its Hospital Service for the Indi-
gent Program. The full amount was appropriated
by the legislature to match county funds for hos-
pitalization of acutely ill or injured indigent per-
sons. No provision, however, was made by the
lawmakers for funds to continue the program of
the State Welfare Board for hospitalization of
public welfare recipients.
Other Association-Supported New Laws
Upon the recommendation of the Florida
Orthopedic Society, the Association supported
amendments to the Physical Therapy Law.
Among the provisions was a grandfather clause
to allow registration of certain physical thera-
pists who were not graduates of approved schools,
but who had certain qualifications acceptable to
the State Board of Medical Examiners.
The entire amount requested by the State
Board of Health to continue 10 medical student
scholarships was granted. The sum of $70,000
was appropriated for this purpose.
The budget request of the State Board of
Health for the purchase of Salk polio vaccine for
indigents was granted. The amount appropriated
was $250,000.
Additional Legislation Enacted
Among the numerous other measures of inter-
est to Association members, a few deserve men-
tion in this brief resume of legislative action.
The Mandatory Hospital Licensing Law was
sponsored by the Florida Hospital Association.
It provides for the definition of a hospital and
licensure by the State Board of Health.
Amendments to the Florida Pharmacy Act
were sponsored by the Florida Pharmaceutical
Association. One change was removal of the pro-
vision for the preparing, compounding and dis-
pensing of drugs by persons other than physicians
under a physician’s direct supervision. The law
still provides that a physician may compound,
prepare and dispense drugs provided he himself
does so.
A law was enacted defining psychology and
providing for the certification of psychologists.
It is known as the Psychologists Certification
Act.
Statutory revisions were made which strength-
en the power of the Osteopathic and Chiroprac-
tic Boards to control the persons under their
jurisdiction.
Taking effect immediately upon its approval
by the Governor on June 3, an act was passed
granting the state attorney or the county solicitor
the power, at his discretion, to have autopsies
performed upon dead bodies found within the
county, either before interment or after inter-
ment, whenever, in his opinion, such autopsies
are necessary in order to ascertain whether or
not death was criminally caused.
Membership Cooperation
The Association’s Committee on Legislation
and Public Policy, with Dr. H. Phillip Hampton
as chairman, and the Association’s Executive Of-
fice, with Mr. W. Harold Parham, Assistant Man-
aging Director, who represented the Association
in Tallahassee during the entire session, deserve
the plaudits of the membership for their tireless
efforts in behalf of constructive legislation for the
protection of the health and welfare of Floridians.
Supporting them were the component county so-
cieties and their officials, who laid the ground
work for the success of the program adopted. It
is noteworthy that approximately half of the
county medical societies had representatives at
the public hearing held by the Senate and House
Public Health Committees to consider the natur-
opathy bill. Ably assisting Dr. Hampton in ex-
pressing the Association’s position on that oc-
casion were Dr. Edward R. Annis of Miami and
the Association’s Secretary-Treasurer, Dr. Samuel
M. Day of Jacksonville. The officers of the As-
J. Florida, M. A.
August, 1957
EDITORIALS AND COMMENTARIES
163
sociation, and particularly Dr. Edward Jelks,
gave unstintingly of their time and effort to pro-
mote the entire legislative program. The degree
of cooperation and support given the Association
leaders by the membership in large measure also
determined the success of the program and set an
excellent example of teamwork within the Asso-
ciation.
Florida Medicine and the Future
A close look at a recent membership study of
the Florida Medical Association in relation to
future growth points up the need' for injecting
long range planning into the Association’s pro-
grams, activities and services. Thinking along
this line in a big way is in order.
Florida is growing at a faster rate than any
state in the union except for two small thinly
populated Western states. Since the first of 1950,
the number of persons moving into Florida each
week to establish permanent homes has averaged
2,614. This figure is based on an estimate of
3.800.000 residents in the state in 1955, represent-
ing a 43.7 per cent increase since 1950. With
resident births in excess of resident deaths by
927 weekly, this latest available report1 indicates
that Florida’s population growth is now averaging
3,568 weekly. Between 1940 and 1955, the
population figures practically doubled, with a net
increase of 43.7 per cent. Estimates of future
population mount to 4,960,000 by 1962 and
6.100.000 by 1967.
Growth of membership in the Association pre-
sents an interesting parallel. Members numbered
1,370 in 1940 and 2,743 in 1955, almost an exact
doubling of the figures, but representing a net in-
crease of 711 members, or 39.9 per cent. The
net increase in the two years that have elapsed
since that time is 326 members, or 11.9 per cent.
The average yearly net increase in membership
for the last five years ( 1953-1957) has been 157.
The long look ahead indicates that on reliable
estimates of population growth and growth in
membership of the Association, there will be
3,854 members in 1962 and 4,639 members in
1967, whereas, on the basis of one physician for
every thousand residents of the state, there will
be need for 4,960 physicians in 1962 and 6,100 in
1967. It appears that with the new medical
schools, the number of physicians coming from
1. Directory of Florida Industries, 1956-1957 Edition, published
by the Florida State Chamber of Commerce, Jacksonville.
other states and the Association’s placement serv-
ice to aid in the placing and equitable distribu-
tion of new physicians, the need will be met.
What will living be like 25 years from now?
The magazine, “Changing Times,” assumed the
prophetic role recently by answering that ques-
tion in an article entitled “Look 25 Years Ahead
— Great Changes Coming,” touching on almost
every phase of life. Under the subhead, “Health,”
the article said: “Medical bills will be paid for in
advance, through insurance and prepaid plans.
But it doesn’t look as if compulsory health in-
surance under government auspices is in the
cards." If the magazine proves a true prophet
and that specter is out of the way, Florida medi-
cine may look forward to a particularly bright
future if it shoulders its responsibility now and
plans wisely for the challenge that lies ahead.
“Heedless Horsepower”
A new deadly disease has the American people
in its grip, and no miracle drug is in sight to stop
its frightful toll of human lives.
Heedless horsepower is the chronic disease
of the Age of the Automobile. Its symptoms are
many and various. The heavy foot on the accel-
erator; the eye fixed on the climbing speedome-
ter; the hand on the horn; the mind idling
while the car is in high.
In its twenty-third annual highway safety
publication, “Heedless Horsepower,” The Travel-
ers Insurance Companies of Hartford, Conn.,
point to the fact that 40,000 Americans were
killed and 2,368,000 injured in 1956 on the
nation’s highways. That is an increase of 6 per
cent in fatalities and nearly 10 per cent in in-
juries over 1955’s total.
“The disease of heedless horsepower is highly
contagious,” the booklet states. It can be spread
by an irresponsible word, an inflated claim, a
careless example. Everyone who is in a position
to influence drivers should learn that horse-
power, in the hands of the heedless, is the funda-
mental cause of the ever mounting toll of dis-
aster.
In recent years, engineers have made many
attempts to feature safety equipment in the new
cars. Probably many lives have been spared by
safety glass, seat belts, padded instrument panels,
all-steel bodies, and other protective measures.
Nevertheless, these safety devices can be nullified
24 hour therapeutic
blood levels with
a single (1 Gm.) dose
cnex Sulfamethoxypyridazine, the new, long-acting sulfona-
ide, now enables the physician to attain more effective
' Ifa therapy with these unequaled clinical advantages —
)W DOSAGE1 —only 2 tablets per day.
\PID ABSORPTION1 — therapeutic blood levels within the
ur, blood concentration peaks within 2 hours.
tOLONGED ACTION1— 10 mg. per cent blood levels that
rsist beyond 24 hours on a maintenance dose of 1 Gm.
?OAD-RANGE EFFECTIVENESS— particularly efficient in uri-
iry tract infections due to sulfonamide-sensitive organisms,
eluding E. coli, Aerobacter aerogenes, paracolon bacilli,
reptococci, staphylococci, Gram-negative rods, diphtheroids
id Gram-positive cocci.
GREATER SAFETY— high solubility, slow excretion and low
dosage help avoid crysta I luria. No increase in dosage is rec-
ommended; the usual precautions regarding sulfonamides
should be observed.
CONVENIENCE —the low maintenance dosage of 1 Gm. (2
tablets) per day for the average adult offers optimal con-
venience and acceptance to patients.
TABLETS: Each tablet contains 0.5 Gm. (7Vi grains) of sul-
famethoxypyridazine. Bottles of 24 and 100.
SYRUP: Each teaspoonful (5 cc.) of caramel-flavored syrup
contains 250 mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
(1) Boger, W. P.; Strickland, C. S. and Gylfe, J. M.: Antibiot. Med. &
Clin. Ther. 3:378 (Nov.) 1956.
3fl. U.S. Pat. Off.
^DERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
i
166
EDITORIALS AND COMMENTARIES
Volume XLJV
Number 2
by any combination of speed plus carelessness,
thoughtlessness or lack of judgment by the driver
behind the wheel.
It is the driver, however, not the manufactur-
er, the advertiser or the salesman, who must bear
the greatest weight of blame, for it is the driver
who can control the horsepower and use it safely
for his greater ease and convenience. It is the
driver who is lectured to, legislated at, prayed for,
preached to — in every medium of public expres-
sion known to man. It is likewise the driver
who nods sagely, promises readily, and forgets
everything but his sense of overwhelming power
when he steps on the gas.
Casualty lists on the highways have mounted
steadily until in 1956 all records of heedless haste
and needless waste were shamefully broken. The
facts of human suffering and death speak for
themselves.
Human error is by far the biggest single cause
of accidents. Figures compiled by The Travelers
show that in 96.4 per cent of the fatal crashes
last year, the automobile was in apparently good
condition. Clear, dry weather prevailed in more
than 85 per cent of these instances.
If this year’s record is equal to that of 1956,
one in 70 Americans will be a statistic — a pain-
wracked survivor, or a name in the obituary
column.
The Florida Medical Association is alert to its
role in helping to meet this national problem. Its
Medical Advisory Committee to the Florida De-
partment of Public Safety is making a notable
contribution in discharging its duties. At the
Association's recent annual meeting, a resolution,
presented by the Pinellas County Medical Soci-
ety, was adopted committing the Association to
urge the American Medical Association, which
has long been working on the problem, to lead
the way in establishing minimum standards of
physical, mental and psychological ability for the
safe operation of motor vehicles.
Especially noteworthy also is the bill for
compulsory minimum safety standards for auto-
mobiles introduced in the House of Representa-
tives by Congressman Bennett of Florida. These
standards would include speed capacity, safety
padding, steering control, lights, visibility aids and
other equipment. He recently told the House
Interstate subcommittee holding hearings on traf-
fic safety problems that it was “totally unrealistic
to expect effective self-regulation in this field,
despite the obvious desire of most manufacturers
to make their products safe.” The American
Medical Association was scheduled to testify
soon before this subcommittee.
Graduate Medical Education
Hematology Seminar and Short Course Held
The Seminar on Hematology, held June 20-22
at the College of Medicine of the University of
Florida in Gainesville, was exceptional. The at-
tendance was fair for so highly specialized a
course and comparable to the previous registra-
tions. The lecturers were noteworthy because of
their practical and informative approach to the
subject, both for the pathologists and the phy-
sicians specializing in hematology. In view of
the increased interest in this specialty, presenta-
tion of this subject will doubtless receive particu-
lai consideration in future planning.
I)r. Steven O. Schwartz, Associate Professor
of Medicine at Northwestern University School
of Medicine, was particularly well received. His
methods of teaching proved to be most helpful to
those not specializing in hematology. The phy-
sicians of Florida who lectured deserve com-
mendation for their excellent presentations.
The lectures of the Twenty-Fifth Annual
Graduate Short Course, also held at the College
of Medicine on June 24-28, immediately follow-
ing the Seminar, were received with the usual
close attention and enthusiasm. The attendance,
however, was less than in previous years. This
decrease was attributed to the fact that the
Course was held in a small city where the group
of local physicians is small. When the University
Hospital is completed and operating, the present-
ing of graduate medical education will be much
easier, and probably the physicians can more
profitably spend their time while in attendance.
The physicians present manifested genuine
pleasure at having Drs. James V. Warren, How-
ard W. Jones, and Georgeanna S. Jones return
for these lectures. Dr. James R. Cantrell of The
Johns Hopkins University School of Medicine,
who gave the lectures on Surgery, made a most
satisfactory presentation. One of the outstand-
ing features in both the Seminar on Hematology
and the Short Course was the contribution made
by the College of Medicine of the University of
Florida. The faculty presented highly specialized
subjects, in each instance making them most
profitable to the practicing physician.
J. Florida, M. A.
August, 1957
EDITORIALS AND COMMENTARIES
167
Report of Florida Delegates to American Medical Association
1957 Annual Meeting
Revision of the Principles of Medical Ethics,
relations with the United Mine Workers of
America Welfare and Retirement Fund, the fed-
eral government’s Medicare program, new stand-
ards for medical schools, a new statement on
occupational health programs and the issue of
Social Security benefits for physicians were among
the wide variety of subjects acted upon by the
House of Delegates at the American Medical As-
sociation’s 106th Annual Meeting held June 3 to
7 in New York City.
Dr. Gunnar Gundersen of La Crosse, Wis.,
member of the A.M.A. Board of Trustees since
1948 and chairman for the past two years, was
unanimously chosen president-elect for the year
ahead. Dr. Gundersen, who also was first chair-
man of the Joint Commission on Accreditation of
Hospitals from 1951 to 1953, will become presi-
dent of the American Medical Association at the
June 1958 meeting in San Francisco. There he
will succeed Dr. David B. Allman of Atlantic
City, N. J., who became the 111th president at
the Tuesday night inaugural ceremony in the
Grand Ballroom of the Waldorf-Astoria Hotel.
The House of Delegates voted the 1957 Dis-
tinguished Service Award of the American Medi-
cal Association to Dr. Tom Douglas Spies, head
of the department of nutrition and metabolism at
Northwestern University Medical School, Chicago,
and director of the nutrition clinic at Hillman
Hospital, Birmingham, Ala., for his outstanding
contributions to the science of human nutrition.
For only the third time in A.M.A. history, the
House also voted a special citation to a layman
for outstanding service in advancing the ideals of
medicine and contributing to the public welfare.
Recipient of this award was Henry Viscardi Jr.,
of West Hempstead, N. Y., founder and president
of Abilities, Inc., which employs only severely
disabled persons.
Physician registration at the New York meet-
ing had already reached an all-time high at 5
p.m. Thursday with 18,982 counted and scores
of registration cards still unprocessed. The pre-
vious high was chalked up at the 1953 New
York meeting when the five day total was 17,958
physicians.
New Principles of Medical Ethics
The House approved the long-discussed revi-
sion of the Principles of Medical Ethics, originally
submitted at the 1956 annual meeting in Chicago.
The final version, presented by the Council on
Constitution and Bylaws and then amended by
reference committee and House discussions in
New York, now reads as follows:
Principles of Medical Ethics
These principles are intended to aid physicians in-
dividually and collectively in maintaining a high level of
ethical conduct. They are not laws but standards by
which a physican may determine the propriety of his
conduct in his relationship with patients, with colleagues,
with members of allied professions, and with the public.
Section 1. — The principal objective of the medical
profession is to render service to humanity with full re-
spect for the dignity of man. Physicians should merit
the confidence of patients entrusted to their care, render-
ing to each a full measure of service and devotion.
Section 2. — Physicians should strive continually to
improve medical knowledge and skill, and should make
available to their patients and colleagues the benefits of
their professional attainments.
Section 3. — A physician should practice a method of
healing founded on a scientific basis; and he should not
voluntarily associate professionally with anyone who
violates this principle.
Section 4. — The medical profession should safeguard
the public and itself against physicians deficient in moral
character or professional competence. Physicians should
observe all laws, uphold the dignity and honor of the
profession and accept its self-imposed disciplines. They
should expose, without hesitation, illegal or unethical
conduct of fellow members of the profession.
Section 5. — A physician may choose whom he will
serve. In an emergency, however, he should render ser-
vice to the best of his ability. Having undertaken the
care of a patient, he may not neglect him ; and unless
he has been discharged he may discontinue his services
only after giving adequate notice. He should not solicit
patients.
Section 6. — A physician should not dispose of his
services under terms or conditions which tend to interfere
with or impair the free and complete exercise of his
medical judgment and skill or tend to cause a deteriora-
tion of the quality of medical care.
Section 7. — In the practice of medicine a physician
should limit the source of his professional income to
medical services actually rendered by him, or under his
supervision, to his patients. His fee should be commen-
surate with the services rendered and the patient’s ability
to pay. He should neither pay nor receive a commission
for referral of patients. Drugs, remedies or appliances
may be dispensed or supplied by the physician provided
it is in the best interests of the patient.
Section 8. — A physician should seek consultation up-
on request; in doubtful or difficult cases; or whenever
it appears that the quality of medical service may be en-
hanced thereby.
Section 9. — A physician may not reveal the confi-
dences entrusted to him in the course of medical at-
tendance, or the deficiencies he may observe in the char-
acter of patients, unless he is required to do so by law
or unless it becomes necessary in order to protect the
welfare of the individual or of the community.
Section 10. — The honored ideals of the medical pro-
fession imply that the responsibilities of the physician
extend not only to the individual, but also to society
where these responsibilities deserve his interest and partic-
ipation in activities which have the purpose of improv-
ing both the health and the well-being of the individual
and the community.
168
EDITORIALS AND COMMENTARIES
Volume XLI V
Number 2
In approving the new Principles of Medical
Ethics, the House of Delegates also reaffirmed
the ‘"Guides for Conduct for Physicians in Re-
lationships with Institutions,” adopted in 1951,
and requested the Board of Trustees to devise
and initiate a campaign to educate both physi-
cians and the general public to the dangers
inherent in the illegal corporate practice of medi-
cine in its various forms.
Guides for Relations with UMWA Fund
In a key action on the basic issue of third
party intervention, as it affects the patient’s free
choice of physician and the physician’s method of
remuneration, the House adopted the “Suggested
Guides to Relationships Between State and Coun-
ty Medical Societies and the United Mine Work-
ers of America Welfare and Retirement Fund.’’
which were submitted by the A.M.A. Committee
on Medical Care for Industrial Workers. In ap-
proving the guides, the House also recommended
that the Board of Trustees study the feasibility
and possibility of setting up similar guides for re-
lations with other third party groups such as
management and labor union plans.
The statement, which outlines both medical
society and UMWA responsibilities, contains
these “General Guides:”
“1. All persons, including the beneficiaries
of a third-party medical program such as the
UMWA Fund, should have available to them
good medical care and should be free to select
their own physicians from among those willing
and able to render such service.
“2. Free choice of physician and hospital
by the patient should be preserved:
“a. Every physician duly licensed by the
state to practice medicine and surgery
should be assumed at the outset to be
competent in the field in which he
claims to be, unless considered other-
wise by his peers.
“b. A physician should accept only such
terms or conditions for dispensing his
services as will insure his free and
complete exercise of independent
medical judgment and skill, insure the
quality of medical care, and avoid
the exploitation of his services for
financial profit.
“c. The medical profession does not con-
cede to a third party such as the
UMWA Welfare and Retirement Fund
in a medical care program the prerog-
ative of passing judgment on the
treatment rendered by physicians, in-
cluding the necessity of hospitaliza-
tion. length of stay, and the like.
“3. A fee-for-service method of payment for
physicians should be maintained except under
unusual circumstances. These unusual circum-
stances shall be determined to exist only after a
conference of the liaison committee and repre-
sentatives of the Fund.
“4. The qualifications of physicians to be on
the hospital staff and membership on the hospital
staffs is to be determined solely by local hospital
staffs and by local governing boards of hospitals.”
The Medicare Program
The House considered three resolutions deal-
ing with the federal government’s Medicare pro-
gram for the dependents of servicemen. The
delegates adopted one resolution condemning any
payments under the Medicare program “to or on
behalf of any resident, fellow, intern or other
house officer in similar status who is participat-
ing in a training program.” Government sanction
of such payments, the House declared, would give
impetus to the improper corporate practice of
medicine by hospitals or other nonmedical bodies.
Such proposals, the House added, would violate
traditional patterns of American medical practices,
seriously aggravate problems of hospital-physician
relationships, encourage charges by hospitals for
residents’ services to patients not under the Medi-
care program, and create a variety of additional
problems in such areas as medical licensure and
health insurance.
In another action on Medicare, the House
recommended that the decision on type of con-
tract and whether or not a fee schedule is in-
cluded in future contract negotiations should be
left to individual state determination. In this con-
nection. however, the House restated the A.M.A.
contention that: the Dependent Medical Care Act
as enacted by the Congress does not require fixed
fee schedules; the establishment of such schedules
would be more expensive than permitting physi-
cians to charge their normal fees, and fixed fee
schedules would ultimately disrupt the economics
of medical practice.
The House also suggested that the A.M.A.
attempt to have existing Medicare regulations
amended to incorporate the Association’s policy
that the practice of anesthesiology, pathology,
radiology and physical medicine constitutes the
J. Florida, M. A
August, 1957
EDITORIALS AND COMMENTARIES
169
practice of medicine, and that fees for services
by physicians in these specialties should be paid
to the physician rendering the services.
New Statement on Medical Schools
To replace the “Essentials of an Acceptable
Medical School,” initially approved by the House
of Delegates in 1910 and most recently revised
in 1951, the House adopted a new statement en-
titled “Functions and Structure of a Modern
Medical School.” Presentation of the document
followed a year of careful study by the Council
on Medical Education and Hospitals in collabora-
tion with the Association of American Medical
Colleges.
The statement is intended to provide flexible
guides which will “assist in attaining medical
education of ever higher standards” and “serve
as general but not specific criteria in the medical
school accreditation program.” The document
encourages soundly conceived experimentation
in medical education, and it discourages excessive
concern with standardization.
“No rigid curriculum can be prescribed for
accomplishing the objectives of medical educa-
tion,” it states. “On the contrary, it is the re-
sponsibility of the faculty of each school contin-
ually to re-evaluate its curriculum and to provide
in accordance with its own particular setting and
in recognition of advances in science a sound
and well-integrated educational program.”
Occupational Health Programs
The House also approved a new statement
on the “Scope, Objectives and Functions
of Occupational Health Programs,” submitted
through the Board of Trustees by the Council on
Industrial Health. The Board report to the
House said: “The statement describes and defines
orthodox in-plant medical programs as understood
in this country today and distinguishes clearly
between such programs and the various plans for
comprehensive medical care of the sick. It
should help to resolve misunderstandings concern-
ing the specialty of occupational medicine.”
In adopting the statement, the House agreed
with a reference committee report which de-
clared that “the House has before it a statement
which for the first time clearly defines the scope,
objectives and functions of occupational health
programs. It marks the needs and boundaries of
occupational medicine. It states in a positive
fashion the proper place of occupational health
programs in the practice of medicine and it
clearly charts the pathways of communication be-
tween physicians in occupational health programs
and physicians in the private practice of medi-
cine.”
Social Security for Doctors
Two resolutions favoring compulsory inclu-
sion of physicians in the federal Social Security
system and another one calling for a nationwide
referendum of A.M.A. members on the issue
were rejected by the House. The delegates re-
affirmed their opposition to compulsory coverage
of physicians under the Old Age and Survivors
Insurance provisions of the Social Security Act.
They also recommended a strongly stepped-up
informational program of education which will
reach every member of the Association, explain-
ing the reasons underlying the position of the
House of Delegates on this issue. The House at
the same time reaffirmed its support of the
Jenkins-Keogh Bills.
Miscellaneous Actions
In considering 66 resolutions and many addi-
tional reports from the Board of Trustees, coun-
cils and committees, the House also:
Congratulated the Board and the Committee
on Poliomyelitis for their prompt action in stimu-
lating national interest in the polio immuniza-
tion program;
Recommended further study and a progressive
program of action, probably including legislative
changes, to solve the problem of narcotic addic-
tion ;
Urged a more careful screening of television
and radio patent medicine advertisements;
Directed the Board of Trustees to investigate
the indiscriminate use of stimulants such as
amphetamine, particularly in relation to athletic
programs;
Directed the Speaker to appoint a committee
of five House members to study the Heller Re-
port, a management survey of the Association’s
organizational mechanisms;
Commended the Law Department for its spe-
cial report on professional liability and urged
state and county medical societies to establish
claims prevention programs and to show the new
film, “The Doctor Defendant;”
Opposed the establishment of any further
veterans’ facilities for the care of non-service-
connected illnesses of veterans;
Condemned the compulsory assessment of
170
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 2
medical men and staff members by hospitals in
fund-raising campaigns;
Commended the television program. Dr.
Hudson’s Secret Journal, its producers and its
star, Mr. John Howard, for an outstanding con-
tribution to the public interest and welfare, and
Recommended payment of transportation ex-
penses of Section Secretaries for A.M.A. meet-
ings which they are required to attend.
Opening Session
At the Monday opening session Dr. Dwight
Murray, retiring A.M.A. president, stressed the
triple theme of the personal touch in medicine,
the necessity for freedom in medical practice and
the need for professional unity. Dr. Allman,
then president-elect, warned against the dangers
of third party contractural agreements involving
fixed fee schedules. The Goldberger Award in
nutrition research was presented to Dr. Paul
Gyorgy of Philadelphia. An A.M.A. citation was
awarded to the Parke-Davis & Company for its
continuing series of institutional advertisements
telling the story of medicine and medical prog-
ress. Dr. H. G. Weiskotten, who retired after
many years as chairman of the Council on Medi-
cal Education and Hospitals, received two bound
volumes of letters of appreciation and also an
ovation from the House of Delegates.
Inaugural Ceremony
Dr. Allman, in his Tuesday night inaugural
address, declared that the physician is constantly
striving for a balance between personal, human
values, scientific realities and the inevitabilities of
God’s will. The inaugural ceremony, which was
telecast over Station WABD-TV in New York, in-
cluded presentation of the Distinguished Service
Award to Dr. Spies and the special layman’s
citation to Mr. Viscardi. Also taking part in the
program was the United States Army Chorus of
Washington, D. C.
Election of Officers
In addition to Dr. Gundersen, the new presi-
dent-elect, the following officers were selected by
the House on Thursday:
Dr. Jesse Hamer of Phoenix, Ariz., vice presi-
dent; Dr. George F. Lull of Chicago, secretary;
Dr. J. J. Moore of Chicago, treasurer; Dr. E.
Vincent Askey of Los Angeles, speaker, and Dr.
Louis Orr of Orlando, Fla., vice speaker.
Four new members were elected to the Board
of Trustees: Dr. George Fister of Ogden, Utah,
to succeed Dr. James R. Reuling; Dr. Cleon
Nafe of Indianapolis, Ind., to succeed Dr. James
R. McVay; Dr. James Z. Appel of Lancaster,
Pa., to replace the late Dr. Thomas P. Murdock,
and Dr. Raymond McKeown of Coos Bay, Ore.,
to replace Dr. Gundersen. Dr. Edwin S. Hamil-
ton of Kankakee, 111., was elected chairman of
the Board at its organizational meeting after the
elections in the House.
Dr. Homer L. Pearson Jr. of Coral Gables,
Fla., was renamed to the Judicial Council. Two
new members were elected to the Council on
Medical Education and Hospitals: Dr. Clark
Wescoe of Lawrence, Kan., to succeed Dr. Weis-
kotten, and Dr. Warde B. Allan of Baltimore,
Md., to succeed Dr. F. D. Murphey of Lawrence,
Kan.
For the Council on Medical Service, Dr.
Robert L. Novy of Detroit, Mich., was re-
elected, and Dr. Hoyt Woolley of Idaho Falls,
Ida., was chosen to replace Dr. McKeown. Dr.
Warren W. Furey of Chicago was re-elected to
the Council on Constitution and Bylaws.
At the Wednesday session of the House the
Illinois State Medical Society made a record state
society contribution to the American Medical Ed-
ucation Foundation by turning over $170,450 to
Dr. Louis H. Bauer of New York, foundation
president.
Respectfully submitted,
Louis M. Orr, M.D.
Reuben B. Chrisman Jr., MD.
Francis T. Holland, M.D.
Registration
Total registration of Florida Medical Association mem-
bers at the 1957 A. M. A. annual meeting in New York
was 159. Members in attendance were:
BELLE GLADE: Wilbert O. Norville (Col.). BRAD-
ENTON: Lowrie W. Blake, Roy W. Gunther, Willis W.
Harris, Richard V. Meaney. CLEARWATER: Lewis A.
Gryte, Robert P. Vomacka. CORAL GABLES: Donald
H. Altman, W. A. D. Anderson, A. Daniel Amerise, Reu-
ben B. Chrisman Jr., Glenn H. Heller, C. Howard Mc-
Devitt, Wesley S. Nock, Frederick P. Poppe, Joseph H.
Rudnick, George F. Schmitt Jr., Louis C. Skinner Jr.,
William L. Wagener Jr., CRYSTAL RIVER: Samuel
R. Miller Jr. DADE CITY: Dwayne L. Deal. DANIA:
Fred E. Brammer. DAYTONA BEACH: Cleland D.
Cochrane, J. Richard West. DELAND: Matthew A.
Moroz. FORT LAUDERDALE: Burns A. Dobbins Jr.,
Richard A. Mills, George T. F. Rahilly, Scottie J. Wilson.
FORT MYERS: James B. Schutt. GAINESVILLE:
Edwin H. Andrews, George T. Harrell Jr. HIALEAH:
Van M. Browne, Albert W. McCorkle. HOLLYWOOD:
Selig J. Bascove, Bertram J. Frankel, Louis J. Novak,
Sidney J. Peck, Randall W. Snow. INDIAN ROCKS:
Warren J. Brown. JACKSONVILLE: Lee E. Brans-
ford, Joseph L. Chilli, Samuel M. Day, Stephen P. Gy-
J. Florida, M. A.
August, 1957
EDITORIALS AND COMMENTARIES
171
land, Louis Limbaugh, Samuel S. Lombardo, Paul V.
Reinartz, Richard V. Reiswig. LAKELAND: David
Sloane.
LAKE WORTH: Alva L. Rowe. LEESBURG:
Arthur P. Buchanan. MARIANNA: Albert E. Mc-
Quagge, Courtland D. Whitaker. MELBOURNE: Theo-
dore J. Kaminski. MIAMI: Ernest R. Barnett, Robert
C. Bartlett, Robert J. Boucek, John E. Burch, Milton
M. Coplan, Victor Dabby, Carl H. Davis, Byron D.
Epstein, John J. Farrell, Gus G. Casten, James H. Fergu-
son, Roger J. Forastiere, M. Jay Flipse, N. Stuart Gil-
bert, George Gittelson, Frederick A. Gunion, William C.
Hutchison, Morris Jaffe, Arnold L. Kane, Solomon
Kann, Harold S. Kaufman, Alexander Kushner, George
D. Lilly, Ronald J. Mann, Stanley Margoshes, E. Sterl-
ing Nichol, Raymond E. Parks, Homer L. Pearson Jr.,
Max Pepper, Benton B. Perry, Ralph L. Pipes, Gerard
Raap, Lyle W. Russell, Walter W. Sackett Jr., Ralph
S. Sappenfield, J. Graham Smith, Donald G. Stannus,
Arthur W. Wood Jr. MIAMI BEACH: 'Jack J. Falk,
Eli Galitz, Jacob A. Glassman, Ralph E. Kirsch, Irwin
H. Makovsky, Marvin L. Meitus, Julius R. Pearson,
David K. Pinks, Charles B. Wigderson.
ORANGE PARK: Marcus B. Bergh. ORLANDO:
Williard H. Boardman, J. Rocher Chappell, George W.
Edwards II, Edward T. Furey, Eugene L. Jewett, Dun-
can T. McEwan, Louis M. Orr, Charles R. Sias. PALM
BEACH: Alvin E. Murphy. PENSACOLA: Arthur
J. Butt, Vernon L. Smith. PUNTA GORDA: Robert H.
Shedd. ROCKLEDGE: John C. Miethke. ST. AUGUS-
TINE: Vernon A. Lockwood. ST. PETERSBURG:
Arnold S. Anderson, Elmer B. Campbell, Paul T. Cope,
Charles K. Donegan, Robert M. Kilmark, James K.
McCorkle, Norval M. Marr Jr., John R. Neefe, William
B. Norris, Richard Reeser Jr., Joseph S. Spoto. SARA-
SOTA: George M. Coggan, Linwood M. Gable, Melvin
M. Simmons, Henry J. Vomacka. TALLAHASSEE:
Edson A. Andrews, James K. Conn, Francis T. Holland.
TAMPA: Frank S. Adamo, Joseph D. Brown, Richard
G. Connar, Stephen P. Gyland, H. Phillip Hampton,
A.M.C. Jobson, Eunice M. Lasche, Alford F. Massaro,
Hugh E. Parsons, Mason C. Smith, Wesley W. Wilson.
VERO BEACH: Vernon L. Fromang, John P. Gifford,
James C. Robertson. WEST PALM BEACH: Robert
V. Artola, John M. Baber, Matthew N. DePasquale,
Ralph M. Overstreet Jr., Raymond R. Preffer, James C.
White. WILDWOOD: Philip Stutsman. WINTER HA-
VEN: Chester L. Nayfield, Wiley T. Simpson. WINTER
PARK: Ruth S. Jewett, Russell W. Ramsey.
Southern Medical Association
Builds Permanent Headquarters
The Southern Medical Association is to be
congratulated on attaining the goal of a perma-
nent home in this first year of its second half
century of existence. The project is now well
under way, and the building is expected to be
completed before the year is out.
The handsome, modernistic edifice will become
the focal point for the association’s 10,000 mem-
bers in 16 states, the District of Columbia,
Puerto Rico and the Canal Zone. It will stand as
tangible evidence of the remarkable growth and
outstanding contribution made by this organi-
zation, on a regional basis, to the progress of
medicine generally and particularly to its ad-
vancement in the South.
Birmingham, which has been headquarters of
the association for 41 of its 50 years, now be-
comes its permanent home. Consideration was
also given to Atlanta, Memphis and Nashville.
The split-level structure, which will house the
executive offices and also the Southern Medical
Journal, is being erected on a tract of nearly an
acre located on Birmingham’s famed Highland
Avenue in a select area in the southeast section
of the city. The site is near the Medical Center.
The building and site will represent an invest-
ment of $175,000, of which $50,000 is land cost.
Representing Florida on the Home Building Fi-
nance Committee is Dr. Walter C. Jones of
Miami. Dr. Jones is a past president of the South-
ern Medical Association.
Postgraduate Obstetric-Pediatric Seminar
(Formerly Tri-State Obstetric Seminar)
Daytona Beach, Sept. 9-11, 1957
All physicians are cordially invited to attend
the Postgraduate Obstetric-Pediatric Seminar at
the Daytona Plaza Hotel in Daytona Beach on
September 9, 10 and 11. The program will be
especially attractive to pediatricians, obstetri-
cians and general practitioners. There is no reg-
istration fee. The faculty will consist of out-of-
state specialists in the fields relating to maternal
and child health.
Plans for the program are rapidly nearing
completion and tentative programs will be mailed
out as soon as they are available.
The meeting is jointly sponsored by the
Bureau of Maternal and Child Health of the
State Health Departments of Florida, Georgia,
South Carolina and Alabama, and the Maternal
Welfare Committees of the four State Medical
Associations. It is approved by the Academy of
General Practice in Category II.
Medical District Meetings
Dr. S. Carnes Harvard, of Brooksville, Chair-
man of the Council of the Florida Medical As-
sociation, has announced that the 1957 Medical
District Meetings will be held the last four days
of October — in Panama City, Oct. 28; in Clear-
water, Oct. 29; in Orlando, Oct. 30, and in Fort
Pierce, Oct. 3 1 .
Dr. Harvard and his district councilors are
arranging an outstanding scientific program.
172
Volume XLIV
Number 2
STATE BOARD OF HEALTH
A New Strain of Influenza
Beginning in April 1957, reports of wide-
spread outbreaks of influenza began to appear
from several Far Eastern countries including
India, Japan, the Philippines and Formosa. The
symptoms were those of typical flu with head-
ache, general myalgia and prostration with tem-
peratures up to 103 F. for three to five days.
Although as high as 15 per cent of exposed popu-
lations were attacked, mortality rates were ex-
tremely low. In Australia, the incidence in chil-
dren under five years of age was particularly high.
Laboratory studies have shown that the etiologic
agent is a new antigenic strain of Type A influ-
enza virus. This is of practical importance since
widespread susceptibility to this new strain is an-
ticipated in the United States and none of the
presently available influenza vaccines confer pro-
tection against this strain of virus.
Physicians and health officials of Florida are
being asked to assist the LT. S. Public Health
Service in detecting the introduction of this new
strain of influenza into the United States. To
date no known cases have occurred, but they are
expected by late summer or early fall.
All cases of influenza or influenza-like ill-
nesses should be promptly reported to the local
health officer on the regular report card, a copy
of which is shown below.
It should be noted that influenza cases may
be reported by numbers only, rather than by in-
dividual names and addresses. Particular at-
tention should be given to reporting cases in per-
sons recently arriving from the Far East.
Laboratory specimens are necessary to de-
termine the exact type of influenza virus causing
an illness. The local health officer will supply
the necessary instructions and containers and will
assist in preparing the specimens for shipment
to the laboratory. Throat washings should be
obtained during the first three days of illness
while the patient is still febrile. The patient
should gargle three times with a sterile fluid sup-
plied by the health department. Two specimens
of whole blood should be obtained, one during
the acute illness and a second, two to four weeks
later. Ten cubic centimeters of clotted blood, ob-
tained in the usual manner, will be satisfactory
for each specimen. Laboratory forms to ac-
company these specimens will be supplied by the
health department. Reports of virus isolation in
the throat washings and hemagglutinin-inhibiting
antibodies in the serum will be sent to the sub-
mitting physician and local health department.
These will be of little direct clinical diagnos-
tic usefulness because of the two to four week
period required for completion of tests.
It is hoped that all private physicians in
Florida will cooperate in this new surveillance pro-
gram since the success in preventing another
widespread epidemic will depend on such co-
operation. and only in this way can we deter-
mine whether another prophylactic vaccine should
be made available.
NOTIFIABLE DISEASE CASE REPORT FOR WEEK ENDING
OFFICE ADDRESS
REPORT BY NUMBERS WHOOPING STREP. SORE THROAT
OF CASES ONLY: MEASLES COUGH INCL. SCARLET FEVER
INFLUENZA CHICKEN POX MUMPS HOOKWORMS
Please sign and mail this card promptly even if you have no cases to report. No postage required.
PHS-2429 (9-55) Form approved.
U. S. GOVERNMENT PRINTING OFFICE. 1956 O - 387195 Budget Bureau No. 68-R580.
J. Florida, M. A.
August, 195?
173
EFFECTIVE, DEPENDABLE THERAPY FOR VAGINITIS
Floraquin® eliminates
trichomonal and mycotic infection;
restores normal vaginal acidity
Leukorrhea is by far the most frequent symp-
tom of vaginitis; trichomonads and monilia are
the most common causes. Many authors have
reported2 trichomonal protozoa in the vagina
of 25 per cent of obstetric and gynecologic
patients. Increased use of broad spectrum
antibiotics has resulted in a sharp rise in the
incidence of monilial infections.
Floraquin effectively eradicates both tricho-
monal and monilial vaginal infections through
the action of its Diodoquin® content. Floraquin
also furnishes boric acid and sugar to restore
the normal vaginal acidity which inhibits patho-
gens and favors the growth of protective Doder-
lein bacilli.
Pitt1 recommends vaginal insufflation of
Floraquin powder daily for three to five days,
followed by acid douches and the daily inser-
tion of Floraquin vaginal tablets throughout one
or two menstrual cycles. G. D. Searle & Co.,
Chicago 80, Illinois. Research in the Service of
Medicine.
1. Pitt, M. B.: Leukorrhea. Causes and Management, J. M.
A. Alabama 25:182 (Feb.) 1956.
2. Parker, R. T.; Jones, C. P., and Thomas, W. L.: Pruritus
Vulvae, North Carolina M. J. 16: 570 (Dec.) 1955.
s
174
OTHERS ARE SAYING
Volume XLI V
Number 2
OTHERS ARE SAYING
FMA — Blue Shield Liaison Committee
On invitation of the Board of Directors of
Florida Blue Shield and approval of the House
of Delegates of the Florida Medical Association,
President Francis Langley appointed seventeen
physicians to form the Advisory Committee.
They represent different professional and geo-
graphic areas and function under the able chair-
manship of Dr. Henry J. Babers, Jr. of Gaines-
ville.
CALIFORNIA STATE
assignments for
PHYSICIANS AND PSYCHIATRISTS
Three Salary groups: $11,400-12,600
12,000-13,200
13,200-14,400
Streamlined employment procedures — interview only
U. S. citizenship and possession of, or eligibility for
Calif, license required
Write: Medical Recruitment Unit, Box A, Stale Personnel
Board, 801 Capitol Ave., Sacramento, California
The Committee is a liaison group between
Blue Shield and its participating members. Blue
Shield needs us and we need it.
Unrest over too much centralization of power
has been expressed recently in Picomeso only
shortly after many of the same members had
wanted to be shed of debate at meetings. Like-
wise, resentment has appeared towards the Blue
Shield Board of Directors by participating mem-
bers.
With Blue Shield too big for “town hall”
meetings and its active members meeting only
once a year with probable carryover of incom-
pleted business, for several years, the Liaison
Committee which is small enough to be flexible
and large enough to be representative, will be a
needed link to the chain of operation.
We cannot expect the impossible of Blue
Shield. It can spend only what subscribers con-
tribute. Although it has a substantial kitty, it
is not inexhaustible. It is able to pay for necessary
care, but needless or over-utilization will wreck
it.
Without Blue Shield we would be in trouble.
With it, we have something to gripe about. The
Liaison Committee wants to learn of criticism to
present to the Board for correction, if possible.
It would also like to hear a compliment occa-
sionally to pass on to headquarters.
Blue Shield was established about twelve
years ago by now older members of the FMA
kicking in on a loan to give it its initial operating
capital. It was our baby. Newcomers too often
consider it as just another insurance company.
The oldtimers are very conscious of the fact that
it saved us from socialized medicine. Youngsters
must be aware that the social monster is not
dead but sleeping and they will need this two
bladed sword kept to give battle on short notice.
Mr. Schroder, its Director, has done a com-
mendable job. Board members give their service
freely. It rents space, equipment and trained la-
bor from its sister, Blue Cross. The two distinct
corporations are like twins. That which will bene-
fit or harm one will do likewise to the other.
When coverage was only surgical, both had
little trouble about people demanding hospitaliza-
tion, for with surgery, there is pain. With ex-
tension to the medical field, subscribers want hos-
pitalization galore to get their money’s worth.
In a hospital flowers are sent by their friends
and they feel important.
J. Florida, M A
August. 195?
175
OranO
POLYMYXIN B-BACITRACIN OINTMENT
to bmut'Qbeeffmc
For topical use: in 'A oz. and 1 oz. tubes.
For ophthalmic use: in '/» oz. tubes.
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe. N. Y.
176
Volume XLIV
Number 2
Premium rates must remain low to serve the
people for whom Blue Shield was created. By
guarding utilization to necessary cases and re-
fusing admission for rest cures will prevent rate
increases.
So let us think of the patient’s actual needs
first, of Blue Shield second and our own physical
convenience last, for a change.
Picomeso Mail Bag
Pinellas County Medical Society
March 4, 1957.
BIRTHS, MARRIAGES AND DEATHS
Births
Dr. and Mrs. Wilfred I.ansman, of Miami Beach,
announce the birth of a daughter, Susan Ann, on May 1,
1957.
Marriages
Dr. Charles B. Wigderson, of Miami Beach, and
Mrs. Doris Pallot, of Miami, were married May 14,
1957 in Miami.
Deaths — Members
Eaton, Joseph W., St. Petersburg April 23,1957
Lancaster, William J., Tampa April 26, 1957
McGugan, Arthur, Denver, Colo. May 28, 1957
Mason, John F., Bradenton May 22, 1957
Schirmer, Adelbert F., Orlando April 5, 1957
Deaths — Other Doctors
Griffin, James Burnie, St. Augustine April 24, 1957
STATE NEWS ITEMS
The Eighth Scientific Assembly of the Florida
Academy of General Practice will be held in the
Soreno Hotel at St. Petersburg, October 31 to
November 2. Dr. Elmer B. Campbell Sr., of St.
Petersburg, Chairman of the Program Committee
of the Academy, is in general charge of the pro-
gram. Assisting him are Drs. Harry R. Cushman
and Frank L. Price, both of St. Petersburg.
Symposiums on antibiotics, arthritis, practical
biochemistry and stress have been planned with
such prominent speakers as Dr. Hans Selye, Pro-
fessor of Medicine, University of Montreal Facul-
ty of Medicine, Quebec, and Dr. Malcom E.
Phelps, President of the American Academy of
General Practice.
Dr. M. Jay Flipse of Miami has been elected
Second Vice President of the American College of
Chest Physicians. Dr. Arnold S. Anderson of St.
Petersburg has been chosen a member of the
Board of Regents, and Dr. Alexander Libow of
Miami Beach has been selected Governor of the
College for Florida.
The BURDICK
ELECTROCARDIOGRAPH
A THOROUGHLY RELIABLE INSTRUMENT
PRECISION RECORDING
— Ask for Demonstration —
urqtcai
^ SUPPLY
ASIA
COMPANY
1050 W. Adams St.
T. B. SLADE, JR.
P. O. Box 2580
Jacksonville, Fla.
J. BEATTY WILLIAMS
J. Florida, M. A.
August, 1957
177
optimal dosages for atahax,
based on thousands of case histories:
mg. (t.i.d.)
TENSION SENILE ANXIETY MENOPAUSAL SYNDROME ANXIETY PREMENSTRUAL TENSION
PHOBIA HYPOCHONDRIASIS TICS FUNCTIONAL G. I. DISORDERS PRE-OPERATIVE ANXIETY
HYSTERIA PRENATAL ANXIETY • AND ADJUNCTIVELY IN CEREBRAL ARTERIOSCLEROSIS
PEPTIC ULCER HYPERTENSION COLITIS NEUROSES DYSPNEA INSOMNIA
PRURITIS ASTHMA ALCOHOLISM DERMATITIS PARKINSONISM PSORIASIS
perhaps the safest ataraxic known
P€^C€ OF MIND AT A RJ X'
<B*ANO Of MYOftOXYXlNt) 1 1 * O
lablets-byrup
Consider these 3 atarax advantages:
• 9 of every 10 patients get release from tension,
without mental fogging
• extremely safe— no major toxicity is reported
• flexible medication, with tablet and syrup form
Supplied:
In tiny 10 mg. (orange) and 25 mg. (green)
tablets, bottles of 100.
atarax Syrup, 10 mg. per tsp., in pint bottles.
Prescription only.
178
Volume XLIV
Number 2
Dr. Arthur J. Butt of Pensacola is touring
Europe as guest lecturer and guest researcher at
several European universities and medical insti-
tutions. He will be guest speaker at Queens Uni-
versity in Belfast. Ireland, while on the continent.
Dr. J. Basil Hall of Tavares discussed “Rabies
Epidemic and Four Years Later” at the recent
meeting of the Southern Public Health Associa-
tion held at Asheville. X. C.
Among members of the Florida Medical As-
sociation who appeared on the program of the
Scientific Assembly of the recent American Med-
ical Association meeting in New York were the
following: Dr. Louis F. Hubener of Gainesville,
joint author of the paper “Experimental Produc-
tion of Acne by Progesterone;” Drs. Gus G.
Casten of Miami and Robert J. Boucek, North
Miami Beach, ‘The Use of Relaxin in the Treat-
ment of Scleroderma;” Dr. John R. Neefe of St.
Petersburg. “Management of Hepatitis;” Dr.
Stephen P. Gyland Sr. of Tampa, “Functional
Hyperinsulinism in General Practice;” Dr. James
H. Ferguson of Miami, “Rupture of the Marginal
Sinus;” Drs. Ralph E. Kirsch, Philip Samet,
Victor H. Kugel and Stanley H. Axelrod of
Miami Beach, “Electrocardiographic Changes
During Ocular Surgery and Their Prevention by
Retrobulbar Injection.”
Dr. Neefe also served as moderator for a pan-
el discussion on hepatitis.
Dr. M. Jay Flipse of Miami served as Vice
Chairman of the Section on Diseases of the
Chest. Dr. Clarence Bernstein of Orlando filled
the position of Secretary of the Session on Al-
lergy. and Dr. Milton M. Coplan of Miami serv-
ed as Representative to Scientific Exhibit. Section
on Urology.
Dr. George W. Karelas of Newberry has been
appointed chairman of the Committee on Rural
Health of the American Academy of General
Practice. He also serves as chairman of the Com-
mittee on Rural Health of the Florida Academy
of General Practice.
Dr. Turner Z. Cason of Jacksonville has been
, reelected president of the Northeast Florida Heart
Association. Among the directors chosen from
the Jacksonville area were Drs. John D. Ferrara.
J. Webster Merritt, Harry W. Reinstine and
Sidney Storch. ( Continued on page 183)
■s the seals of food Housekeeping Maq^ine, Parents Magazine, Rice Leaders
^aerwriters' Laboratories, and is adve^fsed in the A.M.A.'s “Today's Health."
^(parents
Guaranteed by
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A free Filter Queen demonstration will gladly be arranged at you
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a product of
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Chicago 1, III.
IF “ORIENTAL FLU”
SPREADS ACROSS
the UNITED STATES
H If the Far East Flu spreads across the United States, it may lead to the
worst epidemic since 1918. That is an opinion publicly expressed today by
many leading physicians and health officers in this country.
Thanks to the antibiotics, however, many complications that occurred
after World War I will be avoided. A good antibiotic to remember for those
secondary invaders (staph-, strep- and pneumococci) is Erythrocin.
You’ll find Filmtab Erythrocin invaluable in the majority of coccal
infections — including those problems that resist other antibiotics.
In addition, you'll offer patients antimicrobial therapy with a unique
safety record. After Jive years , there has not been a single report of a serious
reaction to Erythrocin.
Filmtab Erythrocin (100 and 250 mg.), in bottles F\ 0 0
of 25 and 100. Usual adult dose is 250 mg. q.i.d. kXuAjOtt
STEARATE (Eryth romycin Stearate, Abbott)
counteracts complications from staph-, strep- and pneumococci
©Filmtab — Film-sealed tablets, Abbott; pat. applied for 700233
182
Volume XLI V
Number 2
COMPOUND
(dlhydroxy aluminum aminoacetate with belladonna alkaloids and phenobarbital)
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs!
belladonna alkaloids
ALONE
100
90
BO
70
€0
50
40
30
20
10
LD 90%*
*15 mg. dose
of spasmolytic
proved lethal
in 90% of
test animals
BELLADONNA ALKALOIDS
WITH
ALUMINUM HYDROXIDE
18 MO. ALKALOIDS
AI(OH),
w/spasmolytic
substantially
reduces spasmolytic
drug effect
IS MG. ALKALOIDS
200 MO. AL (OH),
BELLADONNA ALKALOIDS WITH
DIHYDROXY ALUMINUM AMINOACETATE
(alolyn®, brayten)
* LO 83%
Malglyn Compound
provides maximal
spasmolytic effect
Alglyn
adsorbed only
7%
of alkaloids
IS MO. ALKALOIDS
200 MS. ALOLYN
COMPARISON OP ADSORPTIVE PROPERTIES OF AL(OH), AND ALGLYN
each tablet contains
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked absorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
For both rapid and prolonged antacid effect, with consistently
dihydroxy
aluminum
aminoacetate,
N.N.R.
belladonna
alkaloids
(as sulfates)
phenobarbital
0.8 OMC
o.iea mo.
10.2 MO.
effective spasmolytic and sedative action, rely upon Malglyn
for treatment of peptic ulcer and epigastric distress.
Also supplied: Alglyn* (dlhydroxy alumi-
num aminoacetate, N.N R. 0.5 Gm per tablet).
BELGLYN® (dihydroxy aluminum aminoacetate,
N.N R„ 0.5 Gm. and belladonna alkaloids, 0.152 mi.
per tablet).
Specialities for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA 9, TENNESSEE
J. Florida. M. A.
August, 1957
183
(Continued from page 178)
Dr. James N. Patterson of Tampa has re-
turned from Chicago where he attended a meet-
ing of the Board of Directors of the American
Association of Blood Banks.
Dr. I. Leo Fishbein of Miami Beach is in
Europe where he is visiting psychiatric hospitals
and clinics. In September, Dr. Fishbein will be
in Zurich, Switzerland, for the Second Interna-
tional Congress of Psychiatry.
Dr. Jacob A. Glassman of Miami Beach. As-
sistant Clinical Professor of Surgery at the Uni-
versity of Miami School of Medicine, was one of
the principal speakers at the Annual Postgrad-
uate Seminar presented by the International Col-
lege of Surgeons in mid-July at the Cook County
Postgraduate School of Medicine in Chicago.
Dr. Glassman’s subjects were “Umbilical and
Post-Operative Hernias” and “The Present Status
of Thyroid Surgery.”
Dr. Samuel M. Day of Jacksonville, Secre-
tary-Treasurer of the Florida Medical Associa-
tion, addressed a joint meeting of the Lee-Char-
lotte-Hendry and Collier County Medical So-
cieties on June 17. The following day, Dr. Day
was principal speaker at a combined meeting of
the Manatee and Sarasota County Medical So-
cieties. His topic was “Problems of Blue Shield.”
Mr. Ben C. Willis of Tallahassee, who has
been an attorney for the Florida Medical Asso-
ciation assisting the Committee on Legislation
and Public Policy for the past ten years, has
been appointed judge of the Second Judicial Cir-
cuit by Governor LeRoy Collins.
Dr. Joseph M. Bistowish of Tallahassee has
been elected president of the Southern Branch of
the American Public Health Association.
Dr. Alfred P. Seminario of St. Petersburg has
returned from an extensive tour of various coun-
tries in South America. He lectured by invita-
tion at the British Hospital and Medical School
at Buenos Aires, visited the Orthopedic Society
at Lima, Peru, of which he has been a corre-
sponding member for several years, and addressed
a group at Caracas, Venezuela.
Dr. Bruce W. Alspach of Miami has been
elected president of the Greater Miami Society
of Psychiatry and Neurology. Dr. Bernard Good-
man of Miami Beach is vice president and Dr.
James J. Goodman of Miami, secretary-treasurer.
Dr. Jim S. Jewett of Coral Gables has been
installed as president of the Heart Association of
Greater Miami. Other officers are Dr. Louis
Lemberg of Miami, president-elect, and Dr.
Francis N. Cooke of Miami, vice president.
The training course “Management of Mass
Casualties” is being presented at the Walter
Reed Army Medical Center, Washington. D. C.,
September 9-14 and December 2-7, 1957 and
May 12-17, 1958. The course is also being offered
at the Army Medical Service School, Fort Sam
Houston, Texas, Nov. 18-22, 1957. There is a
quota for each course, and physicians interested
in attending should send their name, priority of
location and date three months in advance to the
State Civil Defense Office or to the Federal
Civil Defense Administration, Region III, Thom-
asville. Ga.
a proven
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BRAND OF MECLIZINE HYDROCHLORIDE
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184
Volume XLIV
Number 2
Dr. John T. Karaphillis of Clearwater has
been visiting various clinics and hospitals in
Greece and England.
Dr. George D. Conger of Miami has been
elected grand chancellor of the Domain of Flor-
ida of the Knights of Pythias.
Dr. Sullivan G. Bedell of Jacksonville and Dr.
John D. Milton of Miami have been appointed
by Governor LeRuy Collins to the State Board of
Health. Dr. Bedell succeeds Dr. Carl C. Mendoza
of Jacksonville, and Dr. Milton succeeds Dr.
Herbert L. Bryans of Pensacola.
Dr. Turner Z. Cason of Jacksonville has been
presented a plaque by the College of Medicine
of the University of Florida in recognition of 25
years service as Chairman of the Medical Post-
graduate Course Committee of the Florida Med-
ical Association which annually sponsors the Grad-
uate Short Course for physicians.
Dr. Thomas D. Cook of New Smyrna Beach
has been elected chairman of the American Red
Cross Chapter of that city.
Dr. J. Rocher Chappell of Orlando was prin-
cipal speaker at a recent meeting of the Ocala
Rotary Club. Dr. Chappell appeared on the pro-
gram as medical officer of the State Civil Defense
Program.
Dr. William D. Rogers of Chattahoochee has
been selected to direct Florida’s mental hospitals
at Chattahoochee, Arcadia, Hollywood and Mac-
clenny.
/-*-
Dr. Richard G. Connar of Tampa was one of
the principal speakers at the recent national
convention of Kappa Delta Phi held in Tampa.
Dr. Seymour W. Rubin of Miami Beach has
returned from Pittsburgh where he attended the
meeting of the American Urological Association
and participated in the scientific exhibit on “Sub-
stitute Urinary Bladder.”
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
Jacksonville Orlando
420 W. Monroe St. 329 N. Orange Ave.
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J. Florida, M. A.
August, 1957
185
just one specific
therapeutic purpose
to curb the appetite
of the overweight patient
Preludin makes reducing:
Effective because it provides potent appetite suppres-
sion, while minimizing the undesirable effects on the
central nervous system which may be encountered
with certain other weight-reducing agents.1
Comfortable because it virtually eliminates nervous
tension, palpitations and loss of sleep.2
Notably safe because it is not likely to aggravate
coexisting conditions, such as diabetes, hypertension
or chronic cardiac disease.3
References: (1) Holt, J.O.S.Jr.: Dallas M. J. 42:497, 1956. (2) Gelvin,
E. P.; McGavack, T. H., and Kenigsberg, S.: Am. J. Digest. Dis. 1 : 155,
1956. (3) Natenshon, A. L.: Am. Pract. & Digest Treat. 7:1456, 1956.
Preludin® (brand of phenmetrazine hydrochloride). Scored, square,
pink tablets of 25 mg. Under license from C. H. Boehringer Sohn,
Ingelheim.
GEIGY
Ardsley, New York
PRELUDIN
(brand of phenmetrazine hydrochloride)
#1557
186
Volume XL1V
Number 2
one dose
a day. . .
J. Florida. M. A.
August, 1957
announcing...
a new practical
and effective method
for lowering blood
cholesterol levels...
Arcofac
Just one dose a day effectively
lowers elevated blood cholesterol
. . . while allowing the patient
to eat a balanced . . . nutritious . . .
and palatable diet
Each tablespoonful of Arcofac contains:
Linoleic acid 6 Gm.
Vitamin B6 0.6 mg.
(sodium benzoate as preservative)
Arcofac is effective in small doses
and is reasonable in cost
to the patient
THE ARMOUR
LABORATORIES
A DIVISION OF ARMOUR AND COMPANY
KANKAKEE, ILLINOIS
Armour... Cholesterol
combines Meprobamate (400 mg.):
Widely prescribed tranquilizer-muscle relaxant. Effectiveness
in anxiety and tension states clinically demonstrated in millions of patients.
Meprobamate acts only on the central nervous system. Does not increase
gastric acid secretion. It has no known contraindications, can be used
over long periods of time.1-2*3
with Path i Ion (25 mg.):
An anticholinergic noted for its extremely low toxicity and high
effectiveness in the treatment of G.I. tract disorders. In a comparative
evaluation of currently employed anticholinergic drugs,
Pathilon ranked high in clinical results, with few side effects,
minimal complications, and few recurrences.4
Now.. . with PATH I BAM ATE . . .you can control disorders of the
digestive tract and the “ emotional overlay” so often associated with
their origin and perpetuation. . .without fear of barbiturate
loginess , hangover or addiction. Among the conditions which have
shown dramatic response to PATH I BA MATE therapy:
DUODENAL ULCER • GASTRIC ULCER • INTESTINAL COLIC
SPASTIC AND IRRITABLE COLON • ILEITIS • ESOPHAGEAL SPASM
ANXIETY NEUROSIS WITH G.I. SYMPTOMS • GASTRIC HYPERMOTILITY
MVIATE
Comments on PATH I BAM ATE from clinical investigators
• “I find it easy to keep patients using the drug
continuously and faithfully. I feel sure this is due
to the desirable effect of the tranquilizing drug.”5
• “The results in several people who were pre-
viously on belladonna-phenobarbital prepara-
tions are particularly interesting. Several people
volunteered that they felt a great deal better on
erenceS". 1. Borrus, J. C.: M. Clin. North America,
ess, 1957. 2. Gillette, H. E.: Internal. Rec. Med. & G. P.
169:453, 1956. 3. Pennington, V. M.: J.A.M.A.,
ess, 1957. 4. Cayer, D.: Prolonged Anticholinergic
apy of Duodenal Ulcer. Am. J. Dig. Dis. 1:301 -309
) 1956. 5. McGlone, F. B. : Personal Communication to
rle Laboratories. 6. Texter, E. C., Jr.: Personal
the present medication and noted less of the
loginess associated with barbiturate administra-
tion.”6
• PATHIBAMATE . ..“will favorably influence a
majority of subjects suffering from various forms
of gastrointestinal neurosis in which spasmodic
munication to Lederle Laboratories. 7. Bauer, H. G.
VlcGavack, T. H.: Personal Communication
•derle Laboratories.
'plied: Dottles of 100 and 1000
llinistration and Dosage: 1 tablet three times a day
.‘altimes and 2 tablets at bedtime. Full
manifestations and nervous tension are major
clinical symptoms.”7
• “In the patients with functional disturbances of
the colon with a high emotional overlay, this has
been to date a most effective drug.”5
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
190
Volume XLI V
Number 2
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CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
qualifications in writing. The Miami-Battle Creek,
Miami Springs, Fla.
INTERNIST WANTED: Established certified in-
ternist desires associate. Florda license, certified or
board eligible. Give full background in first letter.
Write 69-224, P. 0. Box 2411, Jacksonville, Fla.
WANT TO BUY: Used binocular microscope suit-
able for medical student. Write 69-227, P. O. Box
2411, Jacksonville, Fla.
LOCUM TENENS: July 1, 1957 to January 1,
1958. General Practitioner to associate with same.
Suburban Jacksonville. To future association as
agreed. Write 69-229, P.O. Box 2411, Jacksonville,
Fla.
WANTED: Specialist in Obstetrics and Gynecol-
ogy with Florida license to associate with group in
Dade-Broward area. Board man preferred. Write
age, training, chronology of medical experience, refer-
ences. Write 69-230, P. O. Box 2411, Jacksonville,
Fla.
WANTED: Pediatrician or General Practitioner
with special training in pediatrics to associate with
group in Dade-Broward area. Florida license neces-
sary. Write age, training, chronology of medical
experience, references. Write 69-231, P. 0. Box 2411,
Jacksonville, Fla.
WANTED: General Practitioner or Specialty-
General Practitioner combination. Can put you on
percentage to start, with $1000 per month minimum
guarantee. Write 69-235, P. 0. Box 2411, Jackson-
ville, Fla.
WANTED: General Practitioner as an associate
for an established practice, suburb of Jacksonville.
Clinic type building, ample treatment rooms, labor-
atory and other facilities. Interest in OB helpful.
Write 69-236, P. 0. Box 2411, Jacksonville, Fla.
OBSTETRICIAN-GYNECOLOGIST: Board or
board eligible, to associate with mixed group of three
in a well established practice in town of 50,000 in
central Florida. Write 69-233, P. 0. Box 2411, Jack-
sonville, Fla.
TO SETTLE AN ESTATE: Complete doctor’s
office. Old, established location. Clientele can be
reactivated immediately. Terms. Income unlimited.
Write to Mrs. F. J. Farley, 420 North 7th St., Dade
City, Florida.
RADIOLOGIST : Desires association with radiol-
ogist, group or hospital. Fifty years. Board certi-
fied, isotope license. Expensive experience in diag-
nosis, therapy, radium and isotopes. Several publica-
tions. Florida license. Write 69-234, P. 0. Box 2411,
Jacksonville, Fla.
WANTED: Laboratory and X-Ray technician.
Better than average salary. 44 hour week. For in-
formation please contact Dr. Edward Gonzalez, 300
Simonton St., Key West, Fla. Phone CY 6-2714.
GENERAL PRACTITIONER: in South Florida
desires assistant. Good hospital privileges. Favor-
able percentage arrangements with guaranteed mini-
mum income. Must be male, graduate of grade A
United States or Canadian school. Willing and able
to do full general practice. Write 69-215, P. 0. Box
2411, Jacksonville, Fla.
J. Florida, M. A.
August, 1957
191
PRACTICE FOR SALE: Active general practice,
west Florida town near large Airbase. New Hospital.
Town needs physician with surgical training. Write
69-237, P.O. Box 2411, Jacksonville, Fla.
INTERNIST: desires partnership with another
internist; hospital staff also considered. Florida license,
married, age 31. Board certified. Write 69-239, P.O.
Box 2411, Jacksonville, Fla.
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Berquist, Francis L., Lakeland
Butscher, William C. Jr., Ocala
Campbell, Lindsey, D., Chattahoochee
Chambers, William N., Jacksonville
Conn, James K., Tallahassee
Coppola, Vincent Jr., Fort Lauderdale
Cronick, Charles FL, Chattahoochee
Duke, Joseph E., Bradenton
Fusco, Ralph J., Miami
Gist, William T., Canal Point
Harrison, Ben L., Miami
Hendrix, Claude A. Jr., Fort Lauderdale
Hopkins, Wililam B. Jr., Tampa
Ireland, Treadwell L., Lake City
Isham, Robert L., Miami
Jonsson, Ulfar, Miami
King, William B., Tampa
Kohen, Roland J., Miami
Martin, Richard A., Fort Lauderdale
Neale, Richard C., Tampa
Ostling, Burton C., Avon Park
Pavlin, Otto B., Bradenton Beach
Pedigo, Howard K., Bradenton
Rawls, Thompson T., Pompano Beach
Regan, Thomas F., Hollywood
Simon, Howard M. Jr., Hialeah
Vargas, Alvaro, Miami
Watt, Francis H., Tallahassee
Weber, Robert G., Fort Lauderdale
John D. Rockefeller once said, ‘‘The ability to deal
with people is as purchasable a commodity as sugar or
coffee and I will pay more for that ability than for any
other under the sun.”
The art of dealing with people is the foremost secret
of successful men. Without this key to success you can
have great ability and education and still only reach
mediocrity.
The Bulletin, Dade County
M edical Association
in
PREVENTIVE GERIATRICS
a FIRST from TUTAG !
Now — 20 to 1 Androgen-Estrogen
(activity) ratio* !
Each Magenta Soft Gelatin Capsule contains:
Methyltestosterone
2 mg.
Thiamine Hcl.
. 2 mg.
Ethinyl Estradiol
0.01 mg.
Riboflavin
2 mg.
Ferrous Sulfate
50 mg.
Pyridoxine Hcl.
0.3 mg.
Rutin
10 mg.
Niacinamide
20 mg.
Ascorbic Acid
30 mg.
Manganese
1 mg.
B-12
1 meg.
Magnesium
5 mg.
Molybdenum
0.5 mg.
Iodine
0. 1 5 mg.
Cobalt
Copper
Vitamin A
0.1 mg.
0.2 mg.
5.000 I.U.
Potassium
Zinc
2 mg.
1 mg.
Vitamin D
400 I.U.
Choline Bitartrate
40 mg.
Vitamin E
I I.U.
Methionine
20 mg.
Cal. Pantothenate
3 mg.
Inositol
20 mg.
Write for Latest Technical Bulletins.
‘REFERENCE: J.A.M.A. 163: 359, 1957 (February 2)
S. 1. TUTAG & COMPANY
DETROIT 34, MICHIGAN
192
Volume XLIV
Number 2
WOMAN’S AUXILIARY
TO THE
FLORIDA MEDICAL ASSOCIATION
OFFICERS
Mrs. Perry D. Melvin, President Miami
Mrs. I.ee Rogers Jr., President-Elect . liockledge
Mrs. William D. Rogers, 1st Vice Pres... .Chattahoochee
Mrs. Leffie M. Carlton Jr., 2nd Vice Pres Tampa
Mrs. Edward W. Ludwig, 3rd Vice Pres Jacksonville
Mrs. James M. Weaver, 4th Vice Pres.. .Fort Lauderdale
Mrs. Wendell J. Newcomb, Recording Sec’y ... .Pensacola
Mrs. Willard L. Fitzgerald, Treasurer Miami
Report of Annual Meeting of
Woman’s Auxiliary to A. M. A.
Twenty-one delegates and alternates repre-
sented the Woman’s Auxiliary to the Florida Med-
ical Association at the Thirty-fourth Annual
Meeting of the Woman’s Auxiliary to the Ameri-
can Medical Association at the Roosevelt Hotel in
Ne.v York C ity, June 3-7, 1957.
All were pleased when Florida was recognized
in several ways. First came the report of the Past
President, Mrs. Scottie J. Wilson, which was read
by Mrs. Perry D. Melvin, President for 1957-58.
It was gratifying to hear the Florida report and
to realize that the past year had been an out-
standing one, comparing quite favorably with the
reports of the other states. Florida was again
spotlighted when the Today’s Health Contest
awards were given. Escambia County Auxiliary
received the second prize of $25 for Group III
Auxiliaries (those with a membership of 76 to
100); and Broward County Auxiliary received
the third prize of $15 for Group IV Auxiliaries
(those with a membership of 101 or over). It was
also told that 15 counties in Florida exceeded 100
per cent of their contest subscription quota. Mrs.
Wilson accepted these awards for the Florida
Auxiliary, and was also present at the Today’s
Health Breakfast, honoring the states which had
exceeded their subscription quota.
To the Florida group, the highlight of the
convention was the election of Mrs. Richard F.
Stover, Miami, as Third Vice-president of the Wo-
man’s Auxiliary to the American Medical Associa-
tion. Mrs. Stover has ably served as Constitu-
tional Secretary of the national organization dur-
ing the 1956-57 year.
Socially, the convention was a most pleasant
occasion also, with a tea and fashion show, two
luncheons and a banquet adding to the pleasure
of the meeting. Many also enjoyed the gracious
hospitality in the Florida Room at the Waldorf
Hotel.
— 4 / year6 —
The officers and personnel of the Anderson Surgical Supply Company pledge
their continued support to, and offer their cooperation in, the program of the
Medical Association and the Hospital Association in caring for the sick and
promoting the welfare of the people.
OFFICERS
I. Emmett Anderson, Jr., President
Frank E. Cooper, Jr., Vice-President
T. Emmett Anderson, Sec. & Treas.
SALES REPRESENTATIVES
Silvio Polo, Tampa
J. D. Henry, Jr., Gainesville
L. Harry Lloyd, Lakeland
Alvin Hall, St. Petersburg
Carl E. Anderson, Tampa
Harry Townsley, St. Petersburg
Bert Denyes, Ft. Myers
Jack Montgomery, Orlando
Underson Surgical Supply
Co.
Telephone 2-8504
Morgan at Platt Street
Tampa, Florida
Established 1916
cdbco ->
MEMBER
Telephone 5-4362
Cor. 9th St. and 6th Ave. So.
St. Petersburg, Fla.
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Signemycin V Capsules provide the unsur-
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even those strains of staphylococci and
certain other pathogens resistant to other
antibiotics. The addition of the buffering
agent affords higher, faster antibiotic blood
levels following oral administration.
Supplied: Capsules containing 250 mg. (oleando-
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— 1 — ^ Division, Chas. Pfizer & Co., Inc.
J4 Volume XI. IV
Number 2
Relax the best way
... pause for Coke
Make your pause at work
truly refreshing. Have a frosty bottle
of pure, delicious Coca-Cola
. . . and be yourself again.
J. Florida. M. A.
August, 1957
195
©1930 Mead Johnson & Co.
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Pablum High Protein Cereal is derived from soy beans,
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DIVISION OF MEAD JOHNSON & CO.. EVANSVILLE, IND. • Manufacturers of Nutritional and Pharmaceutical Products
196
Volume XLIV
Number 2
BOOKS RECEIVED
Expectant Motherhood. By Nicholson J. East-
man, M.D. Pp. 198. Price, $1.75. Boston, Little, Brown
&• Company, 1957.
This new revised third edition of this little book
appears 10 years after the second edition. It incorporates
the principal advances made in maternity care over the
past decade to the end that it may continue to serve as
a thoroughly modern guidebook for expectant mothers.
Largely distributed by physicians, this handy volume has
gained an extraordinary recognition over the years. It is
likely that more than five million pregnant women have
found it a constant and useful aid during pregnancy. The
new edition does not attempt to make radical changes in
a book which over the last 16 years has proved its
value, but new information has been added on such
matters as anesthesia, diet for mothers, equipment for
both mother and baby. Basically unchanged, however,
the text still offers a common sense approach to preg-
nancy, and this fact has made it the book of choice of
thousands of obstetricians and general practitioners.
The author of this complete, calm, understanding,
authoritative and reassuring guidebook through pregnancy
is Professor of Obstetrics at Johns Hopkins University
and Obstetrician in Chief to the Johns Hopkins Hospital.
He has made his handbook really a supplement to a
doctor’s advice, for he realizes how many questions may
be left unasked, how many instructions may be only
partly understood, how many small uncertainties occur
from day to day.
Organized Home Medical Care in New York
City. A Study of Nineteen Programs. By the Hospital
Council of Greater New York. Pp. 538. Price, $8.00.
Published for The Commonwealth Fund by Harvard Uni-
versity Press, Cambridge, Massachusetts, 1956.
Home medical care in its modern form is a recent de-
velopment that led to this study of organized home
medical care programs existing in New York City on a
more or less experimental basis. That organized home
medical care for the indigent and medically indigent is not
now provided widely over the country is added justifica-
tion for the publication of this report. The objectives of
the study were: to describe and evaluate existing facilities
for provision of organized home care services in New York
City; to determine, by direct interviewing, how patients
and their families have reacted to home medical care; to
establish standards for the operation of home care pro-
grams and for the types of services that should be pro-
vided; to suggest broad criteria for suitability of patients
for home care; to discuss methods of administering home
care programs and to formulate criteria for determining
the qualifications of a hospital to operate such a pro-
gram ; to develop methods of integrating home care pro-
grams with the total pattern of services furnished by hos-
pitals; and to formulate a long range plan for distribu-
tion of home care services throughout New York in order
to assure optimal coverage for all indigent and medically
indigent persons.
The report covers 19 home medical care programs, in-
cluding 16 operated by municipal hospitals, and directs at-
tention to the kinds of patients served, their diagnoses and
lengths of stay under home care, the services rendered,
and the comments of patients and their families. In addi-
tion, it compares different types of programs, and con-
siders in detail the problems of personnel and administra-
tion, the relation of home care to hospital care, and the
costs involved. This is the most extensive study of or-
ganized home medical care programs thus far published,
and the suggested standards for establishing and operat-
ing new programs are more detailed and concrete than
any previously published.
Handbook of Pediatric Medical Emergencies.
By Adolph G. DeSanctis, M.D., with the collaboration
of Charles Varga, M.D., and Ten Contributors. Ed. 2.
Pp. 389. Ulus. 73. Price, $6.25. St. Louis, The C. V.
Mosby Company, 1956.
The material in the first edition of this Handbook was
prepared over a period of years to serve as a guide for
members of the resident staff and for physicians enrolled
in the courses offered by the Pediatric Department of the
Post-Graduate Medical School of New York University-
Bellevue Medical Center. A small handbook was printed
privately for general distribution. It was so well received
in the United States and many foreign countries that
after the fourth printing was exhausted, a second edition
was undertaken.
Much of the text of this second edition has been com-
pletely rewritten and new illustrations and tables have
been added. The chapters on Metabolic Emergencies,
Accident and Poison Prevention, Genitourinary Emergen-
cies, and Respiratory Paralysis in Poliomyelitis are new.
Additions have been made to the list of household
poisons. Although references are made to methods and
procedures used in other medical centers and hospitals,
the text represents the methods used in University Hospi-
tal, New York University-Bellevue Medical Center.
SUN RAY PARK
HEALTH RESORT
SANITARIUM IN MIAMI
Medical Hospital American Plan
Hotel for Patients and their families.
REST, CONVALESCENCE, ACUTE and
CHRONIC MEDICAL CASES. Elderly
People and Invalids. FREE Booklet!
Acres Tropical Grounds, Delicious Meals,
Res. Physician, Grad. Nurses, Dietitian.
125 S.W. 30TH COURT, MIAMI, FLORIDA™0";*,,
MEMBER, AMERICAN HOSPITAL ASSOCIATION
MEMBER, FLORIDA HOSPITAL ASSOCIATION
Under New Medical
Direction and Man-
agement.
J. Florida, M. A.
August, 1957
197
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
| — m i a i | — ■
Westbrook. Sanatorium
Rl CHMON D
established 1011
VIRGINIA
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures— electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff I>AUL v- ANDERSON, M.D., President
' REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request • P. O. Box 1514 - Phone 5-3245
iOOOOOOOOOOOOOf
198
Volume XL1V
Number 2
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
INvoliiafrio Illnesses and Problems of Addiction
Psychotherapy. Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association of
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D.
Medical Director
P. O. Box 218
ALBERT F. BRAWNER, M.D.
Assistant Director
Phone 5-4486
OOOOOOOOOO&QOOOOOQOOQOQQQQQOOOOOOOOOQQOQQQOCXXtQQQOQO&GOOOQQOOOOQOOOOOOeZO
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
Asheville, North Carolina
AFFILIATED WITH DtJKF. UNIVERSITY
A non-profit psychiatric institution, offering
modern diagnostic and treatment procedures —
insulin, electroshock, psychotherapy, occupa-
tional and recreational therapy — for nervous and
mental disorders.
The Hospital is located in a 75-acre park, amid
the scenic beauties of the Smoky Mountain
Range of Western North Carolina, affording ex-
ceptional opportunity for physical and nervous
rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic
services and therapeutic treatment for selected
cases desiring non-resident care.
R. CHARMAN CARROLL, M.D.
Diplomate in Psychiatry
Medical Director
ROBT. L. CRAIG, M.D.
Diplomate in Neurology and Psychiatry
Associate Medical Director
000€>OOOOOQOOOOOOOOOOOQOOQOOOOOOOOOQO ©OGC
I. Florida. M. A.
AUGUST, 1957
INDEX TO ADVERTISERS
199
* Abbott Laboratories 133, 180, 181, Third Cover
* Allen’s Invalid Home 204
* Ames Co., Inc. 134
» Anclote Manor 205
» Anderson Surgical Supply Co. 192
» Appalachian Hall 205
* Armour Laboratories 186, 187
► Ayerst Laboratories 178
* Ballast Point Manor 199
* Brawner’s Sanitarium 198
* Brayten Pharmaceutical Co. 182
* Burroughs Wellcome & Co. 175
» California State Personnel Board 174
* Convention Press 204
» Coca Cola Co. 194
» Dcsitin Chemicals Co. 136
► Drug Specialties. Inc. 129
► Fort Lauderdale Beach Hospital 200
* Geigy Pharmaceuticals 185
► Charles C. Haskell & Co. 126
* Health — Mor, Inc. 179
► Highland Hospital, Inc. 198
* Hill Crest Sanitarium 200
* Lakeside Laboratories 125
► Lederle Laboratories 127, 164, 165, 188, 189
• Lewal Pharmaceutical Co. 128
• Eli Lilly & Co. 138
• Mead Johnson &• Co. 195
• Medical Protective Co. 174
• Medical Supply Co. 184
• Miami Medical Center 201
• Parke-Davis & Co. Second Cover, 123
® Pfizer Laboratories 183, 190, 193
• A. H. Robins & Co. 135
• Roerig & Co. 177
• St. Albans Sanitarium 204
• Schering Corp. 137
® Schieffelin & Co. 190
• G. D. Searle Company 173
• Smith, Kline & French Labs. Back Cover
® E. R. Squibb & Sons 130
® Sun Ray Park Health Resort 196
• Surgical Supply Co. 176
• Tucker Hospital, Inc. 197
• S. J. Tutag & Co. 191
• Wallace Laboratories 130a, 130b, 131
• Westbrook Sanatorium 197
® Winthrop Laboratories, Inc. 132
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Pi
• * v
jiBS P
Tyi WOiVBLL.' -J
5M
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto
malic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St.
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9. Florida
200
Volume XLIV
Number 2
FORT LAUDERDALE BEACH HOSPITAL
125 N. Birch Rd., Ft. Lauderdale, Florida
GERIATRICS
(care of the aging)
REHABILITATION. . . .
CONVALESCENT CARE
A private hospital especial l>
planned for the medical care
and rehabilitation of the
CHRONICALLY ILL, the
AGED, and the HANDICAP-
PED.
Departments of Medicine, Ra-
diology, Laboratory, Dietary,
Dentistry, Rehabilitation, Oc-
cupational and Physiotherapy.
Patients accepted for long or
short term tare under direction
of private physician.
MEDICAL RESIDENT STALE
For information write
Medical Director
Louis L. Amato, M.D.
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D. James K. Ward, M.L-
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala. Phone WOrth 1-11-
, M. A
957
SCHEDULE OF MEETINGS
201
ORGANIZATION
PRESIDENT
SECRETARY
ANNUAL MEETING
Medical Association
Medical Districts
thwest
theast
thwest
theast
Specialty Societies
of General Practice
Society
iologists, Soc. of
iys., Am. Coll., Fla. Chap.
id Syph., Assn of
Ifficers’ Society
il and Railway Surgeons
Gynec. Society
& Otol., Soc. of
lie Society
ists, Society of
Society
Reconstructive Surgery
lie Society
ic Society
ical Society
, Am. Coll., Fla. Chapter
il Society
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Joel V. McCall Jr., Daytona Beach
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Burns A. Dobbins Jr., Ft. L’d’dale
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
Miami Beach, May 10-14, ’58
Panama City, Oct. 28, ’57
Orlando, Oct. 30, ’57
Clearwater, Oct. 29, '57
Fort Pierce, Oct. 31, ’57
St. Petersburg, Oct. 31-Nov. 2, 57
Miami Beach, May 1958
Nov. 30-Dec. 1, ’57
Tan. 58
Miami Beach, May 1958
» 7i
W. Palm Beach, Oct. 31-Nov. 3, ‘57
Miami Beach, Mav 1958
Nov. ’57
Miami Beach, May 1958
Miami Beach, May 11, ’58
Miami Beach, May 1958
Science Exam. Board
Banks, Association
'ross of Florida, Inc
hield of Florida, Inc
■ Council
es Assn
Society, State
Association
al Association
il Examining Board
il Postgraduate Course
Anesthetists, Fla. Assn.
Association, State
aceutical Assoc., State
Health Association
iu Society
ulosis & Health Assn,
ri's Auxiliary
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax.
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauder, le
Ashbel C. Williams, Jacksonville
Edward R. Smith, Jacksonville
Bryant S. Cattoll, D.D.S. Jax.
William P. Hixon, Pensacola
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal.
Martha Wolfe R.N.. Coral Gables
Grover F. Ivey, Orlando
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakelard
Judge Ernest E. Mason, Pen«ncola
Mrs. Perry D. Melvin, Miami
M. W Emmel. D.V.M., Gainesville
Mrs. Carol Wilson, Jax.
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Joseph J. Lowenthal, Jacksonville
G. J. Perdigon, D.D.S., Tampa
Sidney Davidson, Lake Worth
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Mvers
Clarence L. Brumback, W. P. B
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
Gainesville, Nov. 9, ’57
Ponte Vedra, May 1958
Miami Beach, Mav 1958
» - 'ii
Gainesville, Oct. ’57
Miami Beach, May 18-21, ’58
Clearwater, Nov. 21-22, ’57
Miami, Nov. 24-26, ’57
Clearwater, Oct. 17-19, ’57
Jacksonville, May 18-21, ’58
Ft. Lauderdale, Oct. 31-Nov. 2, ’57
Miami Beach, May 10-14, ’58
l Medical Association
Clinical Session
Medical Association
Medical Association
Medical Assn, of
[spital Conference
|ern Allergy Assn,
fern, Am. Urological Assn
fern Surgical Congress
list Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden. Ala.
E. T. McCafferty, Mobile, Ala.
Geo. F. Lull, Chicago
Mr. V. .0. Foster, Birmingham
Douglas I.. Cannon. Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Mac'nnis. Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton. Mobile, Ala.
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Miami Beach, Nov. 11-14, ’57
Macon, April 27-30, '58
Miami Beach, May 14-16, ’58
Charleston, S.C., Nov. 1-2, ’57
Hollywood, Jan. 12-16, ’58
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy, Insulin, Electroshock, Hydrotherapy.
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Member American Hospital Association
202
Volume XLIV
Number 2
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
WILLIAM C. ROBERTS, M.D., President . .Panama City
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . Jacksonville
SHALER RICHARDSON. M.D., Editor. Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR., M.D... AL-58 Ocala
GEORGE S. PALMER, M.D. . . A-58 Tallahassee
CLYDE O. ANDERSON, M.D. .C-59 Si. Petersburg
REUBEN B. CHRISMAN JR., M.D. D-60. .Coral Gables
MEREDITH MALLORY, M.D. B-61 Orlando
JOHN D. MILTON, M.D. PP-58 Miami
FRANCIS H. LANGLEY, M.D.. .PP-59. . . .St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . Jacksonville
EDWARD JELKS, M.D. (Public Relations) . .Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D. Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D. Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm. AL-58 Brooksville
First— ALPHEUS T. KENNEDY, M.D. 158 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D. 3-58 Jacksonville
Fourth — DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D. ...6-58 Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON M. 7JVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
TOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm Orlando
THOMAS H. BATES, M.D "A” Lake City
FRANK L. FORT, M.D “B” Jacksonville
ALVIN L. MILLS, M.D “C” St. Petersburg
JOHN D. MILTON, M.D “D” Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
LEO E. REILLY, M.D. AL-58 Panama City
ROBERT B. McIVER, M.D B-58 Jacksonville
GRETOHEN V. SQUIRES, M.D. A 59 Pensacola
DONALD W. SMITH, M.D. D 60 Miami
BLUE SHIELD LIAISON
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A-58 Tallahassee
JOHN J. CHELEDEN, M.D. B-58 Daytona Beach
JOHN M. BUTCHER, M.D. C 58 Sarasota
PAUL G. SHELL, M.D. D-58 Fort Lauderdale
GRFTCHEN V. SQUIRES, M.D. A 59 Pensacola
HENRY L. HARRELL, M.D. B-59 Ocala
JAMES R. BOLL WARE JR., M.D. C-59 J.aheland
RALPH M. OVERSTREET JR., M.D. I) 59 W. Palm Beach
MERRITT R. CLEMENTS, M.D. A 60 Tallahassee
ROBERT F.. ZELLNER, M.D. B 60 Orlando
WHITMAN C. McCONNELL, M.D. C 60 St. Petersburg
RALPH S. SAPPENFIELD, M.D. D-60 Miami
HAROLD E. W’AGER, M.D. A-61 Panama City
CHARLES F. McCRORY, M.D. B-61 Jacksonville
JOHN S. STEWART, M.D. C-61 Fort Myers
DONALD F. MARION, M.D. D6I Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
SAMUEL B. D. RHEA, M.D. A 59 Pensacola
ALFONSO F. MASSARO, M.D. C 60 Tampa
WILLIAM A. VAN NORTWICK, M.D. B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm. D 58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D. A 60 Tallahassee
J. K. DAVID JR., M.D. B-61 - Jacksonville
CIVIL DEFENSE AND DISASTER
I. ROCHER CHAPPELL, M.D., Chm.... AL-58 Orlando
WILLIAM W. TRICE JR.. M.D....C-58 Tampa j
JOHN V. HANDWERKER JR., M.D....D-59 Miami
WALTER C. PAYNE JR., M.D....A-60 Pensacola I
W. DEAN STEWARD, M.D....B-61 Orlando 1
CONSERVATION OF VISION
CARL S. McLEMORE, M.D., Chm. AL-58 Orlandt
HUGH E. PARSONS, M.D C-58 Tampi |
CHARLES C. GRACE, M.D. B 59 St. Augustin,
ALAN E. BELL, M.D A-60 P ensacolv !
LAURIE R. TEASDALE, M.D. D 61 W. Palm Bead
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm. W. Palm Bead
FRANCIS H. LANGLEY, M.D. St. Petersbur
JOHN D. MILTON, M.D Miam
DUNCAN T. McEWAN, M.D. Ortand
ROBERT B. McIVER, M.D Jacksonvi II
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C 59 Tamp
BURNS A. DOBBINS JR., M.D. AL-58 Fort Lauderda ,
EDWARD JELKS, M.D. B-58 Jacksonvil
CECIL M. PEEK, M.D. D-60 _ W. Palm Beac
GEORGE H. GARMANY, M.D. A -61 Tallahass,
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama Cil
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonvil
MATERNAL WELFARE
E. FRANK McCALL, M.D , Chm. B 60 Jacksonvil
WILLIAM C. FONTAINE, M.D. AL-58 Panama Ci
J. LLOYD MASSEY M.D. A-58 Quin,
RICHARD F. STOVER, M.D. D-59 Miat
S. L. WATSON, M.D C-61 Lakelai
J. Florida, M. A.
August. 1957
203
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm AL.58 . Orlando
DEWITT C. DAUGHTRY, M.D. D 58 Miami
S. CARNES HARVARD, M.D. C-59 Brooksville
MERRITT R. CLEMENTS, M.D. A 60 Tallahassee
FLOYD K. HURT, M.D B 61 Jacksonville
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Cables
PAUL J. COUGFII.IN, M.D. AL-58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. B 60 Gainesville
RAYMOND B. SQUIRES, M.D. A-61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D. B-58 Gainesville
JAMES N. PATTERSON, M.D C-61 Tampa
EDWARD W. CULLIPHER, M.D D 59 : Miami
HOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 _ Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 _ - Gainesville
Special Assignment
1. American Medical Education Foundation
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm B-59 Jacksonville
LEO M. WACHTEL, M.D AL-58 Jacksonville
C. FRANK CHUNN, M.D C-58 Tampa
WILLIAM D. CAWTHON, M.D A 60 DeFuniak Springs
V. MARKLIN JOHNSON, M.D D 61 YV. P aim Beach
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm B 61
WILLIAM M. C. WILHOIT, M.D AL-58
I. LLOYD MASSEY, M.D A-58
W. TRACY HAVERFIELD, M.D D-59
MASON TRUPP, M.D C-60 .
NECROLOGY
I. BASIL HALL, M.D., Chm AL-58
WALTER YV. SACKETT JR., M.D D-58
LEO M. WACHTEL, M.D B-59
\LVIN L. STEBBINS, M.D A 60
RAYMOND H. CENTER, M.D. C-61
NURSING
rHOMAS C. KENASTON, M.D., Chm B-59 Cocoa
LARL M. HERBERT, M.D AL-58 Gainesville
IERBERT L. BRYANS, M.D. A-58 Pensacola
VORVAL M. MARR SR., M.D. C-60 St. Petersburg
AMES R. SORY, M.D D 61 YV. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B 59 Jacksonville
OHN J. BENTON, M.D AL-58 Panama City
JEORGE S. PALMER, M.D A-58 Tallahassee
DWARD W. CULLIPHER, M.D D 60 Miami
RANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
•ASCAL G. BATSON JR., M.D., Chm. A 60 Pensacola
VILLIAM J. HUTCHISON, M.D. AL 58 Tallahassee
HAS. L. FARRINGTON, M.D C 58 St. Petersburg
I HOMAS N. RYON, M.D D 59 Miami
1AYMOND R. KILLINGER, M.D. B 61 Jacksonville
Ipecial Assignment
Industrial Health
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm. B-60 Gainesville
FRANZ II. STEWART, M.D. AI. 58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD RF.ESER JR., M.D. C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D. A-61 Pensacola
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm. A-60 Chattahoochee
NELSON H. KRAEFT, M.D AL-58 Tallahassee
WILLIAM L. MUSSER, M.D. B-58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D. D 61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO I.. PARKS, M.D., Chm. B 61 Jacksonville
HENRY I. LANGSTON, M.D. AL-58 Marianna
JOHN G. CHESNEY, M.D. D-58 Miami
HAWLEY 11. SEILER, M.D. C-59 Tampa
HAROLD B. CANNING, M.D. A 60 Wewahitchka
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
C. W. SHACKELFORD, M.D., Chm. A-61 Panama Citv
FRANK V. CHAPPELL, M.D. AL 58 Tampa
A. BUIST LITTERER, M.D. D-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.D. B 60 Jacksonville
WOMAN S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm. A 60 Tallahassee
JOHN H. TERRY, M.D. AL 58 Jacksonville
WILEY M. SAMS, M.D D-58 Miami
G. DEKI.E TAYLOR, M.D. B-59 Jacksonville
CHARLES McC. GRAY, M.D. C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec, 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate _ Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
JOHN S. McEWAN, M.D., 1925 Orlando
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valiev, Wash.
EDWARD JF.LKS, M I)., 1937 Jacksonville
LEIGH F. ROBINSON, M.l)., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. MclVF.R. M.D., 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
I OHN I). MILTON, Ml)., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
Jacksonville
Pensacola
Quincy
_ Miami
Tampa
Tavares
Miami
Jacksonville
Pensacola
Clearwater
204
Volume XLIV
Number 2
Allens Invalid Home
MILLEDGEVILLE, GA.
Established 18‘JO
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
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SAINT ALBANS
A M I Y A T I PSYCHIATRIC HOSPITAL
RADFORD, VIRGINIA
STAFF
James P. King, M.D.
Director
James K. Morrow, M.D.
Thomas E. Painter, M.D.
Clara K. Dickinson, M.D.
Daniel D. Chiles, M.D.
James L. Chitwood, M.D.
Medical Consultant
Affiliated Clinics: Bluefield Mental Health Center
Bluefield, W. Va.
David M. Wayne, M.D.
Harlan Mental Health Center
Harlan, Ky.
C. H. Crudden, M.D.
Beckley Mental Health Center
Beckley, W. Va.
W. E. Wilkinson, M.D.
Florida, M. A.
ugust, 1957
205
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MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants in Psychiatry
MUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WAITER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
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Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall. Asheville, N. C.
206
Volume XLIV
Number 2
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Used in Tokyo, as it is everywhere
Pentothal alone among intravenous
anesthetics brings you a record of
more than 20 years’ world-wide use
More than 2500 published reports confirm the many advantages
that keep Pentothal Sodium an agent of choice in intravenous
anesthesia. Among these advantages: quick response, moment-to-
moment control, smooth induction, swift recovery. No other intra-
venous anesthetic has proved itself more thoroughly. Qfjfmtt
PENTOTHAL Sodium
193
(Thiopental Sodium for Injection, Abbott)
JEW YORK AC ADC Y OF J
MED 1C I NE
2 E I 0 3RD ST
JCW YORK N Y 2 9 J C-C
NEW
Compazine
Spansule
t
capsules
combine the advantages of
an outstanding tranquilizer and a
unique sustained release dosage form
anxiety
senile agitation
stress
tension
postalcoholic states
agitation
confusion
restlessness
m
m Available: io mg. and 15 mg.
‘Compazine’ Spansule capsules
Smith , Kline & French Laboratories , Philadelphia
For prompt, prolonged
relief of mild and
moderate mental and
emotional disturbances
characterized by —
*T.M. Reg. U.S. Pat. Off. for proclorperazine, S.K.F.
fT.M. Reg. U.S. Pat. Off. for sustained release capsules, S.K.F.
Patent Applied For
SEPTEMBER, 1957
Vol. XLIV
OFFICIAL PUBLICATION OF THE
' ■
FLORIDA MEDICAL ASSOCIATION
■r- •
IfpT
m
H
F==
i
ijgpgt
mm
Hi m -*
RESISTANCE IS LESS OF A PROBLEM
CHLOROMYCETIN
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
SENSITIVITY OF 100 STRAINS OF HEMOLYTIC STAPHYLOCOCCUS AUREUS
TO CHLOROMYCETIN AND OTHER IMPORTANT ANTIBIOTIC AGENTS*
100
90
80
70
60
50
40
30
20
10
0
*This graph is adapted from Kempe, C. H.: California Med. 84:242, 1956. The single
bar designated as “Antibiotics F” represents three widely used, chemically related agents
grouped together by the investigator. Strains isolated January-June, 1954.
CHLOROMYCETIN (chloramphenicol, Parke-Davis) is a potent therapeutic
agent and, because certain blood dyscrasias have been associated with its
administration, it should not be used indiscriminately or for minor infec-
tions. Furthermore, as with certain other drugs, adequate blood studies
should be made when the patient requires prolonged or intermittent therapy. c K nt
\
PARKE, DAVIS & COMPANY • DETROIT 32, MICHIGAN { fp):
A REPORT ON A PROMISING CONCEPT IN ANTIMICROBIAL THERAPY:
CONCURRENT ADMINISTRATION OF CHLOROMYCETIN AND GAMMA GLOBULIN
In treatment for infection, the physician is confronted
with complex interactions between pathogen, anti-
microbial agent and host. The pathogen represents
the unselected factor, the therapeutic agent the com-
ponent over which the physician exercises maximum
control. But even with optimal antibiotic therapy,
the eventual elimination of the infective agent and
the resolution of pathologic changes depend upon
efficient host response.1,2
Passive transfer of antibodies through gamma globu-
lin provides a broad antibacterial spectrum because
of origin in adults exposed to a variety of microorgan-
isms. Employed as a protective element against some
of the more common contagious diseases, gamma
globulin permits more competent participation by
the host in the fight against established infection.
Rationale for immuno-antibiotic therapy lies in simul-
taneous direct attack on the pathogen and re-en-
forced host resistance, which implies usefulness in
treatment for acute fulminating, highly refractory,
or prolonged infections.
EXPERIMENTAL STUDIES ENCOURAGING
In carefully controlled studies in mice, Fisher and
his colleagues in Parke-Davis Research Laboratories,
using pooled human gamma globulin and Chloromy-
cetin (chloramphenicol, Parke-Davis) concurrently,
demonstrated a high degree of therapeutic effective-
ness in infected animals.3 Five types of infection
induced with species of Staphylococcus aureus,
Streptococcus pyogenes, Proteus vulgaris and Pseu-
domonas aeruginosa responded to joint therapy with
gamma globulin and Chloromycetin, each agent hav-
ing shown at deliberately low doses in previous work
little or no activity in these mouse infections when
used separately. Fisher’s experiences with hemolytic
streptococci have been confirmed.4
Tests now in progress with pneumococci, salmonellae
and additional strains of pseudomonas and proteus
indicate that marked increases in survival rates may
be anticipated in any infection where chlorampheni-
col has previously demonstrated therapeutic activity.3
These observations suggest that immuno-antibiotic
therapy can effect cures in a variety of refractory
microbial diseases.
PROMISING IN EARLY CLINICAL TRIAL
Observations analogous to those of Fisher have been
reported from the clinic.3'7 More recently, the clinical
use of gamma globulin in conjunction with anti-
biotics was undertaken by Waisbren8 on the basis of
Fisher’s experimental work. His series of 46 patients
with systemic and localized infections due to various
strains of staphylococcus, pseudomonas, salmonella,
proteus and to the pneumococcus had failed to re-
spond to maximum effort with conventional thera-
peutic measures. Marked clinical improvement in
six of these acutely ill patients shows clearly ". . . that
in certain instances the addition of gamma globulin
to antibiotic therapy may give a clinical result that
could not have been obtained with the antibiotics
used alone. In each of these cases, a long and exten-
sive control period in which antibiotics were being
vigorously administered had failed to produce a
response but when gamma globulin was given with
approximately the same dosages of antibiotic, rather
marked improvements occurred.”8
While the precise mechanism underlying the salu-
tary effect of gamma globulin remains to be clarified,
the existence of quantitative hypogammaglobulin-
emia was ruled out in patients in this series.8
A RATIONALE FOR IMMUNO-ANTIBIOTIC THERAPY
Although the relationship of susceptibility to infec-
tion and status of the host is well recognized, host
resistance is an aspect of infectious disease still not
understood in an era of extensive and of massive
antibiotic therapy. Most antibiotics, in concentra-
tions tolerated by living tissues, have bacteriostatic
rather than bactericidal effect. In the clinic, bac-
teriostatic doses are most frequently given and host
defense mechanisms are responsible for the eventu-
ally satisfactory clinical result.4
The problem of therapeutic failures despite vigorous
courses of antibiotic therapy may be due to some
disturbance in the immune process.0 In addition,
disproportionately high mortality rates in the ex-
tremes of life lend support to the impression of
inadequate defense mechanisms, since these are
underdeveloped and immature in the very young
and may be impaired or depressed in the aged.4
Any discussion of immuno-antibiotic treatment must
at present remain largely conjectural. From pre-
liminary evidence, however, this approach to ther-
apy appears worthy of consideration, especially in
patients in whom adequate antibiotic therapy for
active infectious processes has been disappointing.
While the concept of enlisting the aid of the host
in combating pathogenic microbes, thereby afford-
ing the physician control of two of the three principal
interacting factors, is not new, enhancement of host
resistance through use of gamma globulin in treat-
ment for microbial disease is indeed a promising one.
REFERENCES:
(1) Swift, P. N.: Bril. M. J. 1:129 (Jan. 19) 1957. (2) Jawctz. E.:
The Forgotten Host, Stanford M. Bull., 11: 84, 1955. (3) Fisher,
M. W. : Antibiotics 6- Chcmother. 7:315, 1957. (4) Welch, H.: The
Host and the Parasite. A New Clinical Approach to Biologic
Relationships, Antibiotics 6- Chcmother. 7:271, 1957. (5) De, S. P,
& Basu, U. P: Brit. M. J. 2: 564, 1938. (6) Goldberg, S. L., &
Bloomenthal, E. D.: Surgery 9:508, 1941. (7) Carnes, H. E.;
Gajewski, J. E.; Brown, P. N., & Conlin, J. H., in Welch, H., and
Marti-Ibanez, F, cd.: Antibiotics Annual, 1954-1955, New York,
Medical Encyclopedia, Inc., 1955, p. 391. (8) Waisbren, B. A.:
Antibiotics 6- Chcmother. 7:322, 1957. (9) Harris, R., Jr., &
Schick, B.: J. Mt. Sinai IIosp. 21: 148, 1954.
PARKE, DAVIS & COMPANY • DETROIT 32. MICHIGAN
IOIM
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
VOLUME xliv. No. 3 ♦ September. 1957
Scien tific A rtich es
Toxoplasmosis, Congenital and Acquired, Sherman B. Forbes, M.D. 227
Optimal Timing in Elective Pediatric Surgery, Thomas J.
Zaydon, M.D. and H. Clinton Davis, M.D. 238
To Catch a Thief, Thomas G. Dickinson, M.D. 242
Rapport in Medicine, S. C. Werch, M.D. 243
Abstracts
Drs. Alvan G. Foraker, H. Phillip Hampton. H. Clinton Davis and
Irwin S. Morse 246
Medical Education in Florida
Progress Report: University of Miami School of Medicine,
Homer F. Marsh, Ph.D.. Dean 248
University of Florida College of Medicine. George T. Harrell
Jr., M.D., Dean 254
History and Development of Postgraduate Medical Education in Florida 261
A Remodeling of the Education Foundation for Practice
Through Postgraduate Medical Education. William
C. Thomas Jr.. M.D. 264
Editorials and Commentaries
A New Responsibility — Precipitating Factors 266
Dedicated Service 267
Modern Medicine Moves Ahead “AMA in Action” 267
The Medical Secretary 270
“Stress of Life" Author to Address Florida Academy of General
Practice, St. Petersburg, Nov. 1-2, 1957 271
Graduate Medical Education, Diabetes Association Meeting.
Gainesville. October 24-26 272
Cleft Palate Seminar, Miami. November 8-9 272
Fifth International Congress of Internal Medicine.
Philadelphia, April 24-26 273
State Board of Health — Asiatic Influenza 274
Genera! Features
Births, Marriages and Deaths 274
Others Are Saying 276
State News Items 278
Classified 284
New Members 291
Obituaries 291
Books Received 298
Schedule of [Meetings 323 I
Florida Medical Association Officers and Committees 324
County Medical Societies of Florida 326
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price $5.00 a year: single numbers, 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411. 735 Riverside Ave.. Jacksonville 3, Fla. Telephone EL 6-1571. Accepted for mail-
ing at special rate of postage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16,
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville.
Florida, October 23, 1924 . I
r. Florida, M. A.
September, 1957
213
your patients with generalized gastrointestinal
complaints need the comprehensive benefits of
Tridal
(DACTIL® + PIPTAL- — in one tablet)
rapid, prolonged relief throughout the G.I. tract
with unusual freedom from antispasmodic
and anticholinergic side effects
One tablet two or three times a day and one at bedtime. Each TRIDAL tablet
contains 50 mg. of Dactil, the only brand of N-ethyl-3-pipendyl
AKESIDE diphenylacetate hydrochloride, and 5 mg of Piptal. the only brand
of N-ethyl-3-pipendyl-benzilate methobromide.
1435 7
214
Volume XLIV
Number 3
a more serene, a happier pregnancy
. . . without nausea
give her i
MAREDOX
7
®
brand
Cyclizine Hydrochloride and Pyridoxine Hydrochloride
because
‘Maredox’ gives the expectant mother new-found
relief from morning sickness.
relieves nausea and vomiting
and
counteracts pyridoxine deficiency
in pregnancy
One tablet a day, taken either on rising or at night,
is all that most women require.
Each tablet of ‘Maredox’ contains:
‘Marezine’* brand Cyclizine Hydrochloride 50 mg.
Pyridoxine Hydrochloride 50 mg.
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
>ARKE- DAVIS ANNOUNCES
^ MAJOR ADVANCE
N FEMALE HORMONE THERAPY
The x-ray diffraction pattern of NORLUTIN distinguishes its crystal structure from that of other progestogens.
(norethindrone, Parke- Davis)
oral progestational agent
with
unequalled potency
and
unsurpassed efficacy
NORLUTIN
(17-alpha-ethinyl-19-
nortestosterone)
RELATIVE POTENCIES
OF ETHISTERONE AND NORLUTIN
IN HUMANS2'3
1
Ethisterone, oral
NORLUTIN is an example of “...increased bio-
logical activity of a steroid when the methyl
group at carbon 10 is replaced with hydrogen.”1
NORLUTIN
INDICATIONS FOR NORLUTIN: amenorrhea,
menstrual irregularity, functional uterine bleed-
ing, infertility, habitual abortion, threatened
abortion, premenstrual tension, dysmenorrhea.
references : (1 ) Hertz, R.; Tullner, W., & Raffelt, E.: Endo-
crinology 54:228, 1954. (2) Greenblatt, R. B.: J. Clin. Endo-
crinol. 16:869, 1956. (3) Hertz, R.; Waite, J. H., & Thomas,
L. B.: Proc. Soc. Exper. Biol, i? Med. 91:418, 1956. (4) Tyler,
E. T.: J. Clin. Endocrinol. 15:881, 1955. (5) Greenblatt, R. B.,
& Clark, S. L.: M. Clin. North America, Philadelphia, W. B.
Saunders Co. (Mar.) 1957, p. 587.
PACKAGING
5 mg. scored tablets (C. T. No. 882), bottles of 30.
UNSURPASSED EFFICACY
in disorders of menstruation and pregnancy
NORLUTIN* Progestational Effect on Endome-
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Presecretory to secretory endometrium after 5 days
^ treatment.
NORLUTIN l Thermogenic Effect “This prepara-
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NORLUTINl Abolition of Arborization in Cervical
Mucus NORLUTIN “...inhibits the fern leaf
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1. Fern leaf pattern. 2. Arborization completely
abolished by NORLUTIN.
NORLUTINl Induction of Withdrawal Bleeding
“As little as 50 mg. of [NORLUTIN] admin-
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period was sufficient to induce withdrawal
bleeding.”2
PARKE, DAVIS & COMPANY • DETROIT 32, MICHIGAN
50172
218
Volume XLJV
Number .3
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
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in the aged.
NICOZOL therapy will en-
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NICOZOL is supplied in cap-
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capsule or V2 teaspoonful
contains:
Pentylenetetrazol .. 100 nig.
Nicotinic Acid 50 tng.
1. Levy, S., JAMA., 153:1260, 1953
2. Thompson, L. , Procter R. ,
North Carolina M. J., 15:596, 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
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J. Florida, M. A.
Septembrr, 1957
219
The Best Tasting Aspirin you can prescribe.
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220
Volume XI. IV
Number 3
brand
POLYMYXIN B-BACITRACIN OINTMENT
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For ophthalmic use: in '/« oz. tubes.
BURROUGHS WELLCOME & CO. (U.S.AJ INC., Tuckahoe, N. Y.
J. Florida, M. A,
eptember, 1957
221
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222
Volume XLIV
Number 3
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W. B.: J. Invest. Derm. 25:341 (Nov.) 1955. 3. McGivney, J.: Texas J. Med. 47.770 (Nov.) 1951.
J. Florida, M. A.
September, 1957
223
optimal dosages for atarax,
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TRILAFON - grey tablets of 2 mg. (black seal), 4 mg. (green seal), 8 mg.
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226
Volume XLIV
Number 3
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ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, September, 1957 No. 3
Toxoplasmosis, Congenital and Acquired
Ocular Manifestations
Sherman B. Forbes, M. D.
TAMPA
Human toxoplasmosis is a disease of increas-
ing importance which offers a challenge in diverse
branches of medicine. The numerous recent pub-
lications on the actual and suspected role of
Toxoplasma in human disease have aroused wide-
spread interest in the clinical manifestations and
the diagnosis of this infection, both in its con-
genital and acquired forms. Toxoplasmosis now
commands the special interest of the pediatrician,
the obstetrician, the general practitioner and oth-
er specialists as well as the ophthalmologist. In
ophthalmology, recent investigations point to this
disease as a highly important factor both in in-
fantile and in adult uveal inflammation. Since
it poses problems likewise for other specialists,
the purpose of this paper is to present a general
clinical approach to the subject, with discussion
of the systemic as well as the ocular manifesta-
tions of the disease, stressing in particular the
problem of prevention of the congenital form
with its dire consequences. Illustrative cases re-
cently reported1 are reviewed and new cases re-
ported.
Toxoplasma gondii, a crescentic or arc-shaped
organism with one end attenuated and the other
more rounded, was first described in 1909 and
its pathogenicity demonstrated in mice.2 Amer-
ican consciousness of this protozoan parasite,
however, stems only from 1939 when its role in
human disease was first determined by its recog-
nition in spontaneous human encephalitis in an
infant.3 Worldwide in distribution, this cosmo-
politan organism is naturally transmitted among
many animals and certain birds, and seemingly
also to hundreds of millions of human beings.4
Certainly, the host range among mammals is
from the most primitive to the most highly de-
veloped. Verified cases of toxoplasmosis in ani-
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 195 7.
mals have been reported from almost all parts
of the world, not only among wild animals such
as hares, rats and pigeons but also among such
frequent pets as dogs and cats and in domestic
animals such as pigs, cattle, sheep, rabbits and
chickens. The widespread occurrence of the para-
site among animals living in close contact with
man provides rich possibilities for infection and
is of epidemiologic importance.5 Cole and his
associates0 established an association between
Toxoplasma - shedding chronically infected pet
dogs and the occurrence of proved human infec-
tion, thus pointing, as have numerous investiga-
tors, to animals as a probable source of toxoplas-
mosis in man. A large percentage of some normal
adult population groups shows antibodies to
Toxoplasma. A study in England disclosed by
the dye test the presence of Toxoplasma anti-
bodies in titers of 1:4 or more in 24 per cent of
a sample of the adult population of Sheffield; in
veterinary surgeons, abattoir workers and rabbit
trappers they were especially high.1’7 The mode
or the multiple modes of transmission, however,
remain one of the numerous puzzling features
of Toxoplasma as yet unsolved.
Epidemiologic data on human toxoplasmosis
indicate that the prevalence of the infection is
highest in areas such as Tahiti and the coastal
region of Guatemala, low in areas such as Iceland
and Alaska, and higher in southern Sweden than
in northern Sweden and in the coastal regions of
Mexico than at the high altitude around Mexico
City. In the United States there are regional
differences in prevalence, with the eastern regions
possibly showing higher rates than the western
areas. Among the Navajo Indians in Arizona
the rate is surprisingly low, while it is higher in
their dogs. From these data, it appears that toxo-
plasmosis is more prevalent in warm moist areas
than in cold areas or hot dry areas.8
228
FORBES: TOXOPLASMOSIS
Volume XLIV
Number 3
This remarkably indiscriminate organism par-
asitizes many different types of cells as well as
many hosts. Originally, many specific names were
given to Toxoplasma from the various hosts, but
biologic and immunologic studies indicate that
these parasites are members of the same species,
Toxoplasma gondii. In the acutely infected host,
the parasite is widely distributed throughout the
body. It has been found, in the late stages of
acute infections, in the blood, urine, feces, milk,
saliva, and serous exudates from the conjunctiva
of various animals.
Congenital Toxoplasmosis
The most recent reports of investigators war-
rant the assumption that the congenital form of
toxoplasmosis results when a nonimmune preg-
nant woman happens to acquire an infection
which is usually inapparent. Infection of the
fetus follows when the resultant parasitemia per-
mits Toxoplasma to establish a nidus in the pla-
centa. Holding this view, Feldman and Miller9
advanced the hypothesis that the earlier in preg-
nancy the infection is acquired, the more cata-
strophic the effect. If the infection occurs early,
a spontaneous abortion would result; if in the
second trimester, a still birth or premature birth;
if in the last trimester, a term birth with varying
degrees of residual damage.
The infection may manifest itself in utero,
or the infant may appear normal at birth, giving
no sign of abnormality until characteristic physi-
cal or behavioral changes are observed after a
period of days or even months. Active toxoplas-
mic infection in the newborn infant may produce
rash, fever, jaundice, hepatosplenomegalv, con-
vulsions, and encephalomyelitis with xantho-
chromic spinal fluid.910 Chorioretinitis may or
may not be present at birth, but develops in the
great majority of the survivors after varying
periods of time. Other effects which may accom-
pany the congenital disease, and which not in-
frequently follow it during infancy and childhood,
are hydrocephaly, microcephaly, convulsive dis-
orders and psychomotor retardation. Cerebral
calcifications are demonstrated in a high percent-
age of the cases. In his study of 103 children
with the disease, Feldman11 reported cerebral
calcifications in 63 per cent, psychomotor re-
tardation in 56 per cent, hydrocephaly or micro-
cephaly in approximately 50 per cent, and con-
vulsive episodes in about 50 per cent. Chorio-
retinitis, present in 99 per cent of the cases, was
the most frequent finding. In 75 toxoplasmic
infants studied by Eichenwald,11 only 40 per cent
had chorioretinitis when first seen, but the per-
centage increased to approximately 80 per cent
when the survivors were subsequently examined.
In 187 cases of congenital toxoplasmosis re-
cently analyzed by Feldman and Miller,9 the
children were four years of age or less in 119
of 176 cases, half of these one year or less; five
to nine years in 38 cases, and 10 to 19 years in
19 cases. Most of the mothers were between 18
and 29 years of age. These authors suggested
a possible relationship between the young mater-
nal age and an age group of increased suscepti-
bility to the disease and commented that these
data could be interpreted as opposing the con-
cept that infected infants often are born some
years after the mother has acquired her initial
infection. The sex incidence was approximately
equal in this series. There were premature births
in one fourth of 141 cases of the series, a figure
somewhat but not greatly in excess of normal
expectation. Some 20 per cent of the premature
infants and 7 per cent of those born at term died,
a difference in survival no greater than gener-
ally expected. In 82 per cent of the cases with
associated chorioretinitis, there were lesions in
both eyes, the bilateral involvement suggesting
that the chorioretinitis results from blood stream
seeding. Residual damage varied in degree, al-
though in most of the cases there were detectable
chorioretinitis, cerebral calcifications, mental re-
tardation and/or disturbances in head size. Not
every infant or child, however, with chorioretin-
itis or cerebral calcifications has congenital toxo-
plasmosis. This infection accounts, in general,
for no more than half of such cases.
Is it likely that the mother of an infant with
congenital toxoplasmosis will produce another
such baby? On the basis of clinical and serologic
findings, it has been assumed that congenital in-
fection occurs only when the mother acquires
the infection during the gestation period. ‘ It ap-
pears justifiable,” Jacobs8 observed, ‘"to assert
that except under unusual circumstances there is
little likelihood of a mother giving birth to more
than one toxoplasmic child in separate pregnan-
cies. This is supported by the histories gathered
by Eichenwald and Feldman on the mothers of
toxoplasmic infants.” Summarizing their obser-
vations, Feldman and Miller9 concluded: “The
disease occurs as an accidental complication of
an inapparent primary toxoplasma infection of
J. Florida, M. A.
September, 1957
FORBES: TOXOPLASMOSIS
229
a pregnant female because such infections may
be accompanied by parasitemia. In so far as we
are aware, all such infants suffer some residual
damage, but most survive. The infection may be
acquired in any season of the year, and human-
to-human transfer is not commonplace. This
complication is not repeated in subsequent preg-
nancies, and it affects more than one offspring
only if the reference pregnancy results in multiple
births.”
A suggestive complicated picture of this type
is presented in a case of congenital toxoplasmosis
reported in my recent series.1 The infection was
diagnosed when a white infant aged four months
was first examined in October 1953. The child
was re-examined in March 1956 at the Walter
Reed Army Medical Center. At that time, the
reaction to the Sabin-Feldman dye test was posi-
tive in a titer of 1:65536, the highest ever recorded
there, and in the mother the titer was 1:4096.
The twin brother of the mother has been under
my care for some time with a discrete central
macular lesion in one eye of long duration. His
reaction to the dye test and the intracutaneous
toxoplasmin test has repeatedly been negative.
In considering the disease manifestations that
may accompany toxoplasmosis, it is particularly
noteworthy that the majority of infections pass
unnoticed.12 Only rarely does a mother recall
symptoms of infection, even though she may have
given birth to an infant with the disease, ap-
parently transmitted in utero. Feldman and
Miller9 found it impossible to detect any illness
pattern during pregnancy suggestive of when
the mothers might have acquired their infection
because four fifths of the mothers denied having
had any illness. It remains largely for the future
to reveal adequate means of detecting the dis-
ease in the mothers and a method of treatment
that will prevent the development of toxo-
plasmosis in the child.12 Present therapy, how-
ever, seems to offer a beginning if there is any
indication of maternal infection during pregnancy
and the obstetrician is alert to the possibilities.
The anomalies resulting from congenital toxo-
plasmosis, therefore, may well be added to the
large and growing list of acquired congenital
defects that pose a problem in preventive medi-
cine. Ingalls14 recently stressed that the field of
acquired congenital anomalies emerges as of equal
stature with genetics itself and should be at-
tacked on a combined front with the threefold
forces of laboratory, clinical, and epidemiologic
methodologies. He advocated application of the
same degree of energy in combating this prob-
lem that has been used in conquering diphtheria
and smallpox and is being directed at poliomye-
litis. “The implication,” he predicted, “of all that
is known of maternal rubella, syphilis, toxo-
plasmosis, and influenza; of the effect of thioura-
cil, lead, or carbon monoxide poisoning during
pregnancy; of diabetic, hematological, circula-
tory, and dietary disturbances; and of traumatic,
radiation, and hypoxic diseases of the mother,
placenta, and embryo is that many, if not most,
congenital anomalies will be eventually brought
under control as appropriate scientific studies
clarify causes.”
Acquired Toxoplasmosis
In contrast to several hundred accumulated
cases of congenital toxoplasmosis recorded in the
literature, reports of clinical toxoplasmosis ac-
quired after birth are relatively few. The first
two well substantiated cases were reported in
1941. Since then, reports indicate that in the
proved cases of acquired toxoplasmosis the sever-
ity of the illness has varied from a mild, one day
febrile illness with local adenopathy and no other
distinguishing clinical features to a fatal, widely
disseminated infection with a rickettsiosis-like
rash, encephalitis, myocarditis and polymyosi-
tis.15 Brown and Jacobs10 recently reviewed the
reported cases and in summation stated that
acquired nonfatal toxoplasmosis may be mani-
fested by a relatively mild syndrome simulating
infectious mononucleosis, as well as by more
severe symptoms grading into those found in the
recorded fatal cases.
The acquired infectious disorders caused by
Toxoplasma organisms are classified by Siim3 as
typhus-like exanthema, meningoencephalitis, cho-
rioretinitis and lymphadenopathy. The exanthe-
matic form of acquired toxoplasmosis is charac-
terized by a typhus-like illness, often of acute
onset, with chills and elevation of temperature
to 104 F., preceded in some instances by fatigue
and malaise of several days’ duration. Typically,
a red, nonhemorrhagic, maculopapular exanthema
involves the entire body except the scalp, the
palms, and the soles of the feet. Appearing at
the earliest on the fourth day of the first week,
the rash disappears one to two weeks later. A
dry cough and pulmonary changes, simulating
atypical pneumonia, usually are present both
early and later, but may be absent. Symptoms
230
FORBES: TOXOPLASMOSIS
Volume XLIV
Number 3
and signs of myocarditis and meningoencephalitis
are frequent complications; there may be lym-
phadenopathy, but enlargement of the spleen has
not been demonstrated. Most cases of this type
have terminated fatally, and at autopsy cell infil-
tration and necrotic foci are present in the heart,
lungs and central nervous system, with Toxo-
plasma-like structures in the myocardium.
A second grave manifestation of the acquired
type is meningoencephalitis. Although it ap-
parently occurs seldom, it has been reported from
Denmark in a three year old girl, from North
Africa, where strains were isolated from three
adults, from the United States in two six year
old boys, and also from Germany. Fever, delir-
ium, generalized convulsions, lymphadenopathy
and a mononuclear pleocytosis featured Sabin’s
fatal case in a six year old boy, the first to be
reported, and at autopsy a meningoencephalitis
was present, and the RH strain of Toxoplasma
was isolated from the brain. Feldman’s case was
also in a six year old boy.
The first verified case of acquired ocular
toxoplasmosis was reported in 1954 by Jacobs,
Fair and Bickerton.17 Toxoplasma organisms
were isolated from an enucleated eye of a 30
year old man with chronic chorioretinitis.
While these three manifestations occur infre-
quently, acquired toxoplasmosis with a lympha-
denopathy as the chief sign is diagnosed with
relative frequency. Siim5 divided this form into
febrile lymphadenitis, a nonfebrile form, and a
subclinical form. In the first subgroup, the onset
may be acute with chills and elevation of tem-
perature to 102 to 104 F., with the fever lasting
for two to four weeks or longer and then de-
creasing by lysis; in the second, the enlarged
lymph nodes are often discovered by the patients
themselves, or by their mothers; and in the
third, the lymphadenopathy is discovered in the
course of routine examination.
In this milder nonfatal form, except for the
lymphadenopathy the clinical examination is of-
ten normal. The enlarged lymph nodes, of hazel-
nut to walnut size, may be tender during the
first weeks of the disease, but are usually painless
later. The firm, discrete nodes, with smooth sur-
faces, are not attached to the underlying tissue.
The covering skin is unaffected and does not itch;
necrosis or formation of fistulas has not been
observed. The lymphadenopathy is often gener-
alized, with swollen nodes present in the sub-
occipital region, in the neck, in the axilla, and
in the groin. It may be, however, that the lymph
nodes are affected in one superficial area only.
There may be enlargement of the hilar shadows.
The spleen is seldom palpable. The clinical course
is usually benign, with complete recovery in most
instances. The enlargement of the lymph nodes,
however, may persist for six to 12 months or
longer, and there may be pronounced fatigue
over a period of months.
Not only is the great variability of the mani-
festations of adult toxoplasmosis particularly
noteworthy, but also the rarity of its recognition
in contrast to the apparently widespread occur-
rence of the causative parasite among animals
throughout the world. Epidemiologic studies
have demonstrated that antibodies and skin sen-
sitivity to Toxoplasma rise with increasing age,
thus indicating continued acquisition of inappar-
ent toxoplasmosis in the adult population and
suggesting rather frequent occurrence of the dis-
ease in adults, but with symptoms so inconspic-
uous as rarely to permit clinical diagnosis. That
it may be acquired in adulthood further sub-
stantiates the accepted concept that congenital
toxoplasmosis is acquired in utero when the infec-
tion is present in the pregnant mother.15
Unfortunately, the maternal toxoplasmosis
which is transmitted to the offspring with such
distressing sequelae is usually of a subclinical
nature, eluding diagnosis. Nevertheless, detection
of acquired toxoplasmosis in pregnancy remains
at present the only possible way of preventing
the tragic cases of congenital toxoplasmosis in
which the severe damage to the brain and the
eyes is irreparable and for which no specific ther-
apy has as yet been devised. In pregnant wom-
en, therefore, who show evidence of inexplicable
fever, lymphadenopathy or excessive fatigue, a
thorough examination should be carried out.
Ocular Toxoplasmosis
The commonest ocular manifestation of con-
genial toxoplasmosis is a necrotizing chorioreti-
nopathy, rather extensive in type, usually involv-
ing the central area, that is, the macula or para-
macular region, and leaving deep scars. As a rule
there are multiple foci. Coloboma of the choroid
may be present,18 as in one case in my first
series. When the lesion becomes quiescent, much
pigment migration and deposition take place.
Rarely, anterior uveitis may occur, but in my
opinion it is more prevalent in the adult form of
the disease. Other ocular changes include microph-
J. Florida, M. A.
September, 1957
FORBES: TOXOPLASMOSIS
231
thalmus, pupillary membranes and congenital cat-
aract, all of which could, of course, be coinci-
dental.
Duke-Elder18 observed that the common in-
fantile type may be associated with a toxoplas-
mal encephalitis which may be characterized by
head retraction, facial palsy, conjugate deviations
and absence of the pupillary and vestibular re-
flexes. Among the sequelae he mentioned hydro-
cephaly, areas of cerebral calcification, mental
retardation and searching nystagmus. Certainly,
chorioretinitis particularly in association with
cerebral calcification, hydrocephaly or micro-
cephaly, and psychomotor disturbances is highly
suggestive of toxoplasmosis, and in the presence
of these manifestations, the incidence of serologic
confirmation of the diagnosis can be as high as
80 or 90 per cent.19 It is, in fact, the most im-
portant sign for the detection of toxoplasmosis
in patients in whom the disease may be suspected
as the cause for congenital cerebral damage. Re-
cently, Deutsch and Horsley20 reported a fatal
case in a newborn infant in which the ocular
lesions were a prominent feature.
Chorioretinopathy may not be apparent at
birth, but the characteristic lesions frequently
develop within a few weeks. Although the macu-
lar region is most frequently involved, in some
instances the lesions are located far out in the
periphery of the retina. It may not be possible
to see them except under full dilatation of the
pupil and most complete funduscopic examina-
tion, which in children may be accomplished only
under general anesthesia. In my experience, the
lesions in a number of cases were in the extreme
periphery and difficult to locate.
In acquired toxoplasmosis, the ocular mani-
festations may be suggestive, but they are not
strikingly characteristic. In the proved fatal cases
and the reported nonfatal adult cases, only an
occasional instance of ocular involvement is re-
ported.21 Feldman22 was able to demonstrate
Toxoplasma antibodies in only 18 of 140 suspect-
ed cases of postnatally acquired toxoplasmic
chorioretinitis. The so-called focal choroiditis,
according to Woods,21 is the lesion most fre-
quently encountered. Approximately one half of
such lesions apparently are attributable to ac-
quired toxoplasmosis, quite similar lesions being
caused by other infectious granulomata, notably
tuberculosis and brucellosis. Next in frequency
is a generalized granulomatous uveitis, quite in-
distinguishable in its appearance and course from
chronic tuberculous uveitis. Other ocular lesions
mentioned by Woods21 are retinal periphlebitis
with vitreous hemorrhages and possibly an acute
optic neuritis. He stated that the rare systemic
symptoms of acquired adult toxoplasmosis —
fever, a generalized lymphadenopathy, nonspecific
catarrhal symptoms, occasionally a pneumonitis,
hepatitis, an exanthematous rash or a meningoen-
cephalitis, and sometimes a blood picture sugges-
tive of infectious mononucleosis — rarely, if ever,
occur in association with ocular lesions. Duke-
Elder18 noted that the disease in the adult “is
usually subclinical in its manifestations, but the
evidence that it may give rise to a necrotizing
chorio-retinitis or a generalized uveitis of a very
recalcitrant type resembling tuberculosis in its
clinical and pathological characteristics is rapidly
growing.’’ McKinney23 recently reported a case
of presumptive toxoplasmic iridocyclitis in an
adult with apparent response to specific therapy.
The course of the acquired ocular disease was
described in a recent comment in these words: “In
verified toxoplasmosis involving the eye there
may be a history of acute retinitis or, less often,
of uveitis, or the inflammatory process may de-
velop gradually. Characteristically, in acquired,
as distinguished from congenital, infections, it
tends to become chronic as the involved cells
change their role from host to that of phagocyte,
with corresponding decrease in multiplication of
Toxoplasma organisms and frequently their in-
clusion in pseudocysts. From these pseudocysts
the infection may later become reactivated.”22
Jacobs8 regarded the brain and the eye as the
most frequent sites of persistence of the parasites
in animals and probably in man. He observed
that possibly because of low immunity in the
ocular fluids and tissues, rupture of pseudocysts
and proliferation of parasites may occur from
time to time, resulting in exacerbations of chorio-
retinal lesions. Hogan, Zweigart and Lewis24
recently demonstrated experimentally the persis-
tence of Toxoplasma in ocular tissue.
Diagnosis
The most commonly recognized clinical mani-
festations of human toxoplasmosis are the results
of congenita! infection. Even though the clinical
picture is more or less characteristic, neither the
manifestations of damage to the nervous system,
which are most frequent, nor those involving the
viscera, such as neonatal jaundice or hepatosple-
nomegaly, are sufficiently definite to permit a diag-
232
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Volume XLIV
Number 3
nosis on clinical grounds alone. The clinical
diagnosis must be confirmed by positive serologic
tests.19 Likewise, the clinical features of ac-
quired toxoplasmic infection are by no means
characteristic for this disease exclusively. The
preliminary clinical diagnosis can be substantiated
only in the laboratory “by the demonstration of
Toxoplasma antibodies in paired blood samples,
and by the isolation in clean laboratory mice or
tissue culture of the parasite from blood, spinal
fluid, lymph node or muscle biopsies, or from
specimens obtained postmortem.”5 Morever, in
the absence of a characteristic ocular symptoma-
tology and concomitant systemic manifestations,
with no adequate therapeutic trial test, and with
no ocular tissue available for isolating or cultur-
ing the parasites, the diagnosis of adult ocular
toxoplasmosis must rest on various diagnostic
tests which reveal an antibody response to the in-
fection.-1
It was not until 1948 that the dye, skin and
complement-fixation tests became available and
served to stimulate worldwide interest in Toxo-
plasma. Recently, Eichenwald25 discussed the
laboratory diagnosis of toxoplasmosis and de-
clared the Sabin-Feldman dye test to be undoubt-
edly the most useful tool in the diagnosis of
Toxoplasma infection. Eyles13 regarded this test
as a milestone in the history of toxoplasmosis of
the greatest importance in dealing with this dis-
ease, in which it is so difficult to isolate the actual
etiologic agent. This test and the titer strength
considered diagnostic, additional laboratory pro-
cedures, notably the complement-fixation and the
toxoplasmin cutaneous tests, and other aspects of
laboratory diagnosis will be presented in the dis-
cussion by the distinguished pathologist, Dr.
James N. Patterson.
Treatment
The difficulty in diagnosing toxoplasmosis
and the lack of drugs of demonstrated value have
hampered the treatment of the disease. Recently,
however, as the role of toxoplasmosis in causing
granulomatous uveitis, chorioretinitis, and the
syndrome characterized by lymphadenopathy and
fever has been more fully realized, animal experi-
mentation has led to the discovery of agents ef-
fective against the disease in animals. These
drugs give promise of being effective in man, and
reports of their use in the treatment of human
toxoplasmosis are just now becoming available.
Two groups of drugs offer promising activity:
(1) the sulfonamides, the most active of which
are the sulfapyrimidines (sulfamethazine, sulfa-
merazine, and sulfadiazine) and sulfapyrazine;
and (2) the 2,4'-diamino pyrimidines, the most ac-
tive of which is pyrimethamine (Daraprim).
Among the sulfones, the antibiotics and other
groups, less active compounds have been found.29
While they are of value individually, perhaps
the outstanding feature of the sulfonamides and
pyrimethamine is their synergistic action. In his
recent review of the newer knowledge of the
chemotherapy of toxoplasmosis, Eyles29 con-
cluded that these drugs act together synergistical-
lv most likely by imposing sequential blocks up-
on the metabolic pathway involving para-amino-
benzoic acid, folic acid, and folinic acid. Because
of this synergistic action it is possible to obtain
chemotherapeutic effect with much lower dosages
than with the drugs individually. This author
observed that the reports 23 27 now appearing
describing the use of the sulfonamides and pyri-
methamine in human toxoplasmosis, while diffi-
cult to evaluate, nevertheless appear to indicate
that activity against both acute acquired toxo-
plasmosis and toxoplasmic uveitis and chorioreti-
nitis is becoming reasonably well substantiated.
My experience with this therapy adds evidence
in support of this observation.
Review of Cases
In a recent presentation,! I reported a series of 14
cases believed to be of toxoplasmic origin and discussed
the various aspects of the problem of ocular toxoplasmosis.
In this series, the diagnostic criteria were a characteristic
ocular picture, a careful search for other sources of uveitic
infection, and the presence of a positive reaction to the
intracutaneous toxoplasmin test and the Sabin-Feldman
dye test in each case. In two cases of the series the reac-
tion to the dye test was positive in a titer of 1:32; in
six, 1:64; in two, 1:126; in one, 1:128; in one, 1:256; in
one, 1:512 and later 1:65536; and in one, 1:16384. In five
of the cases the controversial question could be raised re-
garding the possibility of skin testing causing an anam-
nestic rise in the dye titer, a subject Dr. Patterson will
doubtless mention, along with the titer considered diag-
nostic, in the discussion of this paper.
In this first series, most of the cases were characterized
by an acute flare-up of the disease, particularly in the
posterior portion of the uvea, superimposed on previously
existing lesions. The patients ranged in age from four
months to 70 years; more than half, however, were in
the late teens or in the twenties. Nine were females, and
five were males. Arrest of the infection and, in 11 of the
14 cases, some improvement in vision resulted from the
use of Daraprim and sulfonamide therapy. In a few cases
the visual results were dramatic.
The first case of this series illustrates the remarkable
response to systemic antitoxoplasmosis therapy during an
acute attack of uveitis, with probable salvaging of useful
central vision in the one functioning eye. In this case, long-
standing recurrent posterior uveitis with binocular evidence
of posterior fundal lesions typical of toxoplasmosis has
been observed by me since 1949 in a patient then aged 18
with a history of poor vision for 10 years prior to that
time (figs. 1 and 2). In January 1957, this patient, after a
normal labor, gave birth to her first child. The obstetrician
J. Florida, M. A.
September, 1957
FORBES: TOXOPLASMOSIS
233
Fig. 1. — This view shows one of the lesions located
in the macula of the left eye, active in 1949 and not
controlled sufficiently to prevent loss of central vision.
Fig. 2. — Chorioretinopathic scar of minor nature in
the left eye resulting from an active process in 1955, con-
trolled apparently completely by pyrimethamine and
sulfonamide therapy.
reported that the infant was apparently normal in all re-
spects.
In a second case with prompt response to accepted
therapy, a robust 17 year old girl complained in April
1956 of a film over the left eye for several days. The
mother had required intravenous feeding much of the time
during the pregnancy. In the right eye there were multiple
inactive lesions of choroiditis with marginal pigment and
in the left eye much vitreous exudate with many fundal
scars, two of the lesions being active (figs. 3 and 4). Physi-
cal examination, including roentgenograms of the chest and
skull, and the usual tests gave negative results except the
intracutaneous toxoplasmin test, to which the reaction was
strongly positive with perhaps some focal and general re-
action also. There was a positive response to the Sabin-
Feldman dye test in a dilution of 1:512. Under treatment
with Daraprim and Combisul (3) the eye quieted down
within four weeks. In July renewed activity in this eye
ceased and the following month activation of a lesion in
the right eye subsided promptly on resumption of the
treatment. There has been no further activation of the
lesions in the uveal tract. With this therapy, definite im-
provement in the emotional pattern was noted in this case
and in several other treated cases.
The present series of six cases represents additional
instances of ocular involvement of presumptive toxoplasmic
origin. The patients ranged in age from three and one-half
to 37 years; five were females and one male. In all of
these cases the Sabin-Feldman dye test gave a positive re-
sult in dilutions ranging from 1:128 to 1:1024.
Fig. 3. — Discrete scars of chorioretinopathy in the
periphery of the right eye.
Report of Cases
Case 1. — A white woman, aged 37, complained in 1934
of impaired vision in the right eye for five months, which
had rapidly become worse during a period of three weeks
immediately prior to consulting me despite energetic treat-
ment elsewhere. On examination, global injection, a con-
siderable number of flat keratic precipitates, vitreous opac-
ities obscuring a good view of the fundus and some lentic-
ular pathologic changes of a secondary posterior subcapsu-
lar type were noted in the right eye. Bare light perception
was present in this eye. There was little change in the iris.
The left eye appeared normal in all respects. The reaction
to the intracutaneous tuberculin test was positive, and old
tuberculin therapy was given off and on until the response
to this test was negative.
The patient was not seen from 1937 until she returned
in 1948. At that time the right eye was white and quiet;
posterior synechiae, atrophy of the iris and pronounced
secondary lenticular opacification were present, as were
good light perception and projection, and macular and
color perception. There were a few inactive flat keratic
precipitates in this eye. The intraocular pressure was 22
Schidtz. In September, a combined intracapsular extraction
was performed with satisfactory improvement in the eye
during several months’ observation postoperatively. A quiet
but extensive area of chorioretinitis could be made out on
the temporal side, midway between the disk and the per-
Fig. 4. — Extensive scarring to the nasal side of the
disk. There was activity in this area during the course of
observation. The process quieted down promptly on
pyrimethamine and sulfonamide therapy.
234
FORBES: TOXOPLASMOSIS
Volume XLIV
Number 3
riphery. With an aphakic lens, the vision in this eye
corrected to 20/S0 at distance with a Jaeger 3 at near.
The situation remained satisfactory until 1956 when
there was activation of the process in the right eye with
a considerable number of vitreous floaters and some
bleeding in and around one of the larger lesions temporal-
ly. Prior to this episode there had been slight intraconjunc-
tival bleeding in the left eye. Complete laboratory tests
gave negative results, and the Rumpel-Leede sign was ab-
sent. The intracutaneous tuberculin and toxoplasmin tests
gave negative results, but the reaction to the Sabin-Feld-
man dye test was positive in a dilution of 1 : 1024. The ad-
ministration of Daraprim, 25 mg. daily, sulfadiazine four
times daily, Sodium Sulamyd drops in the eye and a sul-
fathiazole ointment on retiring resulted in complete subsi-
dence of the active process within a period of several
weeks.
In this case a patient with a monocular lesion had a
uveitis in 1934 of the anterior as well as the posterior type
requiring cataract surgery. Following a flare-up in 1956,
there was complete subsidence of activity on Daraprim and
sulfonamide therapy. The question arises as to whether or
not there was infection caused by Toxoplasma right from
the beginning.
Case 2. — A white girl, aged three and one-half years,
was first seen in 1944. There was a history of dancing
eyes and poor vision since birth. Delivery at term was
normal. The mother stated that the child could not
hold up her head and that she had had an undetermined
course of fever. An older brother and sister were nor-
mal children.
Except for an inclination to a head nod, the general
physical examination, including roentgenograms of the
skull, gave negative results. In the left eye, there was
a pronounced focusing nystagmus with an internal squint
of about 35 prism diopters with apparently limited ex-
ternal rotation and greatly increased internal rotation.
Funduscopic examination revealed inactive but promi-
nent scars of central chorioretinopathy with much pig-
ment migration and pallor of the disk in the left eye.
The reaction to the intracutaneous tuberculin test and
the test for brucellosis was negative. Muscle surgery
was performed.
The child was not seen again until 1947, when the
pronounced focusing nystagmus was still present. The
eyes were practically parallel. The vision was 20/200
in the right eye and 10/200 in the left eye with about
the same funduscopic findings. Again, the intracutaneous
tuberculin test and the test for brucellosis gave negative
results.
The patient was seen periodically until 1956. At
that time the Sabin-Feldman dye test gave a positive
response in a dilution of 1:512, and the reaction to the
intracutaneous toxoplasmin test was markedly positive.
An operation was performed for nystagmus in which
the eyes were placed in the direction of the quick com-
ponent by resection of the external rectus of the right
eye and resection of the internal rectus of the left eye,
with much improvement in the nystagmus and perhaps
some visual improvement. Therapy with Daraprim once
daily and 0.5 Gm. of sulfadiazine twice daily had to be
discontinued after a period of six weeks because of a
secondary anemia of considerable degree.
At the time of the last examination on Jan. 21, 1957,
the vision was 20/200 plus in the right eye and 20/200
in the left eye. The visual fields were markedly con-
tracted, particularly in the left eye, with central scoto-
mata in both eyes. There was great improvement in
the general condition, and both to the family and to
me there seemed to be improvement in the various
nervous manifestations on the Daraprim and sulfa-
diazine therapy. The bone marrow depression disap-
peared completely without too much medication.
In all probability, this child had had a toxoplasmic
infection from birth. On her record card I had noted
in 1948 that toxoplasmosis was to be considered, but
at that time I was not well enough informed to make
the diagnosis.
Case 3. — A white girl, aged 16, an only child, was
first examined in 1939. There had been a loss of vision
in the left eye for about one year. Delivery at term
had been normal although the mother had been ill dur-
ing the pregnancy. The child seemed to be normal at
birth. On ocular examination, the right eye appeared
normal in all respects. In the left eye, anteriorly there
were a few more or less quiescent keratic precipitates.
It was difficult to obtain a view of the fundus. There
were multiple areas of choroiditis in the central region
to the temporal side with many vitreous opacities, thin-
ning of the vitreous structure and secondary posterior
subcapsular lens opacity. The vision in the right eye
was 20/30 plus and in the left eye 10/200. The intra-
cutaneous tuberculin test and also the test for brucellosis
gave negative results.
The patient was not seen again until 1956. In the
interim, she had married and now had two children
living and well, but had had three miscarriages prior to
the birth of these children. She complained of nausea,
headaches, nervousness and at times emotional disturb-
ances. The right eye showed some scarring to the
temporal side with pigment migration rather far out to-
ward the periphery, multiple scars above and much pig-
ment, a considerable number of vitreous floaters and
also scars of a chorioretinopathy in the periphery be-
low with much pigment. In the left eye, a mature lens
opacity was present with no view of the fundus ob-
tainable. The intracutaneous tuberculin and brucellergen
tests gave negative results, but the reaction to the intra-
cutaneous toxoplasmin test was markedly positive. The
Sabin-Feldman dye test gave positive results in a dilu-
tion of 1:128. The general physical examination, includ-
ing roentgenograms of the skull, gave negative evidence.
The treatment consisted of Daraprim once a day,
0.5 Gm. of sulfadiazine twice daily, and Sodium Sulamyd
drops and sulfathiazole ointment locally in the eyes.
Nicotinic acid was prescribed by mouth along with sub-
lingual histamine. There was careful laboratory super-
vision to guard against bone marrow depression. Dur-
ing the four months since this therapy was begun, there
has been considerable improvement in the vitreous opac-
ities in the right eye. The condition of the left eye
remains about the same. There is great improvement
in the general condition with decrease of the nervous
symptoms.
In all probability, this is a case of congenital toxo-
plasmosis. In 1957, the Sabin-Feldman dye test gave
negative results in the two children.
Case 4.- — A white woman, aged 35, had a central ac-
tive elevated lesion of a chorioretinitis in the right eye
when she first consulted me in 1953. The left eye ap-
peared to be normal. The intracutaneous tuberculin and
brucellergen tests gave negative results. A general phy-
sical examination, including roentgen examination of
the teeth and one extraction, was carried out. Routine
treatment was instituted with the lesion in the right eye
quieting down and remaining so until 1957, when some
reactivation of the area occurred. At that time, the re-
action to the intracutaneous tuberculin and brucellergen
tests was negative, but positive to the intracutaneous
toxoplasmin test with vesiculation. The response to
the Sabin-Feldman dye test was positive in a dilution
of 1:512. Daraprim once daily and Combisul twice a
day were prescribed. The eye quieted down with no
other measures, the lesion became highly discrete, and
there was a residual vision of 20/200 minus.
Whether or not this monocular lesion, observed from
1953 to the present time with a prolonged period of
quiescence followed by reactivation in 1957, was toxo-
plasmic in origin is problematic despite the positive re-
action to the intracutaneous toxoplasmin test and to the
dye test in a dilution of 1:512.
Case 5.— -A white man, aged 24, first consulted me in
1930. Posterior uveitis of considerable degree was pres-
ent, particularly in the left eye with some activity ir'.
this eye. The vision in the right eye was 20/100 and in
the left eye 5/200. He was seen rather frequently for
J. Florida, M. A.
September, 1957
FORBES: TOXOPLASMOSIS
235
a time and then was referred to Dr. William Y. Sayad
of West Palm Beach, as he lived in that area. He did
not return until November 1956, at which time there
was a history of complete loss of central vision in the
left eye and vision always having been poor in the right
eye. He had had considerable old tuberculin therapy
given by Dr. Sayad.
In the fundus of the right eye there were multiple
pigmented areas in the macula and paramacular region.
Similar but much more extensive lesions with some
elevation and heavy pigmentation were present in the
left eye. There seemed to be some activity with a con-
siderable amount of vitreous exudate in this eye. The
vision was again 20/100 minus in the right eye and less
than 20/200 in the left eye, not improved. Both the
intracutaneous tuberculin and toxoplasmin tests gave
moderately positive results, while the brucellergen test
gave negative results. The reaction to the Sabin-Feld-
man dye test was positive in a dilution of 1 : 1024.
With the institution of treatment consisting of old
tuberculin therapy, Daraprim once daily, Combisul twice
daily and a multiple vitamin, the left eye quieted down
with complete inactivation of one lesion that was
certainly active. In addition to the home treatment,
there has been some office therapy with streptomycin
and Sodium Sulamyd iontophoresis. The vision has im-
proved little, of course, but there has been some general
improvement, particularly noted by the family.
In this case with a positive reaction to the intra-
cutaneous tuberculin test, the question arises as to wheth-
er there is present a tuberculoprotein sensitivity, a
toxoplasmic infection, or a combination of the two.
Certainly, the patient has recently been doing well on
the accepted therapies for each, instituted at the same
time.
Case 6.— A white woman, aged 21, had a spot on the
left eye and poor vision in this eye when she first con-
sulted me in July 1953. Examination revealed multiple
areas of choroiditis in the macula and paramacular region,
with much pigment in the central lesion, and some pallor
to the temporal side of the disk, probably associated with
a retinitic optic atrophy. The vision in this eye was
2/200. The right eye was normal with a vision of 20/20.
The intracutaneous tuberculin and brucellergen tests gave
negative results.
The patient was not seen again until 1956, when the
situation was about the same. The reaction to the intra-
cutaneous tuberculin and toxoplasmin tests was moder-
ately positive, and negative to the brucellergen test.
The Sabin-Feldman dye test gave a positive result in
a dilution of 1:128. The general physical examination,
including roentgenograms of the skull and chest, gave
negative results. Therapy consisted of Distrycin injec-
tions, Daraprim once daily, 0.5 Gm. of sulfadiazine twice
daily, Sodium Sulamyd drops in the eyes twice daily
and a sulfathiazole ointment at night. The ocular situa-
tion remains about the same. Inasmuch as there were
no general complaints, there is no yardstick to follow
as to whether or not there was improvement in the
general condition.
A monocular involvement of chorioretinopathy due
to toxoplasmosis possibly may be present in this case,
and it may be that a tuberculoprotein sensitivity also is
present.
Summary
The clinical aspects of toxoplasmosis in its
congenital, acquired and ocular forms are pre-
sented, and the salient features of the causative
parasite, T. gondii, are reviewed, During the few
years that this organism has been recognized as
being capable of producing fatal human congen-
ital disease and giving rise to inapparent infec-
tions in human adults, the disease has become the
concern of the obstetrician, the pediatrician, the
general practitioner, the internist, the ophthalmol-
ogist and the pathologist as well as the parasi-
tologist.
Congenital toxoplasmosis is a pediatric prob-
lem with the responsibility for early diagnosis
obviously resting on the obstetrician and the
pediatrician. It occurs when a nonimmune preg-
nant woman acquires a usually inapparent infec-
tion, which, through resultant parasitemia, is
transmitted placentally to the fetus, often caus-
ing irreparable damage to the central nervous sys-
tem. The obstetrician’s alertness to the clinically
insignificant symptoms of this infection in the
pregnant patient, coupled with prompt therapy,
may be the means of preventing the serious and
at times fatal manifestations in the infant. Only
in this way can sufficient data be accumulated to
chart progress in dealing with this acquired con-
genital disease and its dread manifestations.
The pediatrician must cope with the residual
damage of the congenital infection and recognize
its origin. The chief benefit to be derived from
a specific diagnosis of congenital toxoplasmosis is
the good prognosis for subsequent children.
There appears to be no adequate evidence that
a mother can give birth to more than one child
with the disease.
In the acquired form, the illness may vary in
verified cases from a mild one day febrile illness
with local adenopathy the only distinguishing
feature to a fatal widely disseminated infection.
Epidemiologic data suggest that the disease oc-
curs rather frequently in adults, but is rarely rec-
ognized because the inconspicuous symptoms sel-
dom permit clinical diagnosis. A high index of
suspicion on the part of the general practitioner
and the internist, as well as the obstetrician,
would help to meet the challenge of this form
of the disease. The actual recognition of both
the congenital and the acquired forms depends
upon clinical awareness quite as much as upon
diagnostic facilities.
The ocular form of the disease constitutes
perhaps its most important human manifesta-
tion. The determination of the important role
of toxoplasmosis in both infantile and adult
uveal inflammation offers an excellent example
of cooperative endeavor between the parasitol-
ogist, the ophthalmologist and the pathologist.
Chorioretinopathy is the commonest manifestation
of congenital toxoplasmosis and is the most im-
portant sign for the detection of the disease in
236
FORBES: TOXOPLASMOSIS
Volume XLIV
Number 3
patients in whom it may be suspected as the cause
of congential cerebral damage. Focal choroiditis
is the lesion most frequently encountered in
adults. Systemic symptoms of acquired adult
toxoplasmosis rarely occur in association with
ocular lesions.
Six cases are reported which, added to an
earlier series, illustrate the importance of clinical
awareness of the disease on the part of the
ophthalmologist.
In congenital, acquired and ocular toxoplas-
mosis, the preliminary clinical diagnosis must be
confirmed in the laboratory by serologic tests.
The Sabin-Feldman dye test is the most useful
diagnostic measure.
Sulfadiazine and pyrimethamine constitute
the accepted therapy at the present time. Their
synergistic action produces chemotherapeutic ef-
fect with much lower dosages than is obtained
with the drugs individually.
Clinicians are urged to add their experience
with this curious parasitic disease to the accumu-
lating data so that clarification of its puzzling
aspects may be expedited.
References
1. Forbes. S. B.: Ocular Toxoplasmosis, Report of Cases. To
be published in the American Journal of Ophthalmology.
2. Nicolle, M. M. C., and Manceaux, L. : Sur un protozaire
nouveau du gondi (Toxoplasma N.G.), Inst. Pasteur Tunis,
Archives 2:97-103, 1909.
3. Wolf, A.; Cowen, D., and Paige, II. H.: Human Toxo-
plasmosis: Occurrence in Infants as Encephalomyelitis;
Verification by Transmission to Animals, Science 89:226-
227 (March 10) 1939.
4. Sabin. A. B. : Toxoplasmosis: Current Status and Unsolved
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5. Siim, J. C. : Toxoplasmosis Acquisita Lymphonodosa : Clin-
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8. Jacobs, L. : Propagation, Morphology, and Biology of
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9. Feldman, H. A., and Miller. L. T. : Congenital Human
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Am. Pract. & Digest Treat. 7:1817-1820 (Nov.) 1956.
11. Feldman, H. A.: Clinical Manifestations and Laboratory
Diagnosis of Toxoplasmosis. Am. T. Trop. Med 2:420-428
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12. Frenkel, J. K. : Pathogenesis of Toxoplasmosis and of In-
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13. Eyles, D. E. : Toxoplasmosis: Summary and Challenge,
Ann. New York Acad. Sc. 64:275-277 (July 5) 1956.
14. Ingalls, T. H.: Causes and Prevention of Developmental
Defects, J. A. M. A. 161:1047-1051 (July 14) 1956.
15. Kass, E. H., and others: Toxoplasmosis in the Human
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of Case Due to Laboratory Infection, Ann. Int. Med.
44:565-572 (March) 1956.
17. Jacobs, L.; Fair, J. R., and Bickerton, J. IL: Adult Ocular
Toxoplasmosis; Preliminary Report of Parasitologically
Proved Case, A. M. A. Arch. Ophth. 51:287 (March)
1954.
18. Duke-Elder, Sir Stewart: Text-Book of Ophthalmology,
Vol. VII, Summary of Systemic Ophthalmology, General
Index, St. Louis, The C. V. Mosbv Company, 1954, p.
6943.
19. Sabin, A. B.; Eichenwald, H.; Feldman, II. A., and Ja-
cobs, L. : Present Status of Clinical Manifestations of Toxo-
plasmosis in Man: Indications and Provisions for Routine
Serologic Diagnosis, J. A. M. A. 150:1063-1069 (Nov. 15)
1952.
20. Deutsch, A. R., and Horsley, M. E.: Congenital Toxo-
plasmosis, Am. J. Ophth. 43:444-448 (March) 1957.
21. Woods, Alan C. : Endogenous Uveitis, Baltimore, The Wil-
liams & Wilkins Company, 1956.
22. Toxoplasmosis of the Eye, Queries and Minor Notes, J A.
M. A. 163:906-907 (March 9) 1957.
23. Toxoplasmic Iridocyclitis, Proceedings, Memphis Eye, Ear,
Nose, and Throat Society, Am. J. Ophth. 43:472-476
(March) 1957.
24. Hogan, M. J.; Zweigart, A. B., and Lewis, A.: Persistence
of Toxoplasma Gondii in Ocular Tissue, Am. J. Ophth.
42:84-89 (Oct.) 1956.
25. Eichenwald, II. F. : Laboratory Diagnosis of Toxoplasmosis,
Ann. New York AcatL Sc. 64:207-214 (July 5) 1956.
26. Eyles, D. E. : Newer Knowledge of Chemotherapy of Toxo-
plasmosis, Ann. New York Acad. Sc. 64:252-267 (July 5)
1956.
27. Wettingfeld, R F. ; Rowe, J., and Eyles. D. E.: Treat-
ment of Toxoplasmosis with Pyrimethamine (Daraprim)
and Triple Sulfonamide, Ann. Int. Med. 44:557-564
(March) 1956.
409 Citizens Building.
Discussion
Dr. James N. Patterson, Tampa: There can be no
doubt but that Dr. Forbes’ paper represents an outstand-
ing clinical contribution in the elucidation of a disease
process which not too many years ago was practically
unrecognized. It represents, too, the expenditure of a
great deal of time and energy over and above that of
the routine practice of ophthalmology.
The procedures available in the laboratory diagnosis
of toxoplasmosis fall into three main categories: (1)
isolation of the organism, (2) serologic tests and (3)
toxoplasmin skin tests.
1. Isolation of the organism by tissue culture or
animal inoculation and identification by morphologic and
serologic studies would provide irrefutable evidence.
This method, however, is not practical since material for
study is usually not available; and if it were, only a few
research laboratories would have the facilities and trained
personnel necessary to carry out properly work of
this type.
2. The main serologic tests are: (1) the dye test
of Sabin and Feldman and (2) the complement-fixation
test.
There is no doubt that the best test presently avail-
able for the diagnosis of all stages of Toxoplasma infection
is the dye test. This test is based on the observation
that both the cytoplasm and nucleus of the organism,
when incubated with normal serum under conditions
of the test, subsequently stain blue upon the addition
of methylene blue; whereas, after exposure to antibody-
containing serum under the same conditions, only the
nucleus takes the stain. The test is technically difficult
and requires the presence of a continuous source of liv-
ing Toxoplasma.
This test becomes positive early in the course of the
disease and remains positive for years, although in
diminishing titer. Sabin and many other investigators
believe that a positive dye test of any degree cannot be
disregarded but that it must be correlated with the his-
tory, clinical findings and other laboratory data. Others,
including Woods, because of the large number of ap-
parently normal persons (Feldman found positive re-
sults in 77 out of 144 residents of Pittsburgh) who give
a positive reaction to the dye test, the degree of posi-
tivity of which rises with advancing age, suggest the
following titers be regarded as of diagnostic value:
Age
Under 10 years of age
10-19 years of age
Over 20 years of age
Titer
1:8 or over
1:32 or over
1:64 or over
It is easy, however, to visualize a patient with an
allergic reaction to a single ruptured pseudocyst as hav-
ing a very low titer.
Frenkel reported in 1948 that an anamnestic rise in
titer of the dye test occurs after a toxoplasmin skin test.
J. Florida, M. A.
September, 1957
FORBES: TOXOPLASMOSIS
237
Feldman, Woods, Jacobs, Fair and Bickerton have not
found that such a rise takes place.
The complement-fixation test becomes positive only
at a later stage of the disease and becomes negative be-
fore the dye test becomes so. Since many cases of toxo-
plasmosis have never exhibited a positive complement-
fixation test, it is of limited value in diagnosis.
3. The intracutaneous test with toxoplasmin is a
test analogous to the tuberculin test in method of admin-
istration and interpretation. A negative skin test does
not rule out the disease since dermal hypersensitivity is
usually absent in the acute stage of the disease and in
infants with congenital toxoplasmosis before the age of
nine months. A positive dermal reaction is usually as-
sociated with the presence of antibody.
Much investigation in this field is taking place. A
new test based on hemagglutination is being performed
by Dr. Leon Jacobs at the National Institutes of Health.
It may eventually replace the dye test according to
some authorities. Another test, a fluorescence inhibition
method, is being investigated by Dr. Morris Goldman at
the Communicable Disease Center of the U. S. Public
Health Service at Chamblee, Ga.
In summary, one can state that the dye test becomes
positive first, the skin test next, and then the comple-
ment-fixation test. In most cases of toxoplasmosis both
the skin and dye tests will be positive. The comple-
ment-fixation test is confirmatory evidence, when posi-
tive. As in all laboratory procedures, however, there
must be careful correlation of the history, physical find-
ings and all laboratory data.
I again wish to compliment Dr. Forbes on this out-
standing contribution.
Dr. Kenneth S. Whitmer, Miami: Dr. Forbes has
described so beautifully and completely what is known
of the disease that there is little left for discussion.
I have followed only two cases of congenital toxoplas-
mosis in which the serum taken in both mother and
child was significant, and in neither of these was the
Eli Lilly toxoplasmin skin test antigen available, nor were
other laboratory tests such as blood cultures, animal in-
oculation, complement-fixation tests or spinal fluid ex-
aminations made.
In one case both ocular and cerebral manifestations
were present, while in the other they were purely ocular.
Both patients survived; so no pathologic specimens
were available. The ocular disease in both babies was
bilateral and central. Both were treated by the drugs
currently in use as described by Dr. Forbes, and in both,
the residua were large central pigmented chorioretinal
scars.
I have not reviewed my other cases of recurrent
choroiditis in the light of the dye test, but have been
using the skin test antigen for the past year or so on
the basis of Frenkel’s suggestion that the test is posi-
tive if an indurated area of 5 to 6 mm. is present with a
surrounding erythematous area of some 10 to 20 mm.
I realize, however, that the skin test alone does not
diagnose toxoplasmosis.
In the absence of other clinical or laboratory causes
of uveitis, the positive skin reactors were treated with
Daraprim and sulfadiazine for fairly long periods of
time. I have been a little disappointed in my results.
One group reported a series of cases of uveitis in which
all patients were given a course of Daraprim and sulfon-
amides, and they concluded that 25 per cent of the pa-
tients improved with this therapy. I have watched
cases in which focal choroiditis flared up, reduced cen-
tral vision to 20/100 or so, and then completely sub-
sided with chorioretinal scarring with no treatment at all.
I should like further to point out that, as in all
forms of chorioretinitis, the diagnosis of toxoplasmosis
is usually presumptive and is made by the exclusion
of other diseases, which is often impossible. I appreciate
discussing Dr. Forbes’ papier very much and am sure it
will stimulate all of us when we are confronted with
one of ophthalmology’s most pierplexing problems, the
differential diagnosis of chorioretinitis.
Dr. Forbes, closing: I wish to thank Dr. Patter-
son and Dr. Whitmer for their excellent discussions.
I agree with Dr. Whitmer that the diagnosis of toxo-
plasmosis is somewhat presumptive and that other causes
of chorioretinitis should be carefully excluded. Also,
I concur in Dr. Patterson’s report on the complement-
fixation test. The reaction to this test is inconstant, it
comes on later, it disappears earlier, and it is not per-
sistent.
An important diagnostic point is the therapeutic test.
The routine Daraprim-sulfonamide therapy is tolerated
in a large percentage of cases of chorioretinitis without
untoward effect. At the outset Daraprim, pyrimethamine
and the sulfonamides were prescribed in fantastic doses,
but my experience has led me to conclude that over the
long course the propier medication is 25 mg. of Daraprim
daily with a moderate dose of sulfonamides. Over a
long period, the patients tolerate this dosage well. The
one case of folic acid deficiency in my series was handled
without difficulty. There have been some reports in the
literature of severe reactions from the accepted therapy,
but the wise course, in my opinion, is to take it easy
and remember that this therapy will have to be con-
tinued over a long period.
One particularly noteworthy point is that in order
to prevent a possible anamnestic increase in titer of the
dye test by the intracutaneous skin testing, the blood
for the dye test is collected before the time of the skin
testing.
Doctor: Your Opinion Is Needed
For the purpose of continuous improvement of The Journal of the Florida Medical Association,
there is a questionnaire on page 277 of this issue to which each member of the Association should
pay particular attention.
There is a place in the questionnaire for your opinion — on original articles, editorials and com-
mentaries, news items, book reviews and other subjects.
It is urgently requested that you spare a few moments to fill in and return this questionnaire. It
is your opinion that will guide The Journal into greater service to its readers.
238
Volume XLIV
Number 3
Optimal Timing in Elective Pediatric Surgery
Thomas J. Zaydon, M. U.
and
H. Clinton Davis, M. D.
MIAMI
Any patient in need of elective pediatric
surgery should be seen, by the surgeon, at the
earliest possible time for individual evaluation.
Though certain generalities can be made as to
optimal age for surgery, it is conceivable that
interval therapy of varied nature might well fa-
cilitate definitive repair. Surgical correction might,
in some instances, be carried out at an even
earlier date than is generally suggested. Need-
less to say, the child should possess sufficient
vitality to withstand surgery. He should have a
satisfactory blood picture; be free of any associat-
ed infection, jaundice or dermatologic problem;
and be of satisfactory weight. The abnormality
and the reaction of the family to the situation
must also be fully evaluated. Whenever possible,
correctable abnormalities should be treated in the
preschool period. The child may then participate
in various activities and be free of ridicule from
playmates. Further, he will avoid loss of school
time, especially when prolonged stage procedures
are necessary.
Hemangioma
Hemangiomas must be carefully individualized
and evaluated early in life if the proper thera-
peutic course is to be decided upon. True, many
will regress; equally true, many will deform, or
destroy vital structures, facial features, and even
the patient himself. If the hemangioma is small,
doing no harm by its presence, or is obviously de-
creasing in size, certainly no therapy is advocated.
These lesions are, however, treated at the earliest
age seen if they are increasing in size, or are
prone to ulcerate, bleed, or become infected. One
is at times justified in waiting six to 12 months
only if the patient is closely supervised and the
family fully cooperative. Needless to say, there
is great esthetic benefit from removal of an un-
sightly lesion. In the ultimate course of pos-
sibilities., though granted to be remote, malignant
change is avoided.
From the Department of Surgery, University of Miami
School of Medicine, Miami.
Exhibit presented at the Eighty-Second Annual Meeting of
the Florida Medical Association, Miami Beach, May 14-16,
1956.
Nevus
There is a variation as to the ideal age for
correction of nevi, with special reference as to
location, extent and exact nature. Generally,
nevi are corrected at two to six years of age.
All nevi which are subjected to chronic irritation,
showing evidence of growth, increased vascularity,
ulceration, change in color, or infection, should be
removed. By removal, the presence of malignant
disease will be ruled out and the possibility of
ultimate malignant change will be eradicated.
The appearance is improved by removal of these
disfiguring lesions.
Inguinal Hernia
Inguinal hernias in infants and children should
be repaired as soon as possible after they are
discovered unless specific contraindications, such
as prematurity, exist. While inguinal hernias
may occasionally obliterate during the first few
months after birth, this outcome should not be
anticipated. The incidence of incarceration dur-
ing the first year of life, with its serious implica-
tions. far exceeds the possibility of spontaneous
cure.
Umbilical Hernia
Spontaneous obliteration of a small umbilical
hernia is so frequent and incarceration is so un-
common that elective repair does not seem war-
ranted unless the hernia persists after the age
of one year. When a large hernia results in
considerable irritability of the infant, elective re-
pair should be performed sooner.
Hydrocele
Most of the hydroceles encountered in in-
fancy will undergo spontaneous regression and will
not require surgery. Surgical treatment should
be considered if the mass is large and tense
enough to cause discomfort, or if the hydrocele
persists after the first year of life. If an accompa-
nying hernia is discovered, the operation should
not be delayed.
J. Florida, M. A.
September, 1957 ZAYDON AND DAVIS:
Undescended Testicle
The incidence of sterility is small and almost
the same when one or both testicles are normally
in the scrotum; therefore, the advisability of
orchidopexy for unilateral cryptorchidism becomes
a serious question. Bilateral cryptorchidism has
better than a 90 per cent chance of sterility and
should receive surgical attention if conservative
measures fail. Orchidopexy is performed after
the age of four years and always before the age
of 10 if the probability of sterility is to be avert-
ed. Surgery also may be required to avoid trauma
to an inguinal testicle or to correct an associat-
ed torsion of the cord. The relationship be-
tween cryptorchidism and malignant disease is
unconvincing. Early surgery with orchidopexy
is indicated when there is an associated hernia.
Hypospadias
Repair of hypospadias is generally initiated
at four to five years of age; however, if there is
a severe ventral curvature or underdevelopment
of the penis of considerable degree, the first stage
may be carried out at two years of age. This
early repair, in the latter instance, will allow
unrestricted development during the early growth
years. Objectives in surgical intervention are:
the release of ventral curvature; repositioning of
the meatus; normal urination in the standing po-
sition, with a normal stream; normal intercourse
and insemination. Of tremendous psychic value
is the restoration of normal appearance and pos-
sible correction of incontinence and enuresis.
Surgery at this age is facilitated by the presence
of more working tissue, thus allowing a definitive,
final type of repair. Undue mental anguish is
avoided, especially the psychic trauma during
school years. Further, priapism, which may com-
plicate the surgery, is easier to avoid early in life.
Of import also is the associated factor of im-
potency, which may possibly be avoided if surgi-
cal correction is carried out early. When the
meatus is at or near the glans and there is min-
imal or no ventral curvature, no surgery should
be performed.
Epispadias
In correcting epispadias, surgery is directed
toward the correction of the dorsal cleft and
the retraction of the penis. This is generally
carried out at four or five years of age. The in-
continence may be helped, and great mental
satisfaction can be afforded the patient.
PEDIATRIC SURGERY 239
Exstrophy of the Bladder
Lreteral diversion is generally carried out at
about two to four years of age and excision or
revision of the bladder at four to five years of
age. The objective in children with exstrophy of
the bladder is to prevent recurrent, ascending
infections of the kidney and an untimely death
due to pyelonephritis. Surgery will eliminate the
sensitive, bleeding, exposed mucosa; the urinary
incontinence may be helped and the urinous odor
avoided.
Thyroglossal Cyst, Sinus or Fistula
Correction of a thyroglossal cyst, sinus or
fistula should be delayed until after two years
of age unless a complication necessitates earlier
intervention. Endotracheal intubation in early
infancy is discouraged for elective procedures
because of the increased incidence of postopera-
tive laryngeal morbidity. Surgery should not be
postponed too long, as there will be recurrent
episodes of infection and troublesome drainage.
These complications tend to add to the scarring
and also to the difficulty of final corrective sur-
gery.
Branchial Cyst and Sinus
Surgery for a branchial cyst and sinus should
be carried out after one or two years of age,
unless the size or symptom complex necessitates
earlier intervention. Varied vagal symptoms such
as vomiting, pallor, and uneasiness may be noted.
There is always the possibility of recurrent in-
flammation and infection, especially at the time
of an infection of the upper part of the respira-
tory tract. The persistent or repetitious discharge
of mucus may be troublesome. The possibility
of malignant change likewise should be borne in
mind.
Cystic Hygroma
Surgical extirpation of a cystic hygroma should
be carried out especially early in infancy if there
is massive involvement, with difficulty in swallow-
ing or breathing, or if there is rapid increase
in size due to hemorrhage. Compromise of vital
structures or infection may justify earlier inter-
vention. Aspiration may well tide the infant
over a critical period while awaiting more satis-
factory conditions. Generally the child should
be at least three or four months of age, or prefer-
ably, about two years of age prior to correction.
240
ZAYDON AND DAVIS: PEDIATRIC SURGERY
Volume XI.IV
Number 3
This rather extensive surgery is better tolerated
and the anesthetic is more safely administered
after the age of two years.
Torticollis (Wryneck)
Generally, one may allow three to six months
for all possible chance of spontaneous improve-
ment or correction of wryneck. Repeated exam-
inations should be made, however, and th^ repair
carried out at the age of six months, or earlier,
if the deformity is severe or the distortion is
becoming progressively worse, with increasing
facial asymmetry. The objective of early sur-
gery is to prevent distortion of cervical and facial
bones and pronounced shortening of skin, fascia
and muscles in the course of growth. An early
repair will prevent a permanent deformity by
avoiding bony distortion over the many years of
growth and eliminate the typical slanted deform-
ity and asymmetry of the face. Freer movement
of the head is allowed. If a definite deformity
has occurred, optimum conditions for restitution
of facial and cervical structures will be establish-
ed.
Megacolon
The infant with congenital megacolon will
usually show signs of constipation, abdominal dis-
tention and partial intestinal obstruction from the
first days of life. When the condition cannot be
controlled medically during the early months,
a temporary colostomy may be indicated before
a curative operation is performed at the age of
one year or older. Usually the aganglionic seg-
ment at the rectosigmoid and colon is resected
with restoration of intestinal continuity at a single
procedure.
Polyposis of Colon
The dangers of malignant degeneration,
hemorrhage and intussusception are such that
children with diffuse polyposis are best treated by
a partial or complete colectomy. The magnitude
of the operation makes it too risky in the first few
years of life. Carcinomatous change is unlikely
at this time. Ideally, the surgery should be de-
layed until the child is six to 10 years of age.
Bronchiectasis
Most children with bronchiectasis respond well
to medical therapy. Surgery is carried out in the
pediatric group when conservative measures fail,
and if the diseased tissue is reasonably well local-
ized. Foreign bodies and bronchial anomalies
rate high along with pneumonia, allergy and si-
nusitis as the etiologic factors in the bronchiectasis
of childhood. Surgery, if necessary, can be per-
formed at any age.
Pectus Excavatum
Mild cases of pectus excavatum do not need
surgical correction. In severe instances there will
be compression of the mediastinal viscera and
esthetic considerations. Dorsal kyphosis is rever-
sible if the condition is treated in childhood.
Surgery should be delayed until the child is three
to five years of age.
Patent Ductus Arteriosus
Although a number of children with a small
patent ductus would live long, normal lives, the
risk of surgery is less than the risk of possible
complications if the condition remains untreated.
When there is a bacterial endarteritis, cardiac fail-
ure or retarded development, the surgery becomes
more imperative regardless of the child’s age.
Surgery is contraindicated when the ductus is
compensating for another cardiac anomaly. When-
ever possible, the operation should be performed
between the ages of three and 10 years.
Coarctation of the Aorta
The over-all poor prognosis of untreated co-
arctation of the aorta makes surgical correction
highly desirable. Except in those unusual in-
stances of uncontrollable cardiac failure in in-
fancy, the operation should be postponed until
the aorta has developed sufficiently to assure ade-
quate patency in adulthood. Surgery after the
age of nine is recommended.
Tetralogy of Fallot
A high mortality and the unpredictable result
make surgery for the tetralogy of Fallot in the
first three years of life undesirable. Good results
require continued adequate patency of the vas-
cular anastomosis or valvulotomy as the child
grows.
Cleft Lip
A cleft lip should be repaired as soon as pos-
sible, even within 48 hours after birth, if the gen-
eral condition of the infant allows. If not, a three
to six week interval may be allowed for satisfac-
tory improvement. In double clefts of the lip,
repair is often made somewhat later, as this pro-
cedure is of greater magnitude. Early repair of
a cleft lip will facilitate feeding and will do much
to relieve the anxiety and embarrassment of the
J. Florida, M. A.
September, 1957
ZAYDON AND DAVIS: PEDIATRIC SURGERY
241
parents at the earliest possible time. Establish-
ment of anatomic position will allow a more nor-
mal growth and development, with the best pos-
sible restoration of the lip and associated nasal
deformity. Pressure of the repaired lip will nar-
row an associated cleft of the palate and allow
the development of a more normal dental arch.
Repair will help to control infections of the upper
part of the respiratory tract, especially when there
is an associated cleft of the palate.
Cleft Palate
The optimum age for repair of a cleft palate
is generally 18 to 24 months, although a satisfac-
tory repair may, in some instances, be carried out
as early as nine months of age. The palate should
be repaired before any definitive speech patterns
have been formed; however, there must be ade-
quate development to insure a proper surgical
correction. Further, at this age, the child is a
better anesthetic risk. Proper palate repair will
provide velopharyngeal closure and assist in the
separation of the oral and the nasal cavity. The
repair will prevent foreign bodies from entering
the nasal cavity; provide better hygiene of the
mouth, nose and middle ear; allow the child to
eat better; diminish upper respiratory tract and
aural infections, thus preserving hearing; make
the development of normal speech patterns more
probable; improve ultimate dentition and facili-
tate any dental correction.
Syndactylism (Webbed Fingers)
Syndactylism is generally corrected at about
five years of age, with surgery being carried out
sooner if the deformity is severe and interfering
markedly with the development or function of the
fingers. Earlier surgery may be carried out if the
joints do not coincide or the fingers are held in a
compact group. If there is free movement of the
fingers or a short skin web, it may well be satis-
factory to allow some delay. The ultimate aim
is to provide normal function of the fingers and
to allow normal growth and development. If sur-
gery is carried out at too early an age, even a
minimal amount of scarring in a young infant
may result in distortion of considerable degree
in these early years. Further, at about five years
of age, better delineation of structures and cir-
culatory conditions allows a more satisfactory ele-
ment of surgical safety.
Ptosis
Four or five years of age is generally the ideal
time for correction of ptosis of the upper eyelid.
At this age, when necessary, there will be ade-
quate fascia lata for repair. The child will be a
better anesthetic risk. Needless delay of correction
may well result in poor vision or severe photo-
phobia, from which the patient may never recover.
Prominent Ears
Prominent ears should be corrected at five
or six years of age. It is extremely important to
avoid ridicule and psychic trauma to the child in
his early school years. Surgery at this time will
not interfere with growth or development of the
ears. A general anesthetic can be administered
more satisfactorily and safely at this age.
Agenesis of Ears
Repair should be delayed in instances of
agenesis of the ears until the child is five or six
years of age, or even postponed until adoles-
cence. The first stage, however, such as position-
ing of an ear segment, may be carried out at two
or three years of age. The reconstructed ear does
not keep pace with growth of the child and must
be made of adult size at the outset. Normally,
there is little further growth of the ear after eight
or nine years of age. The best reconstruction of
the ear will be obtained if surgery is delayed and
one is not pressed into an earlier repair by the
insistence of understandably anxious parents.
Should the repair be carried out at too early an
age, valuable tissue, essential for the best final re-
sults, may be needlessly sacrificed. It is believed
that it is absolutely impractical to consider multi-
ple total ear reconstructions during the growing
years, but rather, construction of one definitive
ear at the optimum time. Needless to say, absence
of an ear is more noticeable in male children and
reconstruction more important to them. Correc-
tive surgery to improve hearing is generally carried
out at two years of age in bilateral agenesis and
at four to five years of age in unilateral agenesis.
Summary
While every patient should be given individual
consideration, nevertheless, there may be an opti-
mal age for the best result in elective pediatric
surgery. An early surgical opinion and proper
timing are stressed.
1006 Huntington Building (Ur. Zaydon).
1242 duPont Building (Dr. Davis).
242
Volume XLIV
Number 3
To Catch a Thief
Thomas G. Dickinson, M.D.
sakasota
There is a thief in our midst who all too fre-
quently mingles unrecognized in our society and
hence goes unapprehended. He is no respecter of
race, creed, color or social position. So adroit is
he in his ways that he often takes from us — pain-
lessly, silently, but completely — our most cher-
ished possession, our eyesight. His victims all too
late discover they have passed the point of no
return into the abysmal ink of blindness. His
name is Glaucoma.
We as physicians can and must help. The re-
sponsibility for the diagnosis and management of
ocular disease has by common consent long been
left to the eye specialist This system might be
satisfactory if the more serious progressive ocular
problems were promptly recognized and referred
for care, but all too often they are not.1 This is
especially true of chronic glaucoma, in which
adequate therapy depends upon early recognition.
At least 20,000 persons, 15 per cent of the blind
population in this country, are totally blind from
glaucoma, and an additional 150,000 are blind
in one eye.2 Of greater importance are the esti-
mated one million persons, approximately 2 per
cent of persons over 40 years of age in the United
States, who have glaucoma and do not know it.
For the sake of illustration, we can over-
simplify glaucoma into acute and chronic types.
The acute type is manifested by the violent, pain-
ful, sudden attack with nausea, vomiting and
rapid loss of vision, a surgical emergency. The
chronic type is characterized by the slow, pain-
less, insidious but relentless loss of the peripheral
field of vision, terminating in blindness. Regard-
less of type, in most cases there is the common
sign of increased intraocular tension.
Reasonably accurate tension readings can be
obtained with any one of a number of instru-
ments. The development of the Berens-Tolman
ocular hypertension indicator, however, has greatly
facilitated the procedure for the estimation of in-
traocular tension by the general physician or the
physician limited to specialties other than the eye.
This small instrument costs only $12, is not deli-
cate, and hence not as easily damaged as the
more complicated tonometer, and gives a statis-
tically proved, accurate indication of the intra-
ocular tension.3 The procedure is simple and
takes only two to three minutes during the gen-
eral physical examination. It can be as conveni-
ently set up as the sphygmometer. How often do
we order a routine roentgen examination of the
chest to rule out tuberculosis or tumor; yet there
are several hundred negative results for every new
case detected. Serologic examinations for syphilis
are routine for every hospital admission, and
there are only about 30 positive results for every
1.000 samples examined. These 30 positive reac-
tions include all the false positives and repeat re-
sponses to examinations performed in known
cases. There were in Florida in 1955 only 151
new cases of syphilis per 100,000 patients, in con-
trast to 2,000 cases of glaucoma in every 100,000
persons over the age of 40. 4
These data suggest that routine tonometry on
persons over 40 may detect a higher percentage
of physical abnormalities than some other proce-
dures routine in the physical examination. Any
physical examination lacking the determination
of the blood pressure is believed to be grossly
incomplete, but consider the difference in the end
result by missing a case of hypertension and a
case of glaucoma. Therapy instituted early in a
patient with hypertension is less likely to modify
the end results than early treatment in glaucoma.
In the latter, a diagnosis a few months earlier
may prevent severe irreversible disability.
Routine tonometry must become a part of the
general physical examination before the one
million undiagnosed cases of glaucoma can be
detected — before the thief can be caught.
References
1. Zeller, R. W., and Christension, L. : Routine Tonometry as
Part of Physical Examination, J. A. M. A. 154 : 1 343-1 345
(April 17) 1954.
2. Schoenberg, M. J.: Report on Progress of Glaucoma Cam-
paign During Past 3 Years, New York State T. Med. 45:738-
740 (April 1) 1945.
3. Information regarding this instrument can be obtained from
Mr. Charles P. Tolman, Director of Glaucoma Research
Project, 83-09 Talbot St., Kew Gardens 15, New York.
4. Berens, C., and Tolman, C. P. : Prevention of Blindness
from Glaucoma, Int’l. Ophthl. Congress 2:1499, 1950.
1950 Arlington Street.
J. Florida, M. A.
September, 1957
243
Rapport in Medicine
S. C. Werch, M.D.
MIAMI
Rapport, probably, is as important a factor to-
wards success with a patient as any attribute that
may be brought to the practice of medicine. When
a harmonious relationship exists between a phy-
sician and a patient, the patient has confidence in
the physician and cooperates with him more eas-
ily. Sometimes rapport is secured easily, but usu-
ally it is attained after considerable effort. Conse-
quently, the physician must be prepared with the
tools necessary not only for its achievement but
for its sustainment as well.
How is rapport secured? And how is it main-
tained? It is secured primarily by means of cer-
tain attributes which should be part of the phy-
sician. It is maintained with interviewing technics
and by consideration and skill in the physical
examination. It is strengthened when the phy-
sician demonstrates leadership during visits, spe-
cial tests, therapy and convalescence and in deal-
ing with the patient’s family. At whatever point,
the watchword is “do not offend.”
The Physician
The importance of the attributes of a phy-
sician warrants dealing with them first.
Few physicians are physically attractive in the
Hollywood sense; not all physicians are tall, dig-
nified individuals, greying at the temples. Fortu-
nately, there are positive personal features over
which all physicians have control — cleanliness,
neatness, simplicity of dress, a dignified carriage
and a calm manner of speaking. These qualities
are important because they instill confidence.
Though desirable, a good physique is not essential
to success in medical practice.
The personality of the physician counts and,
if favorable, will have a favorable effect on his
patients. If his face and speech will convey kind-
ness, understanding and sympathy, the confidence
engendered at the time of introduction to the
patient will be nourished.
Wide interests and inquisitiveness about many
aspects of life are helpful. Since much of medicine
is scientific, and inquiry is the basis of scientific
knowledge, it is to be expected that physicians
will be of inquiring mind. Not all are as inquisi-
tive as Ehrlich was, nor are all able to probe as
Associate Professor, Department of Obstetrics-Gynecology,
University of Miami School of Medicine, Miami.
well as he did; yet only through inquiry can the
physician secure that general fund of knowledge
which will permit him to deal with people of dif-
ferent interests.
During sickness anxiety takes its toll. It would
be well, therefore, if a willingness and readiness
of the physician to be helpful is easily discernible
to the patient. If, in addition, the physician man-
ifests a strong interest in his illness, the patient
may be quieted and will be more easily started
towards recovery.
The favorable reaction of his patients to his
warmth will increase a physician’s self confidence
and help him develop what Sir William Osier oft-
en pointed out, namely, a high degree of equanim-
ity. When a physician attains a state of calm-
ness, he is not thrown off balance by little
disturbances and only rarely by big ones. He is
then infrequently incapable of carrying out his
work and its responsibilities.
The Interview
The art of interviewing is common to most
professions, but even the experienced interviewer
who has studied interviewing technics finds he
could expand his knowledge. Since historical in-
formation contributes largely to an exact diagno-
sis, the medical interview frequently has been
designated as the most important part of the ex-
amination of a patient. Enough time for a thor-
ough and satisfactory interview, therefore, must
be allotted to every new patient.
The patient should be comfortable in a pleas-
ant office setting. Expensive furniture is not nec-
essary, for good taste is the determining factor.
If the physician is not gifted in interior decorat-
ing, he should secure the advice of someone who
is.
The physician should “set the stage” for the
interview. He might begin with a statement on a
timely subject of interest to anyone. Another
good idea is to begin with something worn by the
patient. Of course, it helps the physician to learn
something about the patient beforehand. It would
not be good to talk about Shakespeare to a boxer
unless he is another Tunney, and it would not be
wise to discuss a controversial subject with some-
one who has fixed ideas on the subject and might
be disturbed by discussing it. Nevertheless, it is
244
WERCH: RAPPORT IN MEDICINE
Volume XLIV
Number 3
advisable for a short time to “talk about” some
subject the patient understands before taking up
“the difficulty.” The physician’s purpose in “set-
ting the stage” is to put the patient at ease so that
he will feel free to tell a complete story of his
illness.
The physician should be an informal teacher.
The patient may not understand the importance
of an interview and why much time is sometimes
necessary. He should be told how a physician
conducts an examination and how information
secured during a satisfactory interview can con-
tribute to a diagnosis. Why complete notes are
necessary should be explained. The patient should
understand the legal as well as the medical impli-
cations of complete records. In fact, a patient is
more apt to return to a physician if he knows that
the physician possesses a complete record of his
case; moreover, he will feel an inner satisfaction
in knowing that his physician is thorough. Such
a physician is less frequently sued. The careful
education of a patient is a practical investment,
but advisable mainly because it stimulates a bet-
ter understanding between the physician and his
patient.
A physician cannot afford mental pigeonhol-
ing. Patients smell out moral pigeonholing or
prejudice of any kind. Still the physician should
not accept all that is related as if he had blinkers.
He should watch for chronologic gaps, inconsist-
encies and possible concealment of what may be
important information. He should listen carefully
and critically and observe the patient as he tells
his story; how he carries himself, how he speaks,
how he uses his hands. Much information may
be secured from observation alone. During an in-
terview the physician should be as observant as
Sherlock Holmes.
Questions should be handled judiciously. Dur-
ing the interview the patient “has the floor,” and
the physician should say as little as possible. In
order to keep him to the point, it may be neces-
sary to direct the interview at some point. Unnec-
essary digression wastes time and. what is worse,
often confuses the story. Questions are asked
tactfully as well as sparingly. One does not ask
“How much whisky do you drink?” or “How
many abortions have you had?” It is better to
substitute such words as miscarriages and bever-
age even to patients in whom abortions and
whisky are commonplace.
Emotion or emotional overtone in the telling
of a story is important. A widow may be uncon-
sciously seeking sympathy, a young woman may
be reacting to a broken engagement, a family man
may have lost his job. On the other hand, the
patient may be physically as well as emotionally
ill. If emotion interferes with the telling of a
coherent story, the physician should carefully
help the patient return to “a position” more fa-
vorable to the telling of a coherent story. If emo-
tional overtones becloud a patient’s story, the
physician must be considerate but especially care-
ful of h is interpretation.
The purpose of an interview is to secure all
available historical facts concerning the illness of
a patient. The skill in keeping the patient “to the
point” without losing rapport is in the art of in-
terviewing.
The Physical Examination
From the standpoint of maintaining the rap-
port achieved during an interview, the physical
examination is not merely a series of physical
maneuvers. The attitude of the physician and his
skill are important. If rapport is retained, the pa-
tient is relaxed and cooperative, contributing to a
more revealing examination.
1 he patient should be told how the physical
examination will be made, in order to offset sur-
prise or offense. A pleasant tone is helpful, and,
in the case of children, a soothing tone may be
employed. A sharp tongue or a brusque manner
can destroy rapport as easily as rough handling.
The presence of a near relative should be re-
quested during the examination of a female pa-
tient if a nurse is not available, and unnecessary
exposure should be avoided in the case of a male
as well as a female patient. In examining the
pelvis of a virgin, the rectal route should be select-
ed unless it is inadequate. When skill tempered
with consideration guides the physician in a phys-
ical examination, rapport is retained, and physi-
cal findings are easier to elicit.
Leadership
Leadership is important during the period of
special tests, therapy and convalescence and in
dealing with the family of the patient.
If facts secured from the interview and phys-
ical examination are not contributory to a diag-
nosis, or if confirmation is desirable, special tests
are required. Why they are necessary, then,
should be explained, and it should be clear that
only tests which can be most revealing were
chosen. The patient should feel assured that
there will be no unnecessary medical costs and
J. Florida, M. A.
September, 1957
WERCH: RAPPORT IN MEDICINE
245
should understand the basis on which he will be
charged. It is regrettable to lose a patient after
rapport has been established, and it is distressing
when an outstanding bill strains a physician-pa-
tient relationship. Even if the physician has not
mentioned the bill, the patient may hesitate to
report for another appointment. With suitable
leadership, the patient will keep appointments,
tests will be made, and the results of good medi-
cine will ensue.
Certain therapeutic procedures need detailed
directions while others require little instruction.
Some instruction, nevertheless, always, contrib-
utes. Directions should be clear, and possible un-
toward reactions should be pointed out. Medica-
tions should be judiciously chosen and dosage
gauged with care. Even a small dose of phenol-
phthalein can be irritating. To a sensitive patient
5 grains of aspirin may produce ringing in the ears
while to another 20 grains may be insufficient as a
sedative. Patients appreciate physicians who treat
with care, who explain prescriptions, and who
suggest a telephone call if questions arise or if
untoward phenomena develop. Regardless of the
therapeutic regimen, however, the patient should
feel that what is being done is helping him recover
from his illness. This objective is also accom-
plished through leadership.
A convalescing patient should feel that his
physician’s concern about him is sustained. Proper
supervision may shorten a period of convalescence,
and often there is need for special care. Even if
no care is required, a sincere telephone call works
wonders. A leader is continually interested in
those who depend on him.
The family of a patient is always involved in
his illness, so that the physician should try to
establish rapport with close relatives. Actually,
he should seek out at least one that may be re-
lied upon. Close relatives can be helpful medical-
ly as well as psychologically. A wife or mother
may have to do some nursing, while another rela-
tive may be able to take over some of the responsi-
bilities of the patient, thus relieving him of pos-
sible worries. If death is inevitable, it is good to
consult first with the reliable member of the fam-
ily. Such news always needs wise handling. It is
better if preparations — psychologic, religious and
economic — can be made. Regardless of the med-
ical status of the patient, he benefits when his
family cooperates with his physician. To secure
such cooperation the physician again must exhibit
leadership qualities.
Summary
Rapport is necessary to the success of a phy-
sician-patient relationship. It should be secured
as early as possible and retained throughout the
interview, physical examination, period of special
testing and period of therapy, and also when one
deals with the patient’s family. With physician-
patient rapport the facts necessary for a diagnosis
are obtained more easily, and therapeutic mea-
sures are carried out more successfully. If such
rapport deteriorates, the patient does not benefit
from all the aspects of good medical care.
Jackson Memorial Hospital.
Scientific Papers, Exhibits and Films
Requested for Association’s Annual Meeting
The Scientific Work Committee of the Florida Medical Association has requested that members
of the Association desiring to apply for places on the scientific program of the Eighty-Fourth An-
nual Meeting contact Dr. George T. Harrell Jr., Chairman of the Committee, College of Medicine,
University of Florida, Gainesville.
The scientific program will be divided into three phases — papers, exhibits and films.
Members desiring to present papers on the program of the Scientific Assemblies should submit an
abstract of about 50 words on the subject they plan to discuss. For places on the scientific exhibit pro-
gram, a photograph or sketch of the exhibit together with a brief description of the subject should
be submitted. As for films, a short description of the content is necessary. Films should not be more
than 20 minutes in length.
Dr. Harrell has announced that the deadline for submitting applications is November 1. He and
his Committee will meet in Gainesville on November 16 to select the papers to be presented and the
exhibits and films to be shown.
Serving with Dr. Harrell on the Scientific Work Committee are Drs. Franz H. Stewart and Don-
ald F. Marion, Miami; Dr. Richard Reeser Jr., St. Petersburg, and Dr. Gretchen Y. Squires, Pen-
sacola.
246
Volume XLIV
Number 3
ABSTRACTS
Protein Bound Sulfhydryl and Disulfide
Groups in Squamous-Cell Carcinoma of the
Uterine Cervix. By Alvan G. Foraker, M.D.,
and William J. Wingo, Ph.D. Am. J. Obst. &
Gynec. 71:1182-1188 (June) 1956.
To obtain additional information bearing on
the problem of growth in the uterine cervix,
protein-bound sulfhydryl and disulfide groups
were studied in 27 cases of squamous cell carci-
noma of the uterine cervix and three cases of
intraepithelial carcinoma. These were compared
with biopsies of non-neoplastic cervices. The re-
sults showed: (1) Sulfhydryl groups, related to
various phases of cell metabolism, were found in
endocervical glandular epithelium, and in all
viable squamous cells, whether occurring in epi-
thelium of the portiovaginalis or in intraepithe-
lial carcinoma. Sulfhydryl groups were also found
in regions of neoplastic and non-neoplastic kera-
tinization. (2) Disulfide groups, related to cell
keratinization, were found in keratinizing surface
squamous cells, in epithelial pearls of squamous
carcinoma, and in keratinizing neoplastic cells.
A Statewide Program for Hospitaliza-
tion of the Indigent. By H. Phillip Hampton.
M.D. J. A. M. A. 162:630-632 (Oct. 13) 1956.
Care of the poor is a measure of civilization,
but indigency must be recognized as a disease,
the end result of several causes- — economic, socio-
logic, medical, and political. The judicious use of
aid may relieve suffering and perhaps help to
remove the cause of indigency, but indiscriminate
welfare programs, especially politically inspired,
will be insidiously destructive of initiative and
create more dependency. The treatment of indi-
gency must be specific; a panacea will lead only
to addiction. The goal of successful therapy must
be rehabilitation to independence.
With this generalization, Dr. Hampton out-
lines the specific program in Florida, where he is
chairman of the State Advisory Council on Hos-
pitalization Service for the Indigent. The pro-
vision of hospital care for the indigent in this
state has been a responsibility of the individual
county governments, but the unevenness of bud-
geting and frequent evasion of responsibility have
made the county line, for some patients, a barrier
to good medical care. Recent legislation has made
it possible to initiate a program for hospitalizing
the acutely ill indigent by creating a state and
county matching fund out of which payments can
be made directly to hospitals for the cost of caring
for certified indigents. Further decisions will have
to be made concerning outpatient care for the
indigent and compensation to physicians for indi-
gent medical care. The Florida Medical Associa-
tion has authorized a foundation fund to promote
graduate medical education in hospitals, provide
outpatient care for the indigent, and encourage
better medical care throughout the state.
Rehabilitation to independence must be the
primary purpose of medical care in order to erad-
icate effectively the disease of indigence, Dr.
Hampton concludes. Intelligent administration of
indigent medical care programs by cooperative
effort of the medical profession will provide op-
portunity for rewards far beyond the medical
service rendered.
Study of Respiratory Liver Metabolism
in Surgical Patients. By H. Clinton Davis
M.D.. Irwin S. Morse, M.D., Edward Larson,
Ph D. and Mark Wynn. M.S. J. A. M. A.
162:561-563 (Oct. 6) 1956.
Liver succinoxidase. oxygen-quotient (QCL)
determinations were made on 10 patients under-
going surgery for gallbladder, colon, or pancreatic
disease or peptic ulcer; four patients with ob-
structive jaundice had liver functicn studies in
the course of their preoperative evaluation. Val-
ues suggested slight impairment of in vitro activi-
ty of the enzyme system in the presence of
obstructive jaundice in comparison to an apparent-
ly normal liver. The concept of performing direct
physiologic studies on human tissue is believed
by these authors to be of possible value just as
it has been in laboratory animals. They observe
that the clinical physiologist could well fill some
of the gaps in the understanding and assessment
of altered metabolism.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
J. Florida, M. A.
September, 1957
247
Medical Education
in Florida
Homer F. Marsh, Ph.D., Dean
School of Medicine
University of Miami
George T. Harrell Jr., M.D., Dean
College of Medicine
University of Florida
248
Volume XLIV
Number 3
Progress Report: University of Miami
School of Medicine
Homer F. Marsh, Ph.D., Dean
The School of Medicine begins its sixth year
in September 1957. The five years since its ini-
tial opening in 1952 have been busy ones. There
have been many rewarding accomplishments, and
there have been a number of situations harrassing
and embarrassing to the School’s Administration
and Faculty. Presumably, this is a necessary part
of “growing-up” to be faced by any newly or-
ganized medical school although some of the situa-
tions are highly confusing of background and
necessitate a dilution of effort and energies which
could be better spent in other directions. The
present status of the School has been achieved
through adherence to certain basic principles and
in the exercise of patience and a sense of humor.
A sketch of the status in 1952 will serve as a
reference base for further comparisons. As the
School opened, a faculty component of two full
time anatomists, two full time biochemists, and a
practicing psychiatrist who gave voluntarily of his
time; a class of 28 students; the writer as As-
sociate Dean; and eight cadavers; constituted the
active and passive personnel. Instruction was
started in remodeled quarters at the local Vet-
erans Administration Hospital, and the County of
Dade had agreed to the use of Jackson Memorial
Hospital when and if it were needed for the
clinical phases of instruction. The Dade County
Medical Association had presented a resolution
to the University attesting its interest in and de-
sire to assist the new School. Contrariwise, a
group of five “citizen-tax-payer watch-dogs of the
State’s Treasury” had instituted legal action to
prevent the payment of state subsidy support to
the School. This, then, was the picture in 1952.
Present Status
Despite its inauspicious and austere begin-
ning, the School has grown in stature and scope
of activity. Soon after the beginning of the fourth
year of instruction, the Liaison Committee on
Medical Education made recommendations which
led to full accreditation of the School prior to
graduation of its first class.
Student Body. Each year, an increasing
number of students has been admitted to the be-
ginning class. In September 1957, 75 Florida
residents and five nonresidents are enrolled in the
first year class. This number approaches the
maximum number planned for the School, which
is 76 to 84 per class. All students admitted to the
first five classes were residents of Florida; indeed,
in keeping with terms of the legislation governing
the subsidy support, all had been residents of
Florida for a minimum period of seven years
prior to admission. That the state as a whole has
been served in the student body is reflected in
the origin of the students. Fifty of the state’s
67 counties have been represented or are now
represented by enrolled students.
The School now has 60 graduates. Although
Florida’s medical licensure laws do not require
an internship as a prerequisite to licensure, all
graduates have completed or are now engaged in
internships. It bespeaks the acceptability of the
instructional program that men and women who
have completed the four year program have
served or are now serving internships in hospitals
such as the Philadelphia General, Washington
University Medical Center, University of Texas
Medical Center, University of Illinois Research
Hospital, Grady Memorial of the Emory Uni-
versity Center, and the New York Hospital of
the Cornell group.
The “proof of the pudding” will, of course,
come to light as the graduates take their places
in the communities of the state as practitioners,
and about one half of the first graduates are now
settling down in practices; the remaining one
half is occupied in various graduate training pro-
grams in special fields of medicine and surgery.
Faculty. The major number of faculty mem-
bers of the preclinical departments are full time,
salaried appointees and devote their entire time
to the School’s requirements. A few physicians,
interested in one or another of the preclinical
fields, are serving on the instructional staff as
volunteers.
J. Florida, M. A.
September, 1957
PROGRESS REPORT: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
249
The heavy demands of administrative nature,
organization of the teaching activities, develop-
ment of research work, and the supervision of
patient care, have necessitated the organization
of the clinical departments around a core of full
time faculty members. This core has been sup-
plemented and complemented by a number of
faculty members drawn from the practicing physi-
cians of Dade County. From the initial group
of four full time and one volunteer member in
1952, the faculty has expanded to about 100 full
time and 485 volunteer members in the current
academic year.
About 35 of the full time members are in
the preclinical departments, and the remainder
are in the clinical departments of medicine, sur-
gery, pediatrics, obstetrics-gynecology, and psy-
chiatry. It is worthy of note that about 20 of
the full time men in the clinical fields are support-
ed from extramural funds and devote a major
portion of time to research activities.
In the relationships between the School and
its teaching Hospital, the chairmen of the five
major clinical departments, and chairmen of sec-
tions therein, also are chiefs of the corresponding
hospital services, being responsible for the super-
vision of the care of staff patients of the Hospital
and its clinics.
Organization of the clinical segment of the
faculty has not escaped criticism of a few mem-
bers of organized medicine who believe the sal-
aried faculty violates the code of ethics and
principles of organized medicine. Although this
Present Preclinical Sciences Building in Coral Gables.
VA Hospital appears in background.
is not the place, nor is there adequate space in
which to present an exhaustive picture of the
situation, suffice it to say care has been taken to
avoid any implication of the School’s practicing
medicine as a corporation. Full time faculty
members who are licensed as physicians are per-
mitted to see private patients in consultation or
for ultimate care PROVIDED such patients are
referred to them by another licensed and prac-
ticing physician. There is a dollar limit placed
on the extent of such practice, and neither the
School nor Hospital requires the faculty member
Model of Medical Education and Research Building. Construction to begin in October 1957.
250
PROGRESS REPORT: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
VolumeXI.IV
Number 3
to turn over to either of these institutions any
part of his earnings from this or other sources.
Instructional Facets. The primary raison
d’etre for this or any undergraduate medical
school is to offer a solid educational experience in
the inter-related basic medical sciences and the
clinical applications thereof. Although different
technics are used for accomplishment of this ob-
jective, our own curriculum is organized in such
a manner as to provide for three basic thoughts.
( 1 ) There is an opportunity to guide the students
through an experience in the basic sciences as
individual disciplines, yet (2) integrating be-
tween the various basic sciences to show their
interrelationships as parts of medicine as a whole
and, (3) correlating between the basic sciences
and the clinical areas to show the dependency
of the latter on the former.
Time does not permit a detailed explanation
as to the manner in which these ideas are effec-
tive, but it is sufficient to say that the manner
lies somewhere between the commonly applied
“vertical” plan of building on the basic sciences
as separate disciplines and entities, and the newer-
developed “horizontal” plans which attempt to
bring all aspects of a four year curriculum into
one completely integrated whole.
Two or three interesting and unusual aspects
of the instructional work may be presented herein.
In an effort to make an opportunity for stu-
dents’ appreciation of the general practice of
medicine, a program is operating in the fourth
year curriculum. In this year, students spend al-
most 100 per cent of their time in the clinics un-
der supervision of the faculty. The general medi-
cal clinic is staffed by a full time internist, medi-
cal resident house staff, general practitioners, and
medical students. Students who are assigned to
this clinic work alongside the general practitioners
as they see the patients and have the opportunity
to observe them in their approach and relation-
ships with patients. In the event an extraordinary
situation presents itself, the internist is at hand
for assistance. At the end of the clinic session, a
group discussion is held between all staff of the
clinic, and selected cases are reviewed. It is dur-
ing such sessions that the students and general
men may profit by the observations of the in-
ternist. The student has a chance to benefit from
the activities and contact with the general men,
and the general practitioner has a chance to
benefit from a continuing postgraduate experience.
At the present time, about 50 general men are
working in the medical clinics, and it is planned
this type of participation will be extended to
other areas of medicine for the benefit of the
general men.
The geographic area holds attraction to many
elder citizens. Many of these men and women
make positive contributions to the community,
yet many have problems which may be nonmedi-
cal in basic origin and need help in resolving their
difficulties which may take on a medical aspect.
Two years ago a gerontology clinic was organized
as an experimental clinic. This is spoken of as
the "comprehensive medical clinic” or “total-push”
program. Professional personnel includes intern-
ists, psychiatrists, clinical psychologists, social
service workers, and welfare workers as a tightly
knit team which attempts to evaluate all facets
of a patient’s complaint. After a patient has
been seen by the individuals of the team, a con-
Aerial view of Jackson Memorial Hospital, clinical teaching facility.
J. Florida, M. A.
September, 1957
PROGRESS REPORT: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
251
Small group conference teaching, Department of Obstetrics-Gynecology.
ference is held in an attempt to work out relief
for the patient. His problem may be simple of
solution, needing, perhaps, only guidance into
broader social contacts, or some assistance from
the Welfare Department. If the problem is es-
sentially medical, the patient will be referred to
a specific clinic for remedial measures. Under
any circumstances, the clinic functions as a good
area for emphasizing the comprehensive picture of
man and the various interrelationships which
may have an impact on his well-being. It is
worthy of note the latest faculty addition to this
clinic is a physician who, although 80 years old,
still is quite capable of appreciating the problems
of the aged and interested in getting down to
basic issues involved therein. The clinic’s activ-
ity has grown rapidly and is exciting comment
nationally.
Research Activity. No modern medical
school can expect to build its reputation on the
quality of its instructional programs alone. Not
only is the faculty expected to offer a sound edu-
cational opportunity, but it is expected to further
medical knowledge and skill through research.
Although it has been quite busy in initial organ-
ization, the faculty has expanded its research
interests and activities until, in the current year,
almost $1,000,000 in research activity is support-
ed by various independent and governmental
agencies. As about 100 specific projects are in-
cluded in the over-all program, these cannot be
listed herewith, yet a few may be touched upon in
brief.
To a Floridian, perhaps one of the most
startling subjects for a research project is “smog,”
yet the U. S. Public Health Service succeeded in
interesting our Department of Pharmacology in
this very important problem. Supported to the
amount of almost $50,000 annually, this project
has a basic objective of studying the toxic con-
stituents of smog and attempting to learn more
of the mechanisms which lead to the formation
of this dangerous pollutant in air. The same de-
partment is deeply involved in testing numerous
compounds used in industry for their potential
toxigenicity and, particularly, their carcinogenic
properties. During the summer just past, a rather
comprehensive undertaking at the request of the
U. S. Air Force was outlined and put into opera-
tion. This concerns the possible detrimental ef-
fects of exposure to radar radiation of high fre-
quency. This program will involve a number of
the departments and will attempt to clarify many
mystifying observations involving the effect of
radar exposure on the human as a whole and
on isolated tissues.
As a result of a collaborative effort between
the Department of Bacteriology and the Variety
252
PROGRESS REPORT: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
Volume XLIV
Number 3
Students’ first introduction:
Anatomy, with Dr. George H. Paff.
Childrens Hospital, a virus diagnostic laboratory
has been in operation for its second year. The
laboratory, in so far as can be learned, is the
only comprehensive facility for service and re-
search in Florida for virus studies. Studies on
the antigenic structure of viruses and basic fea-
tures of immunity in the virus diseases are be-
ing made.
Advances in the surgery of the heart have
demanded better means of carrying the patient
along during such surgery. The Department of
Surgery has been quite active in improving heart-
lung bypass equipment to permit a more con-
venient medium in which the cardiac surgeon can
perform his work. A rather complete experimental
animal surgery in the Department of Surgery
provides facilities for expanding the skills and
knowledge in the field of surgery.
Three basic areas of activity have commanded
the attention of the Department of Medicine.
An extensive, nationwide approach to the chemo-
therapy of cancer is being directed from this
Department. This work involves the chemical
synthesis of new compounds, their screening in
animals for chemotherapeutic effect, and final
testing in humans of any which show promise.
Parts of this work are being carried on in about
half-a-dozen medical schools in the United States,
and in several hospitals scattered throughout the
nation. Cardiopulmonary laboratories supported
jointly by the Miami Heart Institute and the
School of Medicine provide excellent and com-
plete facilities for studies of physiologic back-
ground involving various cardiac conditions. A
third broad area of activity is that concerning
studies on connective tissue. These are basic
Pathology Laboratory.
J. Florida, M. A.
September, 1957
PROGRESS REPORT: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
253
studies designed to throw light on the role of
connective tissue in aging and in cardiac dis-
ease. The work was recently recognized by a
prize from the Ciba International which, annually,
reviews the tremendous amount of work done in
the aging processes by investigators throughout
the entire world.
The School is pleased that the magnitude and
quality of research being carried on has im-
proved constantly. That this work is done in
rather meager quarters attests to the broad and
consecrated interests of the faculty.
Physical Facilities. The provision of ade-
quate physical plant in which the School’s work
may be carried on has hardly kept pace with
demands. The preclinical science departments
still are housed in the remodeled building at the
Veterans Administration Hospital in Coral Gables,
while the clinical departments carry out their
work in the Jackson Memorial Hospital. Only
recently, provisions were made to relieve the
rather acute shortage of space for research activ-
ity by two moves. A sizable building located ad-
jacent to the Hospital was purchased by the Uni-
versity and remodeled to house certain basic
research laboratories used essentially by the De-
partments of Medicine and Surgery. In October
1957, construction is scheduled to begin on a new
medical research building which will be of eight
stories and about 100,000 square feet of floor
space. This building has been financed in part
by a grant from the U. S. Public Health Service
and in part by the University. Its completion
will do much to relieve the problem of housing
research programs.
The next major requirement in the School’s
development is that of providing a more adequate
educational building, and although plans have
been roughly laid out to include a $3,000,000
structure, funds have not yet been accumulated.
The educational building is planned to become a
physical extension of the research building and will
have its activities integrated on a departmental
basis with the floor layout of the research build-
ing. .
The School is fortunate in having the facilities
of Jackson Memorial Hospital at its disposal for
clinical instruction. This hospital, of 950 bed
size, is in the process of expansion as provided
by a $6,000,000 bond issue approved by the free-
holders of the County last November. When this
expansion and improvement program is completed,
it will be difficult if not impossible to find a
better clinical teaching facility in the southeast-
ern states.
The picture of the School as it is today re-
flects a major beginning toward an outstanding
and complete medical education and medical serv-
ice center in Dade County. In the immediate
future, prospects are bright for some important
additions to the over-all situation involving the
School and its teaching hospital. Plots of land
have been assigned to two groups on which it is
planned to build two private hospitals adjacent
to the teaching hospital. A third group is in the
discussion stage of coming to an affiliation with
the School and removing present facilities to the
grounds of Jackson Memorial Hospital for im-
proved patient care and teaching programs in
the area of children’s diseases.
Despite certain temporary needs, the School’s
Administration and Faculty believes the state’s
investment through subsidy support has been
justified and that all areas of the state are certain
to benefit from the investment.
254
Volume XLIV
Number 3
University of Florida College of Medicine
George T. Hakret.l Jr., M.D., Dean
On Sept. 8, 1956, the first class of 47 medical
students was enrolled in the new College of Medi-
cine of the University of Florida at Gainesville.
The basic philosophy on which the program has
been planned was described in the September 1954
issue of the Journal of the Florida Medical Asso-
ciation. A more complete discussion of the role of
the University in medicine was presented later
to the Council on Medical Education and Licen-
sure of the American Medical Association and
published in the Journal of the American Medical
Association, June 23, 1956. The faculty is deep-
ly grateful to the Florida Medical Association for
its advice and help in our planning and for its
solid support during these formative years.
Students
The first class, which will graduate in 1960,
was selected from 280 applicants. In all, 124
prospects were interviewed personally by the
faculty selection committee. The ratio of Florida
residents to nonresidents among the applicants
was 3:2. Ten women applied, and three were
accepted. The 44 Florida residents came from
20 counties, from Escambia to Dade; the maxi-
mum number, from Duval, constituted 15 per cent
of the class. One student each came from Mary-
land, New York and Wisconsin. At the time of
admission, 18 students (38 per cent) were mar-
ried, and others have subsequently taken the
step. Only two students had not received a Bache-
lor’s degree at the time of entrance; five had ad-
vanced degrees in bacteriology, psychology, chem-
istry, or agriculture. The scores achieved on the
Medical College Admission Test, which is ad-
ministered nationally to all prospective students,
places the class average in the upper 50 percentile
of the entire country.
The students entered from 13 different colleges
out of the state and three in Florida; slightly less
than half of the students (23) entered from other
colleges in the University of Florida. Three stu-
dents received state scholarships in 1956, and an
additional one was awarded to a second year
student in 1957.
The 50 members of the second class (1961),
which will enter this month, were selected from
332 applicants. The 43 Florida residents come
from 19 counties, and seven nonresidents from
Georgia, Illinois, Connecticut, Massachusetts and
New York. The students enter from 19 colleges
and universities throughout the country. Four
received state scholarships.
The same size classes will be accepted for the
fall of 1958 and 1959; thereafter, the classes may
be enlarged to 64 if the number of high quality
applicants increases.
Faculty
An exceptionally well qualified, young and
enthusiastic faculty has been recruited for the
basic science departments. Chosen on the basis
of teaching ability and research potential, individ-
ual members were selected to bring together wide-
ly varied backgrounds and interests. A deter-
mined effort was made to obtain men and women
who had a liberal arts background .and who had
attended small colleges before they had under-
taken professional training in a large university.
Three of the department heads have been abroad
since joining our faculty to lecture in medical
schools in Europe and South America or to give
scientific papers at international meetings. Others
had received part of their training abroad before
coming to Gainesville.
The faculty for the third and fourth years of
clinical teaching is now being selected. The head
of the Department of Medicine is in residence
and other members will be arriving in the fall.
The Professors of Surgery, Psychiatry, Obstetrics,
Pediatrics and Radiology will be appointed dur-
ing this school year.
New department heads are appointed approxi-
mately one year in advance of the time their
teaching duties begin. This “lead time” is ex-
tremely important and offers the chairmen an op-
portunity to search widely for staff, examine
teaching methods in use elsewhere and develop a
curriculum fitted for our needs. This amount of
time is required also to select equipment carefully
and order supplies, write syllabi and laboratory
outlines, plan research programs and tend to a
multitude of other details before student teach-
ing begins and the patient load develops.
J. Florida, M. A.
September, 1957
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
255
Physical Plant
The new school was located on the Univer-
sity campus so that it might rely on all the re-
sources of a large State University and participate
in the other varied educational activities under
way. The land chosen for the site is situated
toward the periphery of the heavily built up area
of the present main campus. In this manner a
satellite operation can be developed with sufficient
room to become a cohesive unit as new programs
are activated in the Health Center. The site is
in close proximity to the rest of the campus for
students’ convenience, but on a highway for the
ready transportation of future patients. In this
fashion the problems of traffic, parking, growth,
and addition of other units — such as pharmacy,
dentistry, and research — could be anticipated and
preliminary planning done now.
The Medical Sciences Building has been de-
signed with a basic science wing toward the west
and a wing for the clinical departments toward
the east. In the cross wing are certain expensive
large facilities which will be shared. The basic
science and clinical departments placed on a given
floor were selected so that they might have a
common interest in teaching, research, or both.
In this fashion it is hoped that departmental bar-
riers will be kept to a minimum and that the
student will tend to think of both clinical and
preclinical areas as different facets of medicine as
a whole. This design results in two vertical axes
for movement of people and supplies: one at the
center of the building for the medical school; and
a second off the main lobby to the east for
nursing and other fields related to clinical medi-
cine.
The Teaching Hospital connects with each of
the seven floors of the Medical Sciences Building;
two floors extend above. Functions in the hospital
have been related floor by floor with the present
building. For example, the ground floor is plan-
ned for horizontal movement of supplies which
would be carried in carts or handtrucks. At this
level are found the receiving dock, storage spaces,
morgue, shops, post office and locker rooms for
personnel. The first floor is planned for horizontal
movement of people — students, patients, visitors
and staff. On the second floor, the Department
of Anatomy is placed with the surgical special-
ties of urology, orthopedics and neurosurgery,
The J. Hillis Miller Health Center on the campus of the University of Florida at Gainesville. The Medical
Sciences Building, at the left foreground, which houses the College of Medicine and College of Nursing, was
dedicated Oct. 13, 1956. The 400 bed Teaching Hospital and Clinics, in the right foreground, is scheduled for
occupancy in October 1958. Dormitories and classrooms for other parts of the University are shown in the
background.
256
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Volume XLIV
Number 3
which can help in the teaching of anatomy. The
workshop for surgeons is the operating room,
and the clinical visualization of anatomic struc-
tures is done with x-rays; so these two functions
are found on the second floor in the Teaching
Hospital and clinics. This horizontal functional
relationship has been carried out as far as possible
throughout the entire physical plant.
The main vertical axis for the hospital opens
off the corridor which connects the main lobbies
of the hospital and Medical Sciences Build-
ing. Staff, visitors, and students can reach any
floor whether they enter from the campus or
highway. A secondary axis for ambulatory pa-
tients who will be housed in the new type ambu-
lant floor and seen in the clinics is provided.
Supplies and food will move by dumb waiters
which open into rooms at the nursing station on
each floor. Papers, records, and small items can
be sent through an automatic pneumatic tube
system. A Health Center dial phone system and
One of the individual study cubicles assigned to
each medical student. Called a "thinking office,” it
emphasizes the most important part of a physician’s work
and thus preparation for medical practice. In many
other ways, the design of the Medical Sciences Building
demonstrates the student-centered program of the Col-
lege of Medicine.
an intercom system to each patient room on each
floor complete the communication network.
Teaching facilities have been planned with the
greatest amount of flexibility possible. A study
cubicle has been designed so that the student may
start on his first day in medical school the pat-
tern of thinking he will follow for the remainder
of his professional life. For the first two years
the study cubicles or “thinking offices” are placed
on the first floor of the Medical Sciences Build-
ing; for the third and fourth years they will be
located on the same floor of the Teaching Hos-
pital equally distant from the library.
All classrooms and laboratories on all floors
have been sized for student groups of 16. Semi-
nar or small classrooms for a single group also
serve as departmental libraries and are found in
each wing. Intermediate size classrooms for two
to three student groups (35 to 50 students) are
found at the clinical end of the building so that
they may be used by the College of Nursing and
by allied health professions as well as the clinical
departments. Lecture rooms seat three to four
student groups (50 to 70 students). The student
laboratories have been designed as multipurpose
facilities. Four student groups (64 students) may
be taught at one time, or each of the laboratories
may be divided by movable partitions into two,
three or four units. In all teaching laboratories
each student has his own place in the center.
Large basic pieces of equipment which are shared
by a group are found at the ends of the labora-
tories against blank walls. Special instruments
or demonstrations for each group are found at the
sides under the windows on unassigned counters,
each of which contains its own storage space.
Opening off each side of the main teaching
laboratories are preparation rooms for the depart-
ments housed in that wing. In this fashion maxi-
mum use of the laboratories can be achieved for
more than a single course. A general type “sit-
down” laboratory has been placed on the even-
numbered floors while special “stand-up” type
facilities are found on odd-numbered floors.
Lecture rooms primarily designed for projection
are on even-numbered floors, while those intended
chiefly for demonstration are on odd-numbered
floors. By this arrangement a class need only
walk up or down one floor to use a different type
of facility.
On the ground floor, animal quarters have
been placed at the west end and library stacks
at the east end of the building so that these two
J. Florida, M. A.
September, 1957
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
257
facilities can expand without any disruption of
the functional arrangement as new units are
added to the Health Center.
The research laboratories have been designed
with a four and one-half foot architectural module.
This module permits the use of interchangeable
bench units and allows six inches for pipe space
with each unit. Two modules are used for grad-
uate student, house officer, fellow, or junior facul-
ty member office-laboratory combinations. Three
modules are used for two to three house officers
working together or for a junior faculty member
and technician. Four modules constitute a full-
sized research laboratory for a specific project
with space for technicians, students, or research
assistants. When two modules are added at one
side, it is possible to have open into the laboratory
a special instrument room which can be adapted
to optical recording, tissue culture, and so forth
and a small office for a senior faculty member.
This project type laboratory has proved to be
extremely efficient in the use of space and has
attracted a great deal of attention because of its
flexibility.
The 535 seat auditorium has been planned
for public functions. A separate stairway opens
off the main lobby of the Medical Sciences
FLORIDA'S POPULATION 1955
The location of the J. Hillis Miller Health Center
in relation to the state, county and university campus.
Over two million people, more than 50 per cent of the
population of Florida, live within 125 air miles of
Gainesville or three hours’ driving time. On the basis
of experience in other Southern states of comparable
size, the majority of patients will be referred from the
area within the concentric circles.
Building so that the use of this facility will not
interrupt any activities in the medical school. The
acoustics have proved to be almost perfect, so
that the room is in great demand for chamber
music concerts, various scientific and lay meetings
A multipurpose teaching laboratory equipped for the ultimate size medical class of 64 students. Lecture rooms,
classrooms, and laboratories on each floor are designed for student groups of 16 or multiples of this student
module. In the design of the physical plant every possible effort has been made to achieve the greatest amount
of flexibility so that the curriculum may be changed from year to year and the teaching space used for many
purposes.
258
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Volume XLIV
Number 3
by groups on and off campus — even the football
coaches’ “clinic.” We have encouraged its use
particularly for cultural purposes, to emphasize to
the future physician that he must be a part of
the community in which he practices.
From every part of the building, except lecture
rooms and the auditorium, the student can look
out at trees and green grass. This emphasis on
intangible values and subtle influences has been
intentionally planned in the building. The archi-
tectural design has been kept open to resemble
the Florida type of indoor-outdoor living. Bright
cheerful colors have been selected for floors and
walls, and the general atmosphere has been kept
as informal as possible consistent with a profes-
sional atmosphere.
A large number of visitors — medical educa-
tors, architects, practicing physicians from other
states, as well as citizens of Florida — have been
coming to see the building. The number of visi-
tors and the detailed inquiries have been suffi-
ciently great that one member of the nonacademic
staff has been assigned to serve as a guide as
needed. Educators and physicians from South
and Central America. Australia, Canada. England.
Germany, Sweden, Israel and other parts of the
world have visited during the past year. We are
particularly pleased that the general public is
proud of its new medical school. It is a source of
professional gratification that our architectural
plans have been borrowed by new schools now
in the stage of development as well as by estab-
lished schools which are adding new buildings.
Equipment
The laboratory furniture for the major teach-
ing areas and the research laboratories for the
basic science departments has been installed. In-
sofar as possible, equipment has been selected
which will simulate that in use in hospital labora-
tories or in the physician's own office. For ex-
ample. a new type of portable, direct writing
recorder has been designed and built especially for
our Physiology-Pharmacology teaching labora-
tory. The data are recorded on paper strips which
resemble the clinical ECG and EEG records
which a physician obtains on his patients.
Specialized pieces of equipment for research
—such as an ultracentrifuge, electrophoresis ap-
paratus, radioisotope counters, phase microscopes
and micromanipulator with miniature electrodes
as small as one twenty-five thousandth of an inch
— have been installed and are operating. On order
and scheduled for delivery during the fall are
the special fluoroscope and equipment for cardia-
catheterization studies, respiratory physiology lab-
oratory and an electron microscope.
We are indeed grateful to voluntary agencies
in the state, such as the Florida and Volusia
County Heart Associations, the American Cancer
Society, the Damon Runyon Fund and many
others which have given us sizable grants for the
purchase of this equipment.
Curriculum
Because we are a new school on an established
University campus, we are working with faculty
and administrative groups from other parts of the
University in studying means to improve the pre-
professional preparation of students. Members
of the medical faculty are serving as preprofes-
sional counselors, and in return a biologist, polit-
ical scientist and humanist are serving on the
Medical Selection (Admissions) Committee. Ev-
ery effort is being made to recruit students with
a broad liberal arts background in addition to the
minimum scientific requirements. With this prep-
aration medical students can be treated as ma-
ture graduate students, and we can move more
quickly toward our primary educational goal — the
training of family physicians for practice in the
small cities of Florida.
The curriculum has been arranged with free
time regularly scheduled for all students, so that
they may feel free to explore more intensively
stimulating aspects of their studies which have
already been presented in the classroom or labora-
tory, pursue independent research, or elect studies
in other areas of the University. Our teaching
is directed toward understanding concepts, princi-
ples and methods rather than toward an accumu-
lation of facts.
Although the primary emphasis is on training
for the M.D. degree, students interested in medi-
cal teaching and research may elect to work to-
ward a Ph.D. in Medical Sciences. A graduate
curriculum has been approved for broad training
in all the basic sciences with a major field of con-
centration in Anatomy, Biochemistry, Micro-
biology. or Physiology. We will require that grad-
uate students elect a minor field outside of the
College of Medicine. Four students are already
enrolled through the Graduate School and are in
residence working at the College of Medicine
toward this degree. As top-flight students apply,
J. Florida, M. A.
September, 1957
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
259
this program gradually can be expanded to 40 or
50 students.
The College of Nursing has also completed
its first year of teaching. During the past year,
medical students regularly demonstrated dissec-
tions in anatomy to nursing students. Other joint
teaching exercises are planned in subsequent
years.
An internship and residency program has been
planned for the Teaching Hospital after, it is open.
Postgraduate Program
In June, the Twenty-Fifth Annual Graduate
Short Course in Medicine sponsored by the Flor-
ida Medical Association was held in the Medical
Sciences Building at Gainesville. The historical
development of postgraduate medical education
in Florida is described elsewhere in this issue.
Organized postgraduate courses, in conjunction
with the Florida Medical Association and the
State Board of Health, are planned for the camp-
us and may be extended to other parts of the
state. Dr. William C. Thomas Jr., formerly a
practicing internist in Gainesville, has been ap-
pointed to the full time faculty as Assistant Pro-
fessor of Medicine and as Director of Postgrad-
uate Education. His plans for continuing educa-
tion are outlined on page 264.
Doctors may attend any teaching exercises at
the school on an informal basis at any time and
are welcome to use the library and other special
facilities.
Research
Research is an integral part of good medical
education. All of the departments in operation
have active research programs under way. In
view of the current interest in Nuclear Science
in the state, it is of interest that all departments
have persons trained in the necessary technics
and are using radioisotopes in their experiments.
Research ranges in type from a fundamental
basic study involving the kinetics of single enzyme
molecules and the emission of quanta of light to
problems that are immediately applicable to pa-
tient care such as the mechanics of respiration.
The latter study is being conducted under a con-
tract with the Department of Defense. Grants
totaling approximately half a million dollars for
support of teaching and research projects have
already been received from the National Insti-
tutes of Health and other governmental agencies,
voluntary health agencies, industry and private
sources.
We have been extremely gratified that more
than a fourth of the first class has requested per-
mission to remain in residence during the summer
to work in various research laboratories. We are
especially grateful to the Florida and Volusia
County Heart Associations for funds which have
permitted us to support student research fellow-
ships in addition to the six awarded by the Na-
tional Institutes of Health.
Needs
Our greatest need is for scholarships and loan
funds. Most University funds for this purpose are
earmarked for other fields and are not available
to medical students. The financial problem of a
medical education has become increasingly press-
ing since the program of government support
under the G. I. Bill is running out. The state
scholarships are of great help, but are limited
in number. W'ith increasing inflation and with
the trend toward earlier marriage in all college
students, more scholarships are urgently needed.
We are indeed grateful to physicians in Flor-
ida who have made individual gifts for use as
short term loans. We have estimated on the
basis of present requests that a Revolving Stu-
dent Loan Fund of $50,000 could be used im-
mediately.
The students have been most appreciative of
the radio-“hifi” record player-television set for
the student lounge which has been bought with
a donation from a physician in the state.
Future
The legislature has appropriated $1,451,000
to construct a building for the College of Phar-
macy. This new wing will be built at the west
end of the Medical Sciences Building so that the
present basic facilities such as Library, Animal
Quarters, and Sterile Central Supply already in
operation can be utilized fully. Facilities have
already been planned and are being built in the
Teaching Hospital for use of the College of Phar-
macy in its teaching program. It will be possible
to give instruction in Hospital Pharmacy and to
expand the program of research and training for
careers in the pharmaceutical industry.
Enrollment in the College of Nursing has far
exceeded expectations. It is most gratifying that
the advanced curriculum has been so widely rec-
ognized. Students in the College of Nursing have
come from as far as Vancouver, British Columbia.
Expanded physical facilities for the College of
Nursing are being built in the Teaching Hospital
260
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Volume XLIV
Number 3
and will be ready by the time the junior class
goes on the wards.
An intensive study has been under way for
two years to determine the best method for train-
ing students in other programs than medicine and
nursing who plan to work in the health fields.
When in full operation, this unique program of
coordination of education and practical training
could teach 500 to 600 students in physical and
occupational therapy, x-ray and medical tech-
nology, clinical psychology, all phases of rehabili-
tation, hospital administration and many other
fields. This program has been tentatively called
a College of Health Related Arts. The physical
facilities for training these associated health pro-
fessions in the Teaching Hospital are being con-
structed in the rehabilitation area. Through the
assistance of the Florida Development Commis-
sion, Wolverton Act Funds have been obtained
from Mississippi and South Carolina to permit the
completion and equipment of the rehabilitation
area. Our Teaching Hospital is one of the few
built since the war which has not received Hill-
Burton construction funds. The limited amounts
available to Florida have been used in commu-
nity hospitals.
The forward-looking program sponsored by
the Florida Medical Association for hospitaliza-
tion of indigent patients should prove invaluable
in our teaching program. Our hospital admin-
istrator is planning procedures and assembling a
staff to open the Teaching Hospital now under
construction and scheduled for completion in the
fall of 1958. Patients will be referred to the staff
by the family physician, except in the case of
emergencies and accidents which will be taken
care of as the need arises. As the name implies,
all patients will be used for teaching.
Plans have been drawn and construction
should start this fall on 104 apartment units for
married students and house officers on the site to
the east of the Teaching Hospital. Recreational
facilities for the use of medical and nursing stu-
dents, house officers and staff are planned for
shaded areas adjacent to our site on the north
and east.
The legislature has designated the University
of Florida at Gainesville as the site of a College
of Dentistry. This College could be incorporated
into the Health Center. No immediate plans have
been made for the development of this school.
As the University continues to grow, the
Health Center with its key unit, the College of
Medicine, will be flanked by other units of the
University related to its program. Women’s hous-
ing is now approaching us from the northeast,
men’s housing from the northwest, and instruc-
tional areas, including the Nuclear Science build-
ing which is part of the larger development of a
Science and Technology Center, from the north.
It is our goal to make the College of Medicine
and its associated units in the Health Center an
extension of the strong right arm of the family
physicians in the state and an institution of which
the profession and people can be proud.
J. Florida, M. A.
September, 1957
261
History and Development of Postgraduate
Medical Education in Florida*
Approximately 26 years ago, Dr. Turner Z.
Cason conceived the idea of having a six week
midwinter seminar on medicine at Gainesville,
Florida. At that time the thought was to pre-
sent only didactic lectures. A general outline
was presented to Dr. J. J. Tigert, President of
the University of Florida, who was most enthu-
siastic and made every effort to begin such a
course. It was planned that the first half of
each week was to be devoted to medicine and the
second half to surgery, thereby permitting the
physicians in attendance who were not general
practitioners or who did not wish to receive
lectures in both surgery and medicine to spend
the remaining days of each week seeing Florida
and having a vacation. It was planned that
English-speaking physicians from Central and
South America would be invited, and Dr. Tigert
offered to send the Professor of the Institute of
Inter-American Affairs to invite these physicians
and to explain the proposed plan and the pur-
pose. There was no way by which the University
of Florida could finance such a propect, and only
$2,000 could be guaranteed. The estimated total
cost was a minimum of $5,000. Beginning a
project of this kind, one conic not be assured of
the attendance or the fees obtained from tuition;
therefore, the idea was abandoned.
Up to that time, no serious thought had been
given in recent years to the establishment of a
medical college in the State of Florida. The
efforts by the Florida Medical Association and the
University of Florida to present graduate medical
education to the physicians of Florida stimulated
the thinking which led to planning for a medical
college as a part of the University system. The
reception of this thinking by the physicians of
Florida aided in advancing the planning.
The following year, 1932, Dr. Gerry R. Hold-
en, President of the Florida Medical Association,
appointed Dr. Cason chairman of the Committee
on Medical Postgraduate Course. The other mem-
bers of this Committee were Dr. George C. Till-
man of Gainesville and Dr. Thomas H. Bates of
Lake City. At the first meeting of the Committee
*Abstracte<l from a History of Postgraduate Medical Edu-
cation in Florida, to be published by the University of Florida.
it was decided to begin the graduate work by
holding a short course designed for the general
practitioner, lasting from Monday morning to
Saturday noon. At a conference with Dr. Tigert.
it was the concerted opinion that this program
should be placed under the General Extension
Division of the University, of which Dr. Bert C.
Riley was the head. The Division materially as-
sisted by printing the programs, arranged for the
meeting place at the University, and many other
details.
The first course was held June 19-24, 1933,
on the campus of the University. The first
two years, an attempt was made to present to
the general practitioners as many phases of general
medicine as was possible. The Committee care-
fully analyzed the results and began to eliminate
subjects gradually, concentrating on medicine,
pediatrics, surgery, gynecology and obstetrics. This
plan still left open five lectures, the subject of
which has varied from year to year; among the
subjects chosen have been diseases of the chest,
psychiatry and plastic surgery.
Turner Z. Cason, M.D.
262
DEVELOPMENT OF POSTGRADUATE MEDICAL EDUCATION
Volume XLIV
Number 3
During the three years the course was held in
Gainesville, it was most successful, and the Uni-
versity as far as possible cooperated. Many dis-
tinguished men, among them Dr. W. Wayne
Babcock, Dr. Chevalier Jackson and Dr. Wilburt
C. Davison, came down as instructors. These
men were the forerunners of many eminent phy-
sicians who lectured at the short course in the
years that followed.
Certain special regulations were established
early. The time of the short course has always
been the last full week in June. It was found that
it was most difficult to get faculty members at
any other time. At that time, physicians in teach-
ing institutions were not so accustomed to making
trips for this type of graduate program as they
are now. Also, it was apparently the easiest time
of the year for Florida physicians to attend. Af-
ter the first two years, the Committee decided
that those selected to lecture at these short courses
must be out-of-state physicians. This was a regu-
lation designed to prevent any criticism of the
Committee for apparently promoting a private
physician. The Committee also established a
precedent to which it has rigidly adhered — never
to ask a lecturer to return more than once in a
successive year. This regulation has met with the
satisfaction of those in attendance, and the lectur-
ers themselves have expressed approval of such
a ruling.
After three years, the University was so cramp-
ed for space that the Committee thought it should
undertake holding the short course in some other
city. The next two years it was held in Orlando,
and the following two in Daytona Beach. Be-
cause of the heat and land breezes in Daytona in
1939, the attendance was poor, and at the in-
sistence of the physicians who had attended
regularly, the Committee decided to transfer the
course given the sixth year to the air-conditioned
Hotel George Washington in Jacksonville.
Because of a conflict in ideas between the
Committee on Medical Postgraduate Course of
the Florida Medical Association and Dean Riley
of the General Extension Division, all relations
with the University of Florida were severed dur-
ing the year 1938-1939. This step was taken by
mutual agreement. In 1939, at the solicitation of
the Committee, the Florida State Board of Health
became a co-sponsor. Since that time, the State
Health Officer or his representative has sat in on
all Committee meetings, rendering valuable as-
sistance. The Board of Health has materially
aided the program both in an advisory capacity
and financially.
Beginning in June of 1940 and each year
since then until June 1957, the short course has
been held in Jacksonville. Each year for a num-
ber of years, those in attendance were polled as
to the continuation of holding this course in
Jacksonville. Each time the vote was almost
unanimous in favor of holding it there. Several
times a poll of the entire Florida Medical Asso-
ciation was attempted with similar results. In
1946, the question of holding it in different cities
each year was seriously discussed by the Com-
mittee. The personnel of the Committee repre-
sented every section of the state, and after deliber-
ation the members were unanimous in their opin-
ion that it should remain in Jacksonville and in
an air-conditioned hotel.
In 1942, a conference was held by the Chair-
man of the Committee and Dr. Tigert, at which
time an invitation was again extended to the
Committee to carry on the graduate medical
course under the auspices of the University of
Florida. It was proposed that a Department of
Medicine of the Graduate School of the Univer-
sity be established and a director appointed. Dr.
Tigert requested Dr. Cason to draw up specific
recommendations for presentation to the Board
of Control at its next regular meeting. This re-
quest was carried out, and the recommendations
were approved by the Board of Control on Feb.
15, 1943, as was the appointment of Dr. Cason
as Director of the Department of Medicine, a
position which he held until July 1, 1957. In
addition to the Director, a faculty composed of
Florida physicians was recommended to the Dean
of the Graduate School and presented to the
Board of Control for approval. These men were
appointed on a dollar a year salary basis. Much
care was given to the selection of this faculty,
both by the Committee and the physicians who
were requested to act in an advisory capacity. Its
members have remained available through the
years to present courses on a variety of subjects
at the request of the component county medical
societies.
In 1939, the Committee decided it would at-
tempt to present highly specialized courses for
physicians in special fields in which they were
interested. With the financial assistance of the
Florida Tuberculosis and Health Association, the
first such course to be presented was on diseases
of the chest and was under the direction of Dr.
J. Florida, M. A.
September, 1957
DEVELOPMENT OF POSTGRADUATE MEDICAL EDUCATION
263
David T. Smith of Duke University School of
Medicine, Durham, N. C. In 1940, a three day
special course in cardiovascular diseases was held
during the week’s short course. Dr. Paul Dudley
White, who had accepted the invitation to give
this course, was unable to do so and appointed
Dr. Ashton Graybiel to take his place. This course
was well attended and well received. Because
of the inability to secure medical lecturers these
special courses were abandoned during World
War II, but were resumed in 1947.
The financial status of the Committee has
always been precarious. The first year it was
necessary for the Chairman of the Committee and
Dr. Tillman to borrow funds from a Gainesville
bank to do some temporary financing. In 1934,
the Florida Medical Association guaranteed $500
a year to support the program inasmuch as the
registration fees were not sufficient. Subsequently,
the Association contributed a total of $1,000.
The Florida State Board of Health’s assistance
has amounted each year to practically one half
of the actual cost. In 1947, the tuition for the
short course was increased from $5 to $10. The
tuition for the special courses has varied from
$10 to $25. Until 1949, the Chairman of the
Committee provided all secretarial help as well
as many other necessary expenses without re-
muneration. Until July 1, 1950, all monies col-
lected were deposited by the Florida Medical
Association and checked out by the Chairman,
who continuously held the dual position of Di-
rector of the Department of Medicine and Chair-
man of the Committee. In 1950, through mutual
understanding, the finances were transferred from
the Association to a special account under the
name of the Director, to be audited by the Uni-
versity of Florida.
In 1947, the employment of a part time secre-
tary was authorized by the Committee. In 1949,
through the assistance of the Florida State Board
of Health, Miss Hazel Donegan, who had pre-
viously acted as secretary to the Committee from
1941 to 1947, was employed as a part time as-
sistant to the Director. In 1950, this was made
a full time position under the Graduate School
of the University of Florida.
The Director recognized the mission of provid-
ing postgraduate medical education would not be
fulfilled unless some provision was made for the
Negro physicians of the state to attend. The
Negroes were not eligible to matriculate as stu-
dents at the University of Florida. This obstacle
was overcome by registering them under the Flor-
ida Agricultural and Mechanical College and se-
curing the cooperation of the Florida Medical,
Dental and Pharmaceutical Association, which
was their organization in Florida. The College
provided a registrar and kept the records for these
Negro physicians. This innovation in 1940 was
enthusiastically received by the physicians of
Florida, and comments by the lecturers were most
favorable. In more recent years, Negro physicians
holding membership in the Florida Medical As-
sociation have registered and attended these gradu-
ate courses.
In 1956, the Department of Medicine of the
Graduate School of the University was incorpo-
rated into the Division of Postgraduate Education
of the College of Medicine, and the 1957 courses
were held in Gainesville at the Medical Sciences
Building of the College of Medicine. A special
course in hematology was presented on June 20-
22, which was followed by the Twenty-Fifth
Annual Graduate Short Course on June 24-28.
The College of Medicine and the University of
Florida made every possible effort to present the
subjects designed for Florida physicians so that
they could receive the maximum benefit. The
President of the University, Dr. J. Wayne Reitz,
manifested personal interest in the undertaking.
Volume XLIV
Number 3
A Remodeling of the Educational Foundation
For Practice Through Postgraduate
Medical Education
William C. Thomas Jr., M.D.
GAINESVILLE
In 1892 William Henry Welch said, ‘‘Medical
education is not completed at the medical school:
it is only begun.”1 In recent years there has been
an increasing interest and participation in post-
graduate medical education by practicing phy-
sicians. This year Maurice Pincoffs restated this
viewpoint when he said, “The M.D. degree is the
symbol of competence for discriminating lifetime
study.”2
The remarkable gains in medical knowdedge
during the past 20 years have sharpened the need
for more postgraduate education, and every phy-
sician who has the responsibility of patient care
is acutely aware of the need for acquaintance with
new facts and theories. The means by which the
physician may continue his medical education can
be described in four categories: reading of current
journals and monographs; attendance at formal
postgraduate courses; medical society and hospital
staff meetings; and contact with professional col-
leagues. The first two methods are considered by
physicians to be the most rewarding.3
Reading. The medical graduate, particularly
after the fifth postgraduate year, is expected to
keep abreast of new developments by the regular
use of journals. Reading of carefully selected
current medical literature is a valuable educa-
tional venture, and one which can be followed at
his convenience by the physician alone. The mere
mass of publications prohibits any general cover-
age of the field of medicine, and the variable
quality necessitates discriminating judgment for
proper appraisal of papers within a given field.
The library of the Health Center at the University
of Florida is available at all times to any phy-
sician who wishes to use it. Other fine libraries
are located in all parts of the state.
Postgraduate Courses. Since World War II
the number of short courses sponsored by medical
Assistant Professor of Medicine and Director of Post-
graduate Education, College of Medicine and Teaching Hospital,
University of Florida.
institutions and societies has increased tenfold.3
This increase not only denotes the desire of phy-
sicians to keep abreast of current developments,
but also signifies an increased awareness by medi-
cal institutions of their responsibility for the con-
tinuing education of the practicing physician.
Medical education begins in the medical school
and associated university hospitals. If the schools
and teaching hospitals are to exercise their full
potential in future medical education and human
welfare, broad concepts must be adopted. Al-
though these institutions are properly administered
with emphasis on the initial education and train-
ing of the physician, it would seem highly de-
sirable that they accept an even greater responsi-
bility for a continuing program of education of
the physician-student. The enlarged concept of
the physician as a continuous student for the re-
mainder of his professional career implies a re-
sponsibility on the part of all departments of
teaching institutions for continual re-education
of earlier students.
The medical school curricula are constantly
revised to incorporate recent knowledge into the
teaching program for the student, and over a
ten year period the revisions in course material
and methods of presentation are usually so ex-
tensive that the course is completely different
from the one of a decade earlier. Thus, the broad
foundation of the physician’s medical education,
which is formed during the years as a medical
student and as a house officer, is the educational
base upon which he subsequently must build his
ultimate medical knowledge. With specialized
courses, seminars, and traineeships medical socie-
ties and institutions offer excellent means for the
physician to obtain advanced and detailed knowl-
edge in any phase of medicine. A brief review,
however, of the subject matter of various short
courses and seminars indicates that few, if any,
are designed for the remodeling of the foundation
of the physician’s professional education.
LpTEMBDER,r>57 REMODELING FOR PRACTICE THROUGH POSTGRADUATE MEDICAL EDUCATION 265
Since the medical school courses are being re-
vised to incorporate new knowledge for the cur-
rent student, the graduate of 10 or 20 years pre-
viously should also profit by the revisions. The
magnitude and multiplicity of new developments
in medicine are such as to render impossible their
evaluation by any single individual. Thus,, the
practicing physician must compensate for lack of
specific knowledge by experience and judgment
based on an awareness that new knowledge has
accrued in areas other than those of his particular
interest. The physician would be aided immeasur-
ably in rendering the highest quality of medical
care in his practice if the wisdom gained through
experience could be added to an always current
foundation of medical knowledge. This ideal of
maintaining a constantly up-to-date store of basic
information does not seem impossible to attain.
Program at the University of Florida. At
the College of Medicine and Teaching Hospital
of the University of Florida, the concept of the
need for continuing education of the physician
has been accepted by all departments as sound
educational policy. This recognition of a broad
role in medical education requires that a program
be developed which is accessible to the physician.
The members of the Florida Medical Association
are aware that an annual short course in medicine
has been conducted for a number of years by the
Association in conjunction with the State Board
of Health, largely through the efforts of Dr. Tur-
ner Z. Cason. It is intended that short courses
will be continued by the College of [Medicine and
that all facilities of the Health Center will be
utilized. Such courses could be designed for the
information of all physicians, regardless of the
type of practice or degree of specialization, and
could provide an opportunity to inaugurate this
type of educational program. Selected advances
in the basic medical, physical, or social sciences
would be correlated with their application to the
recognition and management of disease. Rather
than an attempt to cover isolated aspects of the
entire field of medicine in a long course, such
a program could be divided into a series of one
to two day sessions with each portion devoted to
a single clinical field — pediatrics, medicine, sur-
gery, obstetrics, and so forth. By keeping con-
stantly in mind the basic purpose of remodeling
the medical foundation to a current status, this
program would complement highly specialized
courses sponsored by a clinical or basic science
department, but devoted to more detailed, techni-
cal aspects of a single subject.
The anticipated program for postgraduate ed-
ucation at the College of Medicine of the Univer-
sity of Florida would consist, first, of a series
of basic courses devised to inform the physician
of those developments which have altered pre-
vious teaching with emphasis on clinical applica-
tion of the recent advances; and, second, more
highly specialized short courses and seminars for
those physicians who wish advanced training in
particular subjects, all developed by the various
clinical and basic science departments. With the
completion of the J. Hillis Miller Health Center,
personnel from all fields ancillary to health would
participate in these programs.
Informal educational opportunities are already
available, and all physicians are welcome to at-
tend staff conferences, teaching exercises, and
guest lectures at any time. A lounge has been
provided in the Medical Sciences Building for
visiting physicians, and the secretary for post-
graduate education, who has so ably handled the
administration of the short courses in recent years,
is available now in Gainesville to arrange appoint-
ments with faculty members and conference visits.
A calendar of forthcoming hospital and medical
school activities is now sent to all physicians and
hospitals of the state as well as other interested
persons.
These proposals for postgraduate education
will be integrated with those programs already in
effect in this state. Cooperation and advice of the
Committee on Medical Postgraduate Course of the
Florida Medical Association, the Florida State
Board of Health, and the organized specialty
groups in the state are necessary and will be of
inestimable value in presenting an effective, com-
prehensive program. Criticisms and suggestions
which will assist us at the College of Medicine are
eagerly sought. It is both a privilege and a chal-
lenge to develop a program of continuing educa-
tion which will meet the high standards demanded
by the profession in the state. With the coopera-
tion and assistance of the practicing physicians,
an ultimately successful program will be achieved
so that it may become a reflection of the high
ideals and purpose of those engaged in medical
practice.
References
1. Welch. W. H.: Advancement of Medical Education, Hull.
Harvard Medical School A.. 1892, p. 55.
2. Editorial: The Baltimore Sun, June 16, 1957.
3. Yollan. I). 1).: Scope and Extent of Postgraduate Medical
Education in United States, J. A. M. A. 157:703*708
(Feb. 26) 1955.
266
Volume XI, IV
N u m bee 3
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF
SHALER RICHARDSON, M.D., Editor
Managing Editor
Editorial Consultant ErNEST R Gibson
Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
Committee on Publication
Shaler Richardson, M.D., Chairman. . . Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman .. Jacksonville
Walter C. Jones. M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Hkrschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar. M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr.. M.D Gainesville
Dean. College of Medicine, University of Florida
Homer F. Marsh. Ph.D Miami
Dean. School of Medicine, University of Miami
A New Responsibility ■
It has become increasingly important for the
physician to focus his attention on the precipitat-
ing factors of illness. It is not sufficient, for ex-
ample, for him to make the diagnosis of myo-
cardial infarction due to arteriosclerosis of the
coronary arteries; now he must consider possible
contributing causes.
A man had a heart attack. It was a hot day.
Did circulatory collapse from heat exhaustion play
a part in the immediate illness? Perhaps the un-
fortunate man with the heart attack had played
three sets of tennis that afternoon. Did his game
have a causative effect?
A 55 year old auto salesman retired because
of frequent attacks of precordial pain. If he
walked out to the parking lot. or if he became
agitated in making a sale, he would experience an-
ginal pain. His electrocardiogram showed changes
compatible with healed infarction.
After some 10 months of rest on the beaches,
an occasional movie, and frequent afternoons of
fishing off the river bridges, he felt greatly im-
proved. His attacks of angina were much less
frequent. He had gained 15 pounds.
- Precipitating Factors
Thursday afternoon he was driving his car
home from the garage. His car was sideswiped.
Fortunately, there was no injury except to the
fender; however, he became angry, and a heated
argument ensued. On the way home he had to
stop at the roadside because of precordial pain.
A moment’s rest and two nitroglycerine tablets
enabled him to drive on in comfort.
That evening at dinner, he suffered a severe
attack of precordial pain, was taken by ambulance
to the hospital, and remained there several weeks.
The diagnosis was myocardial infarction.
It is’ not sufficient for the physician to rec-
ognize the myocardial infarction and skillfully
guide the treatment. He must focus attention on
the possible precipitating factors.
Did the auto accident play a part in bringing
on the immediate illness? Does the insurance
liability for accidental injury cover this illness?
These are largely legal questions; yet the legal
questions cannot be answered with justice unless
the medical questions are answered first.
Similar questions are raised every day and
sooner or later must touch each physician. The
J. Florida, M. A.
September, 1957
EDITORIALS AND COMMENTARIES
267
easy way out is for him to give a hasty answer,
or to let his sympathies affect his answers, or
simply to say, “I won’t appear in court.” At the
same time, these questions must be answered by
the medical profession. The truth in these matters
is at the mercy of the physician.
Modern society, with the development of in-
surance coverage and laws for the protection of
the laboring man, has thus dropped a new re-
sponsibility in the lap of the physician. It has
become necessary for each one to focus his at-
tention on the precipitating factors in disease
and to interpret cause and effect without bias.
He must develop his thinking and knowledge
so that he can discern the difference between pre-
cipitating factors in disease and mere coincidence.
He must use the same careful intellectual honesty
and precise unemotional thinking in these matters
that he brings to bear in the treatment of the sick
man.
Time has brought a new job for the physician.
He must assume a responsibility in decisions of a
sociomedical nature in the care of his patients,
and he must learn more of the relationship of
environmental factors to the precipitation of ill-
ness. There is a new responsibility in diagnosis —
know precipitating factors and evaluate them hon-
estly.
Dedicated Service
The Florida Medical Association has been
blessed throughout its long history with able
leaders who have charted the course through the
years that has brought it to its present high status.
Among them is one who for more than a quarter
of a century has cherished a vision of graduate
medical education in Florida of which the profes-
sion could be proud and from which it would ben-
efit increasingly. To the realization of this ob-
jective Dr. Turner Z. Cason of Jacksonville has
given of his time and effort unsparingly across
the years. In the early thirties, he began pioneer-
ing the way that has led to the presentation of
medical postgraduate courses within the state
year after year by many of the nation’s most
distinguished teachers.
As recounted elsewhere in this medical educa-
tion number of The Journal, Dr. Cason was wise
enough to associate the Association’s program with
the Graduate School of the University of Florida,
envisioning as he did a great future for Florida
in the field of medical education. Steadfastly, in
forthright fashion he has persevered, serving as
chairman of the Association’s Committee on Med-
ical Postgraduate Course since this committee was
established in 1932, an appointment which he
continues to hold. Likewise, he served as Director
of the Department of Medicine of the Graduate
School of the University from the time that office
was created in 1942 until he relinquished the post
in July 1957. Over this long period, in this dual
capacity he had rendered valiant service far above
and beyond the call of duty. He has laid the
groundwork ever more firmly for the consumma-
tion of his dream, which, fortunately, he is privi-
leged to see realized in that the Division of Post-
graduate Education of the College of Medicine,
created in 1956, is now in a position to take over
the graduate medical education program as an
integral part of the LTniversity’s unique and com-
prehensive venture into the field of medical educa-
tion.
Honor to whom honor is due. Congratula-
tions to this dedicated doctor on a goal attained
— the happy fruition of a sound concept and a
constructive endeavor which redounds to his credit
and to the benefit and glory of Florida medicine.
Modern Medicine Moves Ahead
“AMA in Action”
The fantastic pace at which modern medicine
moves ahead today is a bit bewildering to the
average doctor. Were it not for the assurance
that he does not stand alone, he might indeed
be overwhelmed. Standing ready to help the
individual physician are his county medical so-
ciety, his state medical society and the national
confederacy of these organizations — the Ameri-
can Medical Association. Always the key man
in this organizational system, he nevertheless finds
in it his mainstay.
An engrossing picture of promoting the science
and art of medicine and the betterment of public
health is graphically portrayed in the AMA’s new
booklet entitled “AMA in Action.” Here is the
story of the pooled efforts of his colleagues to
provide every physician with the innumerable in-
formational sources and services he needs. In
addition, he finds here a yardstick of progress and
an inspirational account of his profession which
will stir his pride and be heart-warming.
Take, for example, the realm of medical edu-
cation, with which this issue of The Journal is
stands for— greater antibiotic
blood levels • faster broad-spectrun
is a new and superior form of
widely prescribed broad-spectrum
in the treatment of more thai
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LEDERLE LBORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
270
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 3
particularly concerned. It is a matter of national
pride that America’s physicians are among the
best trained in the world. They have won this
high rating largely because of the AMA efforts
since 1900 to elevate the standards of medical
education. By taking the initiative, setting stand-
ards for training competent physicians and putting
an inspection and approval program into existence,
the AMA put the diploma mills out of business.
Today, all 82 medical schools are approved, and
four new schools under development are aiming
for provisional approval.
The AMA’s Council on Medical Education
and Hospitals in liaison with the Association of
American Medical Colleges continues to inspect
medical schools periodically, evaluating curricu-
lum, teaching staff, physical and clinical facilities
and administration. It serves, however, in a
guidance rather than a regulatory capacity. Be-
cause internships and residencies are a vital part
of a physician’s training, the AMA Council co-
operates with the American Boards of Medical
Specialties and other organizations in evaluating
hospital teaching programs and lists those ap-
proved.
Evidence of the dedication of physicians to
the task of training top-notch doctors is the fact
that almost half of the physicians teaching in
the nation’s medical schools receive no pay for
their services. Additional proof is found in the
more than five million dollars contributed volun-
tarily by doctors to the American Medical Edu-
cation Foundation since 1952 to aid medical
schools financially.
These and many more highlights of the AMA
in action are set forth in the booklet, which every
physician will wish to read and keep for basic
reference material. Through its pages every mem-
ber of the Florida Medical Association will want
to look with the AMA toward better medicine,
toward better patient care, toward better distribu-
tion of medical services, toward a better inform-
ed public and toward better public health.
The physicians who founded the AMA back
in 1847 were concerned about standards of medi-
cal education, safety of drugs and medical quack-
ery. They agreed on collaborative action as the
best approach to solving these and other problems
confronting the medical profession. How right
they were, and how proud they would be that the
now century-old AMA stands today as a world
leader in medicine and a respected voice in Amer-
ican affairs.
The Medical Secretary
The value of good public relations and efficient
business methods in the practice of medicine has
been brought home to physicians in recent years
in many ways. At the local level, the physician
has recognized more and more that his secretary
or office aide is a key person in the areas of pub-
lic relations and business administration for medi-
cal practice. Too, he has appreciated more and
more that he can reduce his work load per patient
by delegating certain activities in his office to
properly trained personnel.
Since 81 per cent of all self-employed physi-
cians now have at least one full or part time sec-
retary, nurse or technician, these physicians will
welcome efforts to improve training for these
assistants. A research study,1 participated in by
the American Medical Association, was made
recently to provide a basis for the development
and improvement of educational programs in
schools for the training at a high level of secre-
taries for physicians’ offices. Its ultimate objec-
tives were to provide physicians with the most
competent business — medical assistance possible
and to raise the level and status of physicians’
secretaries by improving the quality of their
work.
Conclusions were based on information sup-
plied by approximately 500 excellent medical sec-
retaries and on personal interview with physi-
cians and business educators. The activities per-
formed in physicians’ offices were classified into
three catagories: (1) highly technical medical
activities which, under normal conditions, only
a physician can perform; (2) semitechnical medi-
cal activities which may be performed satisfac-
torily by medical office personnel under the super-
vision of the physician, and (3) business office
activities of a routine or management nature
which are ideally performed by the secretary or
aide.
The survey points out that ‘‘physicians are
not making maximum use of their extensive train-
ing when they unnecessarily perform semitech-
nical medical and business activities. To help
doctors determine what responsibilities can be
delegated properly to office personnel, a system
for assigning duties is currently being prepared
by the American Medical Association and will be
furnished to medical societies within the next few
months.
Proper medical secretarial training and train-
ing for medical aides should be at the post-high-
J. Florida, M. A.
September, 1957
EDITORIALS AND COMMENTARIES
271
school level with a four-year college-degree train-
ing program preferable to a shorter course, ac-
cording to the study. Only schools with strong
business training and strong science departments
can offer the kinds of courses and the quality of
training that are desirable. The survey findings
regarding course content in medical secretarial
training programs will be particularly valuable
to business schools and junior colleges training
medical office employees, to medical societies
working with such schools to expand existing
courses or develop new ones, to societies sponsor-
ing short courses for doctors’ aides and to medical
assistants’ organizations interested in “postgrad-
uate education’’ for members.
The study, which also tabulates physicians’
opinions about necessary personal qualities in the
ideal medical secretary, will provide a pattern
for screening candidates for medical office posi-
tions. It is expected that eventually an evalua-
tion guide based on the survey will be prepared
to aid physicians in hiring properly qualified
secretaries.
On the basis of the survey, steps which medi-
cal associations and medical secretary-assistants
groups can take to help provide a greater force
of better-trained aides in the future include:
1. Encourage schools with the necessary per-
sonnel and facilities to offer high quality medical
secretarial training.
2. Recruit high school graduates for high
quality medical secretarial training.
3. Organize or assist in organizing refresher
courses in medical office administration for the
employed medical secretary and assistant.
4. Persuade persons currently employed as
medical secretaries to increase the effectiveness of
their work through additional training in school
and/or while at work.
5. Point out to physicians the importance of
employing well qualified medical secretaries and
renumerating them adequately.
Undoubtedly, the physician’s secretary can
save him a tremendous amount of time by per-
forming many of the semitechnical and most of
the business activities in the office — if she is well
trained and possesses certain important personal
qualities.
1. The Medical Secretary: Her Duties, Training and Role
on Medical Team, a brochure prepared by the American Medi-
cal Association, provides a summary of a research study report
entitled Knowledges, Skills, and Personal Qualities of Medical
Secretaries by Harold Mickelson, Ed.D., 1957.
“Stress of Life” Author to Address
Florida Academy of General Practice
St. Petersburg, Nov. 1-2, 1957
On an impressive list of speakers who will ad-
dress the Eighth Annual Scientific Assembly of the
Florida Academy of General Practice at St. Peters-
burg on November I and 2, the name of Dr. Hans
Selye, Surgeon, emerges in a shining aura of dis-
tinctive accomplishments to hold a special place
of interest for doctors in Florida.
Born at Vienna, Austria, in 1907, Dr. Selye
descends from three generations of physicians. At
18, while a medical student at Prague, he was
greatly encouraged in his research on the stress
syndrome by not only the moral support, but
also the financial backing secured for his work,
of Sir Frederick Banting, the discoverer of insulin.
By 1931, Dr. Selye had secured his M.D. and
Ph.D. degrees at the German University of
Prague. The year 1942 found him at McGill Uni-
versity, Montreal, Canada, with a D.Sc. degree.
He continued his experiments in endocrinology,
often meeting with strong opposition to his the-
ories. One scientist said, “I don’t always agree
with Hans Selye, but I have yet to prove him
wrong.” The British Medical Journal added, “No
theory in living memory has stimulated research
to such an extent.”
Hans Selye, M.D., Ph.D.
272
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 3
During the decade 1937-1947 Dr. Selye held
professorships in Histology and Biochemistry at
Johns Hopkins and McGill universities and. in
1947. he was Expert Consultant to the Surgeon
General, U. S. Army. Recently, in New Orleans
he dedicated a “stress laboratory” sponsored by
Tulane and Louisiana State universities.
He is the author of a dozen books, the latest
of which is “The Stress of Life.” McGraw-Hill
Book Company, with translations in Swedish.
German and French. The book again emphasizes
his belief that “Stress is a part of life. It is a
natural by-product of all our activities; there is
no more justification for avoiding stress than for
shunning food, exercise or love.” From his anal-
ysis of stress in animals, his colleagues, friends
and himself, he evolved the motto; “Fight al-
ways for the highest attainable aim, but never
put up resistance in vain.”
When asked for his own stress-quotient for his
apparently successful conformity to the stress of
life, he replied, “I do work pretty hard, but I
am not sure that this is due to any special strength
or energy. In fact, it may be the reverse. I just
seem to get so much fun out of my work that I do
not have the strength and energy to stay away
from it.”
The Assembly will be honored by the presence
'T Dr. Malcom E. Phelps, President of the Ameri-
can Academy of General Practice, and one of its
“founding fathers.” The members of the Florida
Chapter are deeply gratified that Dr. Phelps has
found the time to meet with them and address
them.
Other speakers will include Dr. George T.
Harrell Jr., Dean of the University of Florida
College of Medicine; Dr. Ellard M. Vow. Depart-
ment of Internal Medicine. Baylor University:
Dr. Franklin J. Evans. Legal Medicine, University
of Miami School of Medicine; Dr. Robert A.
Hingston, Professor of Anesthesiology, Western
Reserve University; Dr. Donald A. Covalt. As-
sociate Professor. Department of Physical Medi-
cine and Rehabilitation. New York University
College of Medicine; Dr. Edward F. Hartung,
Associate Professor. Clinical Medicine. New York
L’niversity Postgraduate Medical School; Dr.
James Hughes, Professor of Pediatrics. L’niversitv
of Tennessee; Dr. W. D. Snively Jr., Medical Di-
rector, Meade Johnson Company. Instructor in
Fluid Balance, St. Mary’s Hospital. Evansville.
Ind., and University of Colorado Graduate School.
Graduate Medical Education
Diabetes Association Meeting
Gainesville, October 24-26
The fifth annual meeting of the Florida Clin-
ical Diabetes Association will be held October 24.
25 and 26. 1957. in Gainesville at the Medical
Sciences Building of the College of Medicine of
the University of Florida. Dr. Edward R. Smith.
President, urges all members to make reservations
early for motel or hotel accommodations and also
to send for tickets to the football game between
Louisiana State University and the University of
Florida on Saturday, October 26 at 2:30 p.m.
Contact the Division of Postgraduate Education
of the College of Medicine of the LTniversity of
Florida for assistance.
Dr. William R. Jordan of the Medical College
of Virginia. Richmond. Va., and Dr. Sidney Da-
vidson of Lake Worth are among the speakers.
The program will include lectures on diabetes
mellitus and other phases of metabolism.
Cleft Palate Seminar
Miami, November 8-9
The Nemours Foundation and the South
Florida Cleft Palate Clinic, in cooperation with
the Florida Crippled Children's Commission and
the University of Miami School of Medicine, are
pleased to announce an event of major interest to
those concerned with the care of cleft palate pa-
tients.
The concept of the team approach for the
proper habilitation of the cleft palate child has
gained wide acceptance in recent years. This
trend is partially due to research and teaching by
the University of Illinois Cleft Palate Center.
Four members of the staff of the Illinois Cleft
Palate Center will present a seminar on “Modern
Concepts in Multi-Professional Planning for Cleft
Palate Patients” at the McAllister Hotel in Mi-
ami on Friday and Saturday. November 8 and
9. 1957. The registration fee of $10 will include
a dinner on Friday night.
The speakers will be Edward Lis. M.D., pedi-
atrician and Director of the Cleft Palate Center:
Samuel Pruzanskv. D.D.S.. orthodontic consultant
and Coordinator of Research; Herbert Koepp-
Baker. Ph.D.. speech pathologist and original
organizer of the Center: Herbert Kobes, M.D.,
Director of the LTniversity of Illinois Division of
Services for Crippled Children. The formal pro-
J. Florida. M. A.
September, 1957
EDITORIALS AND COMMENTARIES
273
gram will be presented all day Friday and on
Saturday morning. Saturday afternoon will be
devoted to discussion and the presentation of any
patients that members of the audience wish to
bring for consultation. Members of all professions
concerned with the cleft palate patient are cordial-
ly invited to participate.
For additional information, contact Dr. George
Balber, Chairman of the South Florida Cleft Pal-
ate Clinic, 515 N. E. 15th St., Miami 32, or Dr.
William R. Stinger, Director of the Florida Crip-
pled Children’s Commission, Box 1028, Tallahas-
see.
Fifth International Congress of
Internal Medicine
The International Society of Internal Medi-
cine has announced that its Fifth International
Congress of Internal Medicine will be held at the
new Sheraton Hotel in Philadelphia on April 24-
26, 1958. This will be the first meeting of the
society outside of Europe. In making the an-
nouncement. the International Society's Presi-
dent, Sir Russell Brain, who is also President of
the Royal College of Physicians of London, said,
"The Executive Committee of the Society has
chosen the United States for its Fifth Congress
in response to an invitation extended by the
American College of Physicians and with the ob-
jective of securing greater American participation
in its deliberations and of allowing foreign mem-
bers, at first hand, to learn more about Ameri-
can developments in the medical sciences.”
The previous Congresses, at two year inter-
vals, were held in Paris, London, Stockholm and
Madrid. At those meetings, however, the United
States, as well as many other nations throughout
the world, was represented. The present member-
ship of the society, including 48 nations, is about
3.000.
This society, the only international one em-
bracing all aspects of internal medicine, was or-
ganized in 1948 and largely at the instigation of
Professor Nanna Svartz of Stockholm, the physi-
cian to the King of Sweden. It was her conten-
tion that the various branches of internal medi-
cine should be kept in touch with one another,
as is accomplished in North America by the
American College of Physicians, and that this
should be done on a truly international basis.
She also emphasized the importance of purely
personal and nonpolitical contacts among physi-
cians of different countries.
The objectives of the society, as stated in its
Statutes, are ‘‘to promote scientific knowledge in
internal medicine, to further the education of the
younger generation and to encourage friendship
among physicians of all countries.” The members
are ‘‘specialists in internal diseases, acknowledged
as such and accepted by the appropriate national
societies of internal medicine.”
The first president of the International So-
ciety was Professor A. Gigon, of Basel, Switzer-
land. He was succeeded, in 1952, by Dr. Svartz
and she, by Sir Russell Brain, the President of
the Royal College of Physicians of London.
At the Philadelphia Congress it is planned,
through lectures and panels, to analyze medical
achievements of worldwide significance, to evalu-
ate certain apparent problems and to chart courses
of action designed to enhance technical knowl-
edge and to aid in the continuing war against
disease. At the same time, the plan includes
such social and cultural activities as will tend to
promote cooperation, friendship and mutual un-
derstanding among physicians and peace among
their countries.
The 1958 Annual Session of the American
College of Physicians will occur in Atlantic City,
April 28 to May 2, immediately following the
Philadelphia Congress. The members of the Con-
gress are invited to attend all the scientific pro-
grams and extensive exhibits, the foreign mem-
bers on a purely courtesy basis.
T. Grier Miller, M.D., Philadelphia, is the
President of the Congress; Edward R. Loveland,
F.A.C.P. (Hon.), is the Secretary-General; and
Mr. J. Malcolm Johnston, Philadelphia, the Treas-
urer.
Medical District Meetings
Dr. S. Carnes Harvard, of Brooksville, Chair-
man of the Council of the Florida Medical Associ-
ation, has announced that the 1957 Medical Dis-
trict Meetings will be held the last four days of
October — in Panama City, Oct. 28; in Clearwater,
Oct. 29; in Orlando, Oct. 30, and in Fort Pierce,
Oct. 31.
Dr. Harvard and his district councilors are
arranging an outstanding scientific program which
is scheduled for publication in the October issue
of The Journal.
Each member of the Association is urgently
requested to be present at the meeting in his dis-
trict.
274
Volume XMV
Number 3
STATE HOARD OF HEALTH
Asiatic Influenza
At the present time (Aug- 5, 1957) confirmed
outbreaks of Asiatic influenza have been reported
from nine states in the United States. To date
none have been reported in Florida, and the Cen-
tral Laboratory of the State Board of Health has
examined only 13 specimens from suspect cases,
in three of which there was evidence of exposure
to the Asian strain of influenza A virus. Due to
the delay between preparation of these reports
and publication, this situation may be consider-
ably changed by September. A misstatement due
to elapsed time in publication occurred in this
column in the August issue of The Journal when
a report stated that “none of the presently avail-
able influenza vaccines confer protection against
this strain of influenza virus.” At the time of
preparation of this present report, one manufac-
turer is marketing a polyvalent influenza vaccine
containing the Asian strain of influenza A, and five
other manufacturers are in various stages of pro-
duction of either monovalent or polyvalent in-
fluenza vaccine containing the Asian strain.
Emory University School of Medicine
Atlanta, Georgia
Announces
SIX DAYS
of
CARDIOLOGY
(January 13-18, 1958)
Major Problems of Heart Disease
will be discussed by
Members of the Emory University Faculty
and the following visitors:
A. Carlton Ernstene, M.D., Ancel B. Keys, M.D.,
Chairman, Division of Medicine, Professor of Medicine, University
Cleveland Clinic, Cleveland, Ohio of Minnesota; Director of the
Dwight E. Harken, M.D. Laboratory of Physiological Hy-
Assistant Clinical Professor of giene. University of Minnesota
Surgery, Harvard Medical School; School of Public Health, Minnea-
Surgeon, Peter Bent Brigham po I is, Minn.
Hospital; Chief of Department of Edward S Orgain, M.D.
Thoroac Surgery, Mount Auburn profess„r 0f Medicine, Duke Uni-
ond Malden Hospitals, Boston, versity S(hoo| Meditine; Di.
.. , aSS« -r ^ rector. Cardiovascular Disease
Helen B. Taussig, M.D., Service, Duke Hospital, Durham,
Associate Professor of Pediatrics, ^ q
The Johns Hopkins University '
School of Medicine; Director of E- Gr,eV D,mond' ^.D., , ,
the Children’s Heart Clinic of Professor and Chairman of the
the Harriet Lane Home, The Deportment of Medicine; Director
Johns Hopkins Hospital, Balti- °< ,hc Cardiovascular Laboratory,
more Md University of Kansas Medical
Eugene' A. Stead, M.D., Cen,er> Kansos Ci,»- Kansas.
Professor and Chairman, Depart- Gene H. Stollerman, M.D.,
ment of Medicine, Duke Univer- Associate Professor of Medicine,
sity School of Medicine, Durham, Northwestern University, Chicago,
N. C. Ill
Tuition fee: $100.00
Write: Postgraduate Teaching Program, Emory
University School of Medicine, 69 But-
ler Street, Atlanta 3, Georgia
It is expected, however, that only four million
doses will be ready by mid-September for civilian
use, and production goals call for 60,000,000 doses
by February, at which time the anticipated epi-
demic of Asian influenza may well have already
occurred.
Because of these limited supplies, it is rec-
ommended that physicians, nurses, hospital em-
ployees and other health personnel whose services
are imperative for the care of the sick be immun-
nized. Also, if sufficient vaccine becomes avail-
able, other key persons in essential community
services and persons with chronic debilitating dis-
ease could be given preference for influenza im-
munization.
The State Board of Health has no plans at
present for purchase or distribution of influenza
vaccine through County Health Departments.
There would seem to be only the advantage
of less expense in immunizing with a monovalent
vaccine, -as compared with a polyvalent vaccine.
The recommended dosage for adults is 1 cc. sub-
cutaneously. Preliminary studies have indicated
that the intradermal method using 0.1 cc. is not
practical with the present influenza vaccine. Vac-
cine protection is estimated at 70 per cent; it
begins 10 to 14 days after injection and remains
for six months to one year. None of the influenza
vaccines available for civilian use prior to July 15,
1957, contained the Asian strain of virus.
BIRTHS, MARRIAGES AND DEATHS
Births
Dr. and Mrs. Apostolos A. Kartsonis, of Jacksonville,
announce the birth of a daughter, Mary Pia, on May 30,
1957.
Marriages
Dr. Horace A. Day, of Orlando, and Miss Irene R.
Ziegler were married in Orlando on July 14, 1957.
Deaths — Members
Bechman, George E., Jacksonville March 27, 1957
Smith, James A., Sanford February 19, 1957
Geiger, Hugh S., Kissimmee July 6, 1957
Henry, Gordon F., West Palm Beach April 25, 1957
Melvin, Alexis M., South Miami June 18, 1957
Webb, Walter D., St. Augustine June 11, 1957
Griffin, Thos. R., St. Petersburg July 20, 1957
Merrick, Thomas D. Sr., Miami July 9, 1957
Counts, Noah T., Cocoa June 24, 1957
Driskell, Simon E., Jacksonville July 5, 1957
Torbett, Ralph S., Tampa April 28, 1957
Myers, Lucien E., Winter Park July 11, 1957
Deaths — Other Doctors
Engle, Ralph Landis, Coral Gables March 22, 1957
Weeks, Joseph C., Lake City June 29, 1957
Faver, Henry M., Tampa July 7, 1957
Caraker, Charles T. Jr., Perry July 13, 1957
J. FLORIDA, M. A.
September, 1957
275
Pro-BanthIne®provides rapid
control of pain in peptic ulcer
In a two-year study1 by Lichstein and co-
workers, documented by intensive personal
observation and by follow-up studies, Pro-
Banthlne (brand of propantheline bromide)
often brought immediate relief of ulcer pain.
Patients (1 1 per cent) who did not respond
satisfactorily to Pro-BanthTne therapy had
“anxiety manifestations of psychoneurotic
proportions.”
In addition to frequent immediate sympto-
matic relief, Pro-Banthlne reduces gastroin-
testinal motility and diminishes the secretion
and acidity of gastric juice, all-important
factors in the generation and aggravation of
peptic ulcer.
These actions of Pro-BanthTne and its
demonstrated effectiveness in accelerating ul-
cer healing2 3 4'5 mark the drug as a most valu-
able adjunct in the treatment of peptic ulcer.
The suggested initial dosage is one 15 -mg.
tablet with meals and two tablets at bedtime.
An increased dosage may be necessary for
severe manifestations and then two or more
tablets four times a day may be prescribed.
G. D. Searle & Co., Chicago 80, Illinois.
Research in the Service of Medicine.
1. Lichstein, J.; Morehouse, M. G., and Osmon, K. L.:
Am. J. M. Sc. 252:156 (Aug.) 1956.
2. Sun. D. C. H., and Shay, H.: Arch. Int. Med. 97:442
(April) 1956.
3. Rafsky, H. A.; Fein, H. D.; Breslaw, L., and Rafsky,
J. C.: Gastroenterology 27:21 (July) 1954.
4. Schwartz, I. R.; Lehman, E.; pstrove, R.. and Seibel,
J. M.: Gastroenterology 25:4f6 <Nov.) 1953.
5. Silver, H. M.; Pucci. H.. add Almy, T. P.: New Eng-
land J. Med. 252: 520 (March 31) 1955.
s
276
Volume XLIV
Number 3
OTHERS ARE SAYING
Editorial
Medical ethics are basically the same as ethics
for any other homologous group of humans work-
ing together in a common cause. They differ only
in specialized particulars concerned with the serv-
ice or activity which may be unique to a particu-
lar group, and of little or no concern to another.
Ethics are principles. They represent generations
of experience by trial and error. As such, they
are blueprints for the practices and behavior of
the individuals who make up the group. They
distill the best of the past, sustain the needs of
the present, and point to the possibilities for im-
provement of the future. The Golden Rule is the
solid core of all ethics.
Like the law of gravity, the root principle
of ethics cannot change. Interpretation and ap-
plication inevitably vary to a greater or lesser
degree from period to period in history. Varia-
tions come from special situations and changes
of circumstance. Even when they occur after
prolonged and careful consideration by adequate
numbers representative of the group, they are
dangerous. If a majority of the group agrees to
change certain traditional interpretations, and
promulgate a new plan or rule of application in
order to adapt to a real and permanent change
in society or environment, it may and should
very definitely do so — provided the alteration
does not extend the structure dangerously beyond
the supporting foundation of essential basic prin-
ciples.
This is the age of ballyhoo. Old P. T. Barnum
would turn green with envy at any assistant pub-
licity director of a third-rate cosmetics firm.
Even the so-called “allied commercial organ-
izations” who make apparatus and the newer
physik have fallen under the spell and utter
strange and often incomprehensible claims for
their products. It's not surprising that many
physicians seriously question the wisdom of
abiding by old-fashioned rules for the preserva-
tion of dignity and rigid honesty. These virtues
wax and wane in popularity. Now they are at
rather low ebb throughout the world. We are told
we should try to foster and certainly participate
in a moral and religious rededication. If Medicine
wishes to provide its expected share in leadership
at this important period in our history, we
should be slow to change our present rules for
individual conduct and behavior. Liberalization
at this time may well be misinterpreted as capit-
ulation. The advantages of a more liberal inter-
pretation on scores of thorny points are many
and they tempt us mightily. At times, it seems
we're engaged in a tough fight with one good
arm tied behind us by our own foolish choice.
We do have a most extraordinary birthright, how-
ever, and if you look close, some of those immedi-
ate advantages which might be gained look a bit
like pottage! Let’s be sure what we’re trading
for!
D. F. M.
The Bulletin, Dade County
Medical Association
September, 1956.
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DOCTOR
we need your opinion
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278
Volume XLIV
Number 3
STATE NEWS ITEMS
The Emory University School of Medicine at
Atlanta has announced a postgraduate course in
cardiology for six days beginning January 13,
1958. Members of the Emory University faculty
and eight eminent specialists from throughout the
United States will discuss the major problems of
heart disease. The tuition fee is $100. Inform-
ation may be obtained by writing Postgraduate
Teaching Program, Emory University School of
Medicine, 69 Butler Street, Atlanta 3, Georgia.
Dr. Charlotte C. Maguire of Orlando has been
in London, England, where she served as a dele-
gate from the United States to the Seventh World
Congress of the International Society for the
Welfare of Cripples.
Dr. Kenneth A. Morris has been elected presi-
dent of the Jacksonville Chapter of the American
College of Surgeons. Dr. Samuel M. Day has
been chosen president-elect and Dr. George M.
Stubbs, secretary-treasurer. Councilors are Drs.
Frederick J. Waas, E. Frank McCall and James
G. Lyerly Sr. All the physicians are from Jack-
sonville.
Dr. Thomas E. McBride of Apopka has re-
turned from a month in North Carolina where
he attended the annual pediatric seminar held at
Saluda and visited clinics at Winston Salem.
Dr. Frank C. Bone of Orlando has been ap-
pointed chairman of the Central Florida Medical
Meeting Committee. The meeting is held annual-
ly at Orlando.
Dr. Henry I. Langston of Blountstown has
been appointed Director of the Health Depart-
ment of Gulf, Franklin and Wakulla counties
with headquarters at Apalachicola.
Dr. Talmadge S. Thompson of Venice has
been elected president of the Lions Club there.
Dr. Thompson has been a member of the Club
since its founding ten years ago.
The Council on Postgraduate Medical Educa-
tion of the American College of Chest Physicians
will present three Postgraduate Courses on Dis-
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100; 100 mg. (oleandomycin 33 mg., tetracycline
67 mg.), bottles of 25 and 100.
Signemycin for Oral Suspension — 1.5 Gnu, 125
mg. per 5 cc. teaspoonful (oleandomycin 42 mg.,
tetracycline 83 mg.), mint flavored, bottles of 2 oz.
Signemycin Intravenous — 500 mg. vials (olean-
domycin 166 mg., tetracycline 334 mg.), and 250
mg. vials (oleandomycin 83 mg., tetracycline 167
mg.); buffered with ascorbic acid.
World leader in antibiotic development and production
mark tTrademark, oleandomycin tetracycline
280
Volume XLIV
Number 3
FOR THE ENTIRE RANGE OF RHEUMATIC-ARTHRITIC
DISORDERS-from the mildest
to the most severe
many patients with MILD involvement can be effectively
controlled with
MEPRQLONE
many patients with MODERATELY SEVERE involvement
can be effectively controlled with
MEPRQLONE
The only meprobamate-prednisolone therapy
the one antirheumatic, antiarthritic that
simultaneously relie%’es: (i) muscle spasm
(2) joint inflammation (3) anxiety and
tension (4) discomfort and disability.
SUPPLIED: Multiple Compressed Tablets
in three formulas: ‘MEPROLONE’-5 —
5.0 mg. prednisolone, 400 mg. meproba-
mate and 200 mg. dried aluminum hy-
droxide gel. ‘MEPROLONE’-2 — 2.0 mg.
prednisolone, 200 mg. meprobamate and
200 mg. dried aluminum hydroxide
gel. "MEPROLONE’-i supplies 1.0 mg.
prednisolone in the same formula as
"M EPROLON E ’- 2 .
MERCK SHARP & DOHME
DIVISION OF MERCK ft CO.. INC.
PHILADELPHIA 1. PA.
MEPRQLONE’ U a trademark of Merck & Co.. lac.
J. Florida, M. A.
September, 1957
281
eases of the Chest this fall: Hotel Knickerbocker,
Chicago, Oct. 21-25; Park-Sheraton Hotel, New
York, Nov. 11-15, and Ambassador Hotel, Los
Angles, Dec. 9-13.
Tuition for each course is $75. The most re-
cent advances in the diagnosis and treatment of
chest diseases both medical and surgical will be
presented. Information may be obtained from
the Executive Director, American College of
Chest Physicians, 112 East Chestnut St., Chicago
11, 111.
A*
Dr. Everett M. Harrison of Clearwater has
been elected president of the Dunedin Rotary
Club.
Dr. Herbert D. Kerman of Daytona Beach
presented a paper on teletherapy at the recent
Inter-American Symposium on the Peaceful Ap-
plication of Nuclear Energy held at the Brook-
haven National Laboratory, Upton, Long Island.
The Symposium was attended by more than 200
scientists from the 21 American republics.
Dr. Jacob A. Classman of Miami, Assistant
Clinical Professor of Surgery at the University of
Miami School of Medicine, addressed a medical
meeting at Greenwood, S. C., late in August. Dr.
Glassman’s subject was “The Present Status of
Thyroid Surgery.”
The Forty-Third Clinical Congress of the
American College of Surgeons will be held in At-
lantic City, N. J., Oct. 14-18, 1957. Invited
guests at the Congress will include medical stu-
dents from 36 colleges located in the United
States and Canada.
For the ninth year the Lake County Medical
Society has conducted physical examinations and
given immunizations for members of the Nation-
al Guard of the county. This service by Society
members is a part of the over-all public relations
program. Dr. Thomas E. Langley of Eustis was
in charge of the activity this year.
Members of the Society have also served as
round up teams for conducting physical examina-
tions among pre-school children with referrals to
the individual’s private physician for any needed
corrections.
Drs. Alvan G. Foraker and Sam W. Denham
of Jacksonville have been awarded three grants
by the National Cancer Institute for research
when anxiety and tension "erupts” in the G. I. tract...
IN GASTRIC ULCER
J
PATHIBAMATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 wg.)the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of gastric ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATH ILON (25 mg.)the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
■Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEOERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
(ede #•/»•)
282
Volume XLIV
Number 3
projects. The first is for a new three year study
of histochemical changes of aging in human
ovaries. The other two are for continuation of
present studies involving an investigation of cy-
tochemical and cytophysical properties of intra-
epithelial carcinoma of the cervix and an experi-
mental study of induced tumors in rat ovaries.
Drs. Sidney Stillman of Jacksonville and
Ralph B. Spires of DeFuniak Springs have been
reappointed to the State Board of Medical Ex-
aminers by Governor LeRoy Collins. A new ap-
pointment to the Board was Dr. Robert T. Spicer
of Miami.
Dr. George T. Harrell Jr. of Gainesville.
Dean of the College of Medicine, University of
Florida, has been appointed a member of thp
Nuclear Development Commission by Governor
LeRoy Collins.
Dr. Hugh A. Carithers of Jacksonville har
been appointed by Governor LeRoy Collins to a
four year term on the State Children’s Commis-
sion.
Dr. Edward Jelks of Jacksonville has been re-
appointed to a new four term as a member of
the Duval County Welfare Board.
Dr. Chas. J. Collins of Orlando has been
elected president of the State Board of Health
succeeding Dr. Herbert L. Bryans of Pensacola
who served as president for the past 17 years.
The annual meeting of the Southeastern Al-
lergy Association will be held in Charleston, S. C.,
on November 1-2. according to announcement by
Dr. Clarence Bernstein of Orlando, president.
A postgraduate course entitled “Recent Ad-
vances in Diagnosis and Treatment of Arrhyth-
mias” has been scheduled at Mount Sinai Hos-
pital of Greater Miami November 18-22. There
will be evening sessions. The course will be con-
ducted by Dr. Richard Langendorf of Chicago,
Research Associate in Cardiovascular Diseases at
Michael Reese Hospital.
Dr. Leland H. Dame of Winter Park has
been elected to the Royal Society of Health in
London, England.
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATHIBAMATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate Ioginess, hangover or
habituation . . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexefhyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
J. Florida, M. A.
September, 1957
283
!V -2 c^
'S *. C*5, r
' ■ <C3) j ^ . (^Y-
Knox “Choice of Foods” Diet Can Help Your
HYPERTENSIVE Patients to Reduce and Stay Reduced
1. Color coded diets of 1200, 1600 and 1800 calories are
based on nutritionally tested Food Exchanges.1
2. The easy-to-use Food Exchanges (called Choices in
booklet) simplify diet management by eliminating calorie
counting.
3. Diets promote accurate adjustment of caloric levels to
the special needs of the patient yet allow each individual
considerable latitude in the choice of foods.
4. More than six dozen appetizing, low-calorie recipes are
described in the last fourteen pages of the diet booklet.
1. The Food Exchange Lists referred to are based on material in
“Meal Planning with Exchange Lists** prepared by Committees of
the American Diabetes Association, Inc., and The American Dietetic
Association in cooperation with the Chronic Disease Program, Public
Health Service, Department of Health, Education and Welfare.
i
»
v
i
i
i
•
i
a
a
•
i
a
i
a
a
a
i
a
9
i
i
i
c
■
I
X PROTEIN PREVIEWS
— - — ~
Please send me dozen copies of the new, illus-
trated Knox Reducing booklet based on Food Exchanges.
Your Name and Address.
Chas. B. Knox Celatine Co., Inc.
Professional Service Dept. SJ-26
Johnstown, N. Y.
284
Volume XLIV
Number 3
Dr. Francis W. Glenn of Coral Gables has
returned from Indianapolis, Ind., where he attend-
ed a meeting of the Board of Governors of The
American Fracture Association. Dr. Glenn is
Regional Vice President of the Association.
EVERY WOMAN
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
The Eighteenth Annual Meeting of The Ameri-
can Fracture Association is being held in the Ho-
tel Cortez, El Paso, Texas, Sept. 30-Oct. 2.
The meeting will be preceded and coordinated
with The University of Texas Postgraduate
School of Medicine, El Paso Division, which will
meet Sunday, Sept. 29, at the El Pasco County
Medical Society. The University of Texas Pro-
gram is approved Category I by the American
Academy of General Practice. The American
Fracture meeting is approved Category II by the
American Academy of General Practice.
"PREMARIN!
widely used
natural, oral
estrogen
AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
5645
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
qualifications in writing. The Miami-Battle Creek,
Miami Springs, Fla.
INTERNIST WANTED: Established certified in-
ternist desires associate. Florida license, certified or
board eligible. Give full background in first letter.
Write 69-224, P. O. Box 2411, Jacksonville, Fla.
WANTED: Specialist in Obstetrics and Gynecol-
ogy with Florida license to associate with group in
Dade-Broward area. Board man preferred. Write
age, training, chronology of medical experience, refer-
ences. Write 69-230, P. O. Box 2411, Jacksonville,
Fla.
WANTED: Pediatrician or General Practitioner
with special training in pediatrics to associate with
group in Dade-Broward area. Florida license neces-
sary. Write age, training, chronology of medical
experience, references. Write 69-231, P. O. Box 2411,
Jacksonville, Fla.
OBSTETRICIAN-GYNECOLOGIST: Board or
board eligible, to associate with mixed group of three
in a well established practice in town of 50,000 in
central Florida. Write 69-233, P. O. Box 2411, Jack-
sonville, Fla.
INTERNIST: Certified or eligible. Wonderful
opportunity to join group of well trained specialists.
Modern, completely equipped building. Gastroenterol-
ogy training asset but not essential. Excellent aca-
demic, financial, personal satisfaction. Beautiful area.
Give full qualifications. Write 69-240, P. O. Box 2411,
Jacksonville, Fla.
WANTED: General surgeon desires location alone
or with associate. Board eligible, married, Florida li-
cense. Prefer smaller city. Write 69-238, P. O. Box
2411, Jacksonville, Fla.
J. Florida, M. A.
September, 1957
285
symptomatic relief ... plus!
achrocidin is a well-balanced, comprehensive formula for
treating acute upper respiratory infections.
Debilitating symptoms of malaise, headache, pain, mucosal
and nasal discharge are rapidly relieved.
Early, potent therapy is offered against disabling complications
to which the patient may be highly vulnerable, particularly
during febrile respiratory epidemics or when questionable middle
ear, pulmonary, nephritic, or rheumatic signs are present.
achrocidin is convenient for you to prescribe — easy for the
patient to take. Average adult dose: two tablets, or teaspoonfuls
of syrup, three or four times daily.
tablets
ACHROMYCIN ® Tetracycline . 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Bottle of 24 tablet t
syrup
Each teaspoonful (5 cc.) contains:
ACHROMYCIN ® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyrilamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
Available on prescription only
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
•Reg. U. S. Pat. Off.
286
Volume XLIV
Number 3
kids really like ...
SQUIBB IRON. B COMPLEX AND Bu VITAMINS ELIXIR
■ to correct many common anemias
■ to correct mild B complex deficiency states
■ to aid in promotion of growth and stimulation of appetite in poorly nourished children
Squibb
Squibb Quality —
the Priceless Ingredient
Each teaspoonful (5 cc.) supplies:
Elemental Iron 38 mg.
(as ferric ammonium citrate and colloidal iron)
(equivalent to 130 mg. ferrous sulfate exsiccated)
Vitamin Bi2 activity concentrate 4 meg.
Thiamine mononitrate 1.0 mg.
Riboflavin 1.0 mg.
Niacinamide 5 mg.
Pantothenic acid (Panthenol) 1.5 mg.
Pyridoxine hydrochloride 0.5 mg.
Alcohol content: 12 per cent
Dosage: 1 or 2 teaspoonfuls t.i.d.
Supply: Bottles of 8 ounces and 1 pint.
«BUaaATON'<P is A SQUIBS TRADEMARK
J. Florida. M. A.
September, 1957
287
Formula
Miltown® O anticholinergic
Miltown® (meprobamate)
400 mg. ( 2 - methyl - 2 - n -
propyl- 1, 3- propanediol
dicarbamate)
U. S. Patent 2,724,720
tridihexethyl iodide 25 mg.
( 3 - diethylamino - 1 - cyclohexyl -
1 - phenyl - 1 - propanol-ethiodide)
WALLACE LABORATORIES New Brunswick, N. J.
I. Wolf & Wolff, Human Gastric Function
Literature, samples, and
personally imprinted peptic ulcer
diet booklets on request •
Lnow . . care of the man
ither than merely his stomach”1
11 —
Miltown® L. _ anticholinergic
controls
gastrointestinal dysfunction
at cerebral and peripheral levels
tranquilization without
barbiturate loginess
spasmolysis without
belladonna-like side effects
for dm odenal ulcer • gastric ulcer • intestinal colic
spasmic and irritable colon • ileitis • esophageal spasm
G. /. symptoms of anxiety states
a
NEO-SYNEPHRINE
COMPOUND
CMTabieb Jj
offer "Syndromatic” Control
in the COMMON COLD, Allergic Rhinitis
Patients breathe, sleep, work and
play better with new "syndromatic" action.
Neo-Synephrine Compound Cold Tablets...
for... Full "Syndromatic" Relief.
Neo*Synephrine (brand of phenylephrine) and
fhenfadil (brand of thenyldiami/ie), trademarks reg. U.S. Pat. Off.
Neo-Synephrine Compound CtMlabieh
protect patients through the full
range of symptoms
Each tablet contains:
mthak
NEO-SYNEPHRINE HCI, 5 mg.
Mild, long acting decongestive
NASAL STUFFINESS, RHINORRHEA
neima
Acetaminophen, 150 mg.
Effective analgesic and antipyretic
HEADACHE AND ASSOCIATED ACHES AND PAINS
iieiitMlW
Thenfadil® HCI, 7.5 mg.
Dependable , well tolerated antihistaminic
ALLERGIC SENSITIZATION
mMmcti
Caffeine, 15 mg.
MENTAL AND PHYSICAL LASSITUDE
Dose: Adults — 2 tablets three times daily.
Children 6 to 12 years— 1 tablet three times daily.
Bottles of 100 tablets
LABORATORIES
NEW YORK 18, N. Y.
90
Volume XLIV
Number 3
Rauwiloid
A Dependable Antihypertensive
“...by far the most effective
and useful orally administered agent for reducing blood
pressure . . . fully worthy of a trial in every case of
essential hypertension in which treatment is thought
necessary. The severe cases, which always need treat-
ment, are as likely to respond as the mild.”1
1. Locket. S.: Brit. M.J.
1 :809 (Apr. 2) 1955.
Aii Effective Tranquilizer, too
“ . . . relief from anxiety resulted in generally in-
creased intellectual and psychomotor efficiency with
a few exceptions.”2 Rauwiloid is outstanding for its
nonsoporific sedative action in a long list of diseases
burdened by psychic overlay.
2. Wright, W.T., Jr., et al.: J. Kansas
M. Soc. 57:410 (July) 1956.
Dosage: Merely two 2 mg. tablets at bedtime.
After full effect one tablet suffices.
A logical first step when more potent drugs are needed
Rauwiloid is recognized as basal
medication in all grades and types
of hypertension. In combination with
more potent agents it proves syner-
gistic or potentiating, making
smaller dosage effective and freer
from side actions.
Rauwiloid + Veriloid5
In moderate to severe hyperten-
sion this single-tablet combination
permits long-term therapy with de-
pendably stable response. Each tablet
contains 1 mg. Rauwiloid (alseroxy-
lon) and 3 mg. Veriloid (alkavervir).
Initial dose, 1 tablet t.i.d., p.c.
Rauwiloid +
Hexamethonium
In severe, otherwise intractable hy-
pertension this single-tablet com-
bination provides smoother, less
erratic response to hexamethonium.
Each tablet contains 1 tng. Rauwi-
loid and 250 mg. hexamethonium
chloride dihydrate. Initial dose, 3^
tablet q.i.d.
.V»‘
Riker “**—
T ■
4 •' \ . •. i\ .• $’
J. Florida, M. A.
September, 1957
291
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Archer. Lester, Homestead
Bozeman, James D., Orlando
Brown, John O. (Col.) Miami
Castleberry, Jesse W., Orlando
Chambers, Julius B., Winter Park
Creel, Frank L., Pensacola
Daniel, William R., Orlando
Dillard, Edgar A. Jr., Boynton Beach
DiLorenzo, Vincent J., Dundee
Doggett, Thaddeus H., Miami
Dunsworth, William P., Tampa
Ellenbogen, Nina C., Miami Beach
Epps, Earle W., Lakeland
Fomon, John J., Miami
Hicks, John H., Miami
Kass, Paul, North Miami
Kelly, Alexander J. Jr., Tampa
Levine, Oscar, Miami
Maxey, Edward S., Stuart
Mellion, Anson J., Jacksonville
Newhouser, Lloyd R., Miami
Samartino, Gaetano T., Coral Gables
Shorey, Winston K., Miami
Suarez, George J.. Tampa
Turke, George J. Jr., Miami
Tyler, Lockland V. Jr., Pensacola
Walton, Thomas P. Ill, Tampa
Williams, R. Reche Jr. (Col.) Tampa
Ziffer, Albert M., Orlando
Guy Wilkerson Heath
I)r. Guy Wilkerson Heath of West Palm
Beach died in that city on Feb. 3, 1957. He was
62 years of age.
Dr. Heath was born in 1894. He received
his medical training at the Tulane University
School of Medicine in New Orleans, where he
was awarded the degree of Doctor of Medicine in
1920. Upon completion of an internship and a
residency at Macon Hospital in Macon, Ga., he
engaged in the practice of medicine for a short
time in Ruston, La., before coming to Florida.
In 1924. Dr. Heath was licensed to practice
in Florida. He located in West Palm Beach and
when anxiety and tension "erupts” in the G. I. tract...
IN ILEITIS
PATHIBAMATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of ileitis — without fear of barbiturate loginess, hangover or
habituation . . .with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
292
Volume XI. IV
Number 3
(dihydroxy aluminum aminoacetate with belladonna alkaloids and phenobarbital)
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs!
SILLADONNA ALKALOID!
ALONE
160
90
eo
70
60
50
40
30
20
10
LD 90%*
*15 mg. dose
of spasmolytic
proved lethal
in 90"o of
test animals
IS MO. ALKALOIDS
BELLADONNA ALKALOIDS
BELLADONNA ALKALOIDS WITH
WITH
DIHYDROXY ALUMINUM
AMINOACETATE
ALUMINUM HYDROXIDE
(alglyn®, brayten)
Alglyn
1
adsorbed only
LO 83%
7%
of alkaloids
AI(OH),
Malglyn Compound
w/spasmolytic
provides maximal
substantially
spasmolytic effect
reduces spasmolytic
drug effect
| n 1 “7 07
LD l/%
IS MO. ALKALOIDS
200 MO. AL (OH),
IS MO. ALKALOIDS
200 MO. ALQLYN
COMPARISON OF ADSORPTIVE PROPERTIES OF AL(OH), AND ALGLYN
each tablet contains
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked absorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
For both rapid and prolonged antacid effect, with consistently
effective spasmolytic and sedative action, rely upon Malglyn
for treatment of peptic ulcer and epigastric distress.
dihydroxy
aluminum
aminoacetata, o.b omi
N.N.R.
belladonna
alkaloids o.iea mo.
(as sulfates)
phenobarbital re.a mo.
Also supplied: Alglyn* (dihydroiyaiumi.
num aminoacetate, U ti l 0.5 Cm par tablet).
BELGLYN* (dihydroiy aluminum aminoacetata,
N.N R., 0.5 Gm. and belladonna alkaloids, 0.162 m|.
per tablet).
Specialities for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA 9. TENNESSEE
J. Florida, M. A.
September, 1957
293
continued to practice there for 33 years. His
specialty was obstetrics and gynecology. Through
the years he practiced his profession faithfully
and brilliantly as one of its outstanding and most
revered members.
Dr. Heath was a member of the Palm Beach
County Medical Society. Since 1925 he had held
membership in the Florida Medical Association,
and he was also a member of the American Medi-
cal Association and his specialty organizations.
Surviving are the widow, the former Miss
Lillian Mosher, and one son, Guy W. Heath Jr.
Arthur McGugan
Dr. Arthur McGugan died in Denver, Colo.,
on May 28, 1957, at the age of 86 years.
Dr. McGugan was born in New Glasgow.
Ontario, in 1870. He received his early education
in Canada and was graduated from the Univer-
sity of Michigan Medical School in 1892.
Dr. McGugan specialized in Neurology. His
career included serving as Head of the Depart-
ment of Neurology of the University of Michigan
Medical School; Assistant Physician and Clinical
Director of the Michigan State Hospital; Pro-
fessor of Neurology and Psychiatry at the Uni-
versity of Colorado School of Medicine; Special
Lecturer in Neurology at the Boston University
School of’ Medicine; Director of Special Research
for the Department of Mental Disease of the
State of Massachusetts; and Consultant in Neuro-
surgery to the x^merican Expeditionary Force.
Dr. McGugan lived in Winter Park from 1935
to 1951. He was an honorary member of the
Orange County Medical Society, the Florida
Medical Association and the American Medical
Association.
Surviving is his daughter, Mrs. John Hitch,
of Denver.
Harrison G. Palmer
Dr. Harrison G. Palmer died at his home in
St. Petersburg on Feb. 9, 1957. He was 80 years
of age.
Born in Michigan in 1877, Dr. Palmer re-
ceived his medical training in Chicago. He was
awarded the degree of Doctor of Medicine in 1903
by the Bennett Medical College, now a part of
( Continued on Page 298 )
PHENAPHEM' PLUS
Phenaphen Plus is the physician-requested
combination of Phenaphen, plus an anti-
histaminic and a nasal decongestant.
Available on prescription only.
each coated tablet contains: Phenaphen
Phenacetin (3 gr.) 194.0 mg.
Acetylsalicylic Acid (2% gr.) . 162.0 mg.
Phenobarbital (Vi gr.) .... 16.2 mg.
Hyoscyamine Sulfate .... 0.031 mg.
plus
Prophenpyridamine Maleate . . 12.5 mg.
Phenylephrine Hydrochloride . 10.0 mg.
*\
J
294
Volume XI.IV
Number 3
Combined Estrogen -Androgen Therapy Proved 96% Effective
in Preventing Postpartum Breast Engorgement1
Dual Steroid Approach also Successful in Osteoporosis
Of more than 4 million babies born in the
United States this year, approximately 75 per
cent will not be breast fed.2 Combined estro-
gen-androgen therapy will effectively sup-
press lactation and prevent postpartum
breast engorgement in these mothers.
Osteoporosis also ranks high on the list of
present day medical problems because of the
increasing older population.
In either condition, combined estrogen-
androgen therapy produces a complemen-
tary metabolic response with little or no side
effects.
In postpartum breast engorgement the rationale of
therapy is explained as iollows: During pregnancy,
the high estrogen titer exerts an inhibitory eject
on the anterior pituitary, thereby preventing the re-
lease of the lactogenic hormone, prolactin. Postpar-
tum, the estrogen level drops off suddenly, and
allows the release of previously inhibited prolactin
which is now free to initiate the flow of milk. Sex-
hormones re-establish pituitary inhibition, thus
arresting the lactating process.
In Fiskio’s study,1 "Premarin" with Methyltes-
tosterone effectively relieved postpartum breast en-
gorgement and suppressed lactation in 96.2 per cent
of his group of 267 patients. Notably absent were
breast abscesses, nausea, vomiting, excessive lochia,
withdrawal bleeding or virilization. Menses were re-
established after the normal six week period. The
lack of mental depression during the puerperium
was especially gratifying.
Osteoporosis results from impairment of osteoblas-
tic activity, and gonadal hormone decline is possibly
the most prevalent cause. Estrogen stimulates osteo-
blastic activity and increases calcium and phosphorus
retention, while androgen exerts an anabolic or
protein-forming action. Prognosis for bone recalcifi-
cation is good, providing therapy is continued for
extended periods. The possibility of side effects is
minimized because the two hormones exert an op-
posing action on sex-linked tissue.
Estrogen and androgen as combined in "Premarin”® j
with Methyltestosterone provide a treatment of ’
choice in osteoporosis.
Recommended Dosage: (Directions refer to yellow I
tablets. )
Postpartum breast engorgement — Short duration
therapy — ( one week ) — 3 tablets every four hours
for five doses — then 2 tablets daily for rest of week.
Step-down” therapy — ( 10 to 15 days) — 1st day
— 4 tablets; 2nd day — 3 tablets; 3rd day — 2 tab-
lets; thereafter, 1 tablet daily for 10 to 15 days. It is
important to start therapy as soon as possible after
delivery.
O teoporosis: 2 tablets daily, for the first three
weeks. Then 1 tablet daily thereafter. In the female
it is suggested that combined therapy be given in
2 1 day courses with a rest period of about one week
between courses, and be continued for 6 to 12
months; following this period, the patient may be
maintained with cyclic therapy employing "Pre-
marin” Tablets alone.
Supplied in two potencies: Yellow tablets — each contain:
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Bibliography: Available on request.
'Ayerst Laboratories
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and is reasonable in cost
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THE ARMOUR
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A DIVISION OF ARMOUR AND COMPANY
KANKAKEE. ILLINOIS
Armour. ..Cholesterol Lowering . . . Factor
298
Volume XLIV
Number 3
(Continued from page 293)
the Stritch School of Medicine of Loyola Uni-
versity in that city. Returning to his native
state, he engaged in the general practice of med-
icine at Newport, Mich., for nearly 30 years.
In 1936, Dr. Palmer moved to St. Petersburg
and continued in general practice there up to the
time of his death. He was a familiar figure in
local professional circles for more than two dec-
ades. He was a member of the First Presbyterian
Church and held membership in the St. Peters-
burg Yacht Club.
Dr. Palmer was a member of the Pinellas
County Medical Society, the Florida Medical
Association and the American Medical Associa-
tion. He also held membership in the Medical
Association of Wayne County, Michigan.
Survivors include the widow, Mrs. Marian B.
Palmer, of St. Petersburg; two daughters, Mrs.
James B. Wilson, of St. Petersburg, and Mrs.
Raymond J. Smith Jr., of Detroit, Mich.; a
sister, Mrs. S. H. Finell, of Adrian, Mich.; and
a granddaughter, Miss Brenda Wilson, of St.
Petersburg.
HOOKS RECEIVED
Carcinoma of the Breast: The Study and Treat-
ment of the Patient. By Andrew G. Jessiman, F.R.C.S.,
M.D., and Francis D. Moore, M.D. Pp. 135. Ulus. 21.
Price, $4.00. Boston, Little, Brown and Company, 1956.
“In the light of the present evidence, what is best for
the patient?” This is the question posed by the authors
in their Preface, and it is the question they seek to
answer in this monograph. Time and further research,
they say, will prove or disprove their contentions; mean-
while these serve as a rational basis for therapy based on
knowledge available at this time.
The book represents an extension of a Progress Report
initially published in the New England Journal of Medi-
cine. It is written so as to present a consistent and in-
tegrated view of the study and care of patients suffering
with carcinoma of the breast, in the light of current
knowledge and research on the endocrine and metabolic
aspects of the surgical care of that disease.
Clinical Memoranda on Economic Poisons.
Prepared by Technical Development Laboratories, Tech-
nology Branch, Communicable Disease Center, P. O. Box
769, Savannah, Georgia. U. S. Department of Health,
Education, and Welfare, Public Health Service, Bureau of
State Services, Communicable Disease Center, Atlanta,
Georgia. Pp. 78. Price, 30 cents. Public Health Service
Publication No. 476. Washington 25, D. C., Superintend-
ent of Documents, U. S. Government Printing Office,
1957.
The U. S. Public Health Service Communicable Dis-
ease Center, Technology Branch, Technical Development
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
Jarksonville
420 W. Monroe Si.
Telephone EL 4-6661
Orlando
329 N. Orange Ave.
Telephone 5-3537
J. Florida, M. A.
September, 1957
299
If you could
D Q
with a user of the Picker Anatomatic
Century x-ray unit you'd soon know
why this remarkable "new way in x-ray"
machine has come so far so fast.
He'd probably tell you first how incredibly easy it is to use
(just dial the body part and set its thickness..,
then press the button). He might sigh with
relief at having no charts to consult, no
calculations to make (the anatomatic
principle does all the tedious "figgerin"
^ for you).
He'd probably show you how good
a radiograph he gets every time
He might even touch on the peace-of-mind
that comes of having a local Picker
office so near, with a trained Picker
expert always on call for help and counsel
and there 'd be no mistaking
the light in his eye when it
falls on the handsome big-name
unit whose fine appearance
adds so much to the
impressiveness of his office.
P.S. Somewhere along the line the matter of price would
come up ... he'd most likely comment on how little he paid
to get so much. Or he might even be among those who rent
their x-ray machine (Picker has an attractive rental plan,
you know) .
P.P.S. Next best thing is to call your local Picker man in and
let him tell you about this great new machine (find him in your
'phone book) or write Picker X-Ray Corporation, 25 South Broadway,
White Plains, N. Y.
I
• • ' ■ - ■ * * -
MIAMI 35, FLA., 1363 Coral Way
Jacksonville 7, Fla., 1023 Mary Street
St. Petersburg, Fla., 601 Rutledge Bldg.
Orlando, Fla., 1711 Oakmont Street
W. Palm Beach, Fla., 305 South Flagler Drive
300
Volume XLIV
Number 3
Laboratories, P. O. Box 769, Savannah, Ga., advises
that single copies of this bulletin will be supplied to
physicians upon request as long as the supply lasts and
that it is also available for purchase from the Superin-
tendent of Documents, U. S. Government Printing Office,
Washington 25, D. C. Much of the information con-
tained in this bulletin on the human toxicology of pesti-
cides has been gained through reports of human poisoning
cases which are furnished the Technical Development
Laboratories by cooperating physicians. Physicians en-
countering cases of human poisoning involving pesticides
are invited to report them in accordance with instructions
contained in the booklet.
The Riddle of Stuttering. By C. S. Bluemel, M.D.
Pp. 142. Price, $3.50 casebound, $1.50 paper bound.
Danville, 111., The Interstate Publishing Co., 1957.
The problem of stuttering remains obscure despite the
efforts of many earnest workers in the field of speech
disorders. Like the common cold, it is a more compli-
cated matter than first appears. There is not one cause
of the speech disorder, this author explains, but there is a
combination of at least three different causes. In the
speech impediment itself, there are five major components,
with several minor components. Thus the problem of
stuttering is complex.
The author seeks an answer to the riddle of stuttering
in the field of psychiatry. The approach is different from
that of the academic speech therapist, and the conclusions
and the therapy are quite different. Nevertheless,
the goals of all workers in the field of speech disorders
are identical — to assist the stutterer in attaining fluency.
The author presents his conclusions here for the appraisal
of the speech correctionist and the stutterer himself.
Four 12 inch long play Speech Therapy recordings are
available at $3.00 each. All proceeds from the sale of the
book and the recordings have been assigned by the
author to the American Speech and Hearing Foundation.
Principles of Urology: An Introductory Text-
book to the Diseases of the Urogenital Tract. By Mere-
dith F. Campbell, M.S., M.D., F.A.C.S. Pp. 622. Ulus.
319. Price, $9.50. Philadelphia, W. B. Saunders Com-
pany, 1957.
The twofold purpose of this book is to instruct the
student in the broad fundamentals of Urology and to
serve as a practical guide for the physician who is not a
urologic specialist, as he encounters urologic problems.
The author observes in the Preface that this is not in-
tended to be a complete reference textbook nor an arm-
chair urology, adding that the conceit implied by its writ-
ing is founded on an experience of 35 years in the teach-
ing of Urology to both undergraduates and graduate stu-
dents of medicine.
A brief consideration of urologic semantics is followed
by a short syllabus of the more frequently employed
urologic terms, and a brief review of the more important
aspects of urogenital tract anatomy and physiology is
included as an introductory refresher. Urologic symptoms
and their potential significance as indications for special
urologic examination are discussed, while the patho-
genesis, clinical aspects, diagnosis and treatment of the
mere common urologic diseases are considered adequately,
it is believed, to the needs of active daily general prac-
tice either in the office or at the bedside. Special effort
has been made to instruct the reader in the requisites of
physical and laboratory examination and diagnostic study
up to the point of cystoscopic investigation or major uro-
surgical therapy. Minor urologic office procedures such
as meatotomy and the passage of catheters and sounds are
illustrated. A useful and stimulating inclusion in the
book is a chapter of questions with page references to the
answers.
Dr. Campbell, who is the author of several well
known works on Urology, is Emeritus Professor of
Urology, New York University; Consulting Urologist to
Bellevue Hospital, New York, to Variety Childrens Hos-
Grider son Surqieal Supply Go.
Established 1916
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301
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Trigger points
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Frozen shoulder
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o
MERCK SHARP ft DOHMt
DIVISION OF MERCK 1 CO.. INC.
PHILADELPHIA I. PA.
302
Volume XLIV
Number 3
pital, Miami, and to St. Francis Hospital, Miami Beach;
and Lecturer in Urology; University of Miami School of
Medicine.
General Urology. By Donald R. Smith, M.D. Pp.
328. Price, $4.50. Los Altos, Calif., Lange Medical
Publications, 1957.
This volume represents the latest in a series of concise
medical publications on clinical specialties. It is written
for the medical student and the medical practitioner who
has not specialized in urology but whose practice requires
a working familiarity with the diagnostic and therapeutic
technics available for the management of the genitouri-
nary diseases and disorders. In order to serve both
groups the author has combined both the practical and
the theoretic aspects of his subject. In the preface he
observes that although many serious urologic diseases
excite few, if any, symptoms, most can be discovered by
a medical examination which includes a P.S.P. renal
function test, simple radiographic technics, and, above
all, a careful urinalysis. He advises the reader to devote
particular attention to the section on urinalysis, for a
properly performed urinalysis is a very valuable clue to
many urologic diagnoses. Wherever possible, excretory
(intravenous) rather than retrograde urograms have been
used as illustrations since they are available to the non-
specialist and are superior in many ways to retrograde
studies. Selected references to the recent urologic litera-
ture have been appended to appropriate chapters for the
guidance of those who wish to investigate further any
specific disorder.
The author is Clinical Professor of Urology and Chair-
man of the Department of Urology of the University of
California School of Medicine. His teaching ability com-
bined with his wide selection of well chosen x-rays and
the artist’s excellent drawings make this a particularly
useful book for the medical student and the practicing
physician.
The Care of the Expectant Mother. By Jose-
phine Barnes, M.A., D M. (Oxon.), M.R.C.P. (London),
F.R.C.S. (England), F'.R.C.O.G. Pp. 270. Price, $7.50.
New York, Philosophical Library, 1956.
During the last 30 years, the importance of regular
and systematic examination and investigation of the preg-
nant woman has been recognized. The dramatic reduction
in maternal and infant mortality during this period may
be attributed in large measure to the improved care which
mothers receive during pregnancy. This book has been
written as a practical guide for all who undertake the
management of pregnancy. Much of it is based on routine
teaching given to medical students and pupil midwives in
lectures, antenatal clinics and antenatal ward rounds.
Its aim is to be simple and yet comprehensive. The three
sections of this readable study deal with normal preg-
nancy, abnormal pregnancy, and diseases complicating
pregnancy. There are numerous illustrations. The author,
who is Obstetrician and Gynaecologist to Charing Cross
Hospital and the Elizabeth Garrett Anderson Hospital,
London, England, presents in this volume material of
interest to the obstetrician, the general practitioner and
the medical student.
Battle for the Mind. By William Sargant. Pp.
266. Price, $4.50. Garden City, N. Y., Doubleday &
Company, Inc., 1957.
How can an evangelist convert a hard-boiled sophisti-
cate? Why does a PW sign a “confession” he knows is j
false? How is a criminal pressured into admitting his
guilt? Do the evangelist, the PW’s captor, and the
policeman use similar methods to gain their ends? These
and other compelling questions are discussed in this book.
The author spells out and illustrates the basic technic |
used by evangelists, psychiatrists and brain-washers to i
disperse the patterns of belief and behavior already es-
tablished in the minds of their hearers, and to substitute
(Continued on Page 312)
HB-METER
A SCIENTIFICALLY DESIGNED
INSTRUMENT FOR DETERMINING
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Ieptember, 1957
303
appetites
Finicky eaters are headed for a fast nutritional
build-up with Incremin — tasty appetite stimulant.
Incremin offers 1-Lysine for improved protein utili-
zation, and essential vitamins for their stimulating
effect on appetite.
Tasty Incremin is available in either Drops or Tab-
lets. Caramel-flavored Tablets may be orally dissolved,
chewed or swallowed. Cherry-flavored Drops may be
mixed with milk, formula or other liquid. Tablets:
bottles of 30. Drops: plastic dropper-type bottle of
15 cc.
Each Incremin Tablet
or each cc. of Incremin Drops contains:
1-Lysine 300 mg. Pyridoxine (B„) 5 mg.
Vitamin Bis 25 mcgm. (Incremin Drops con-
Thiamine (Bi) 10 mg. tain 1% alcohol)
Dosage: only 1 Incremin Tablet or 10-20 Incremin Drops
daily.
•Reg. U. S. Pal. Off.
LEDERLE LABORATORIES DIVISION
AMERICAN CYANAMID COMPANY
PEARL RIVER. NEW YORK
304
Volume XLIV
Number 3
PRICELE
Today all around us cut-rate and discount houses
flourish. You can buy glasses from $7.98 up. coon vision
comes a shade higher. In fact you can’t put a price
on vision. Your guild optician endeavors to place the finest in
eye wear before the public at the lowest possible prices.
Guild of Prescription Opticians of Florida
J. Florida, M. A.
September, 1957
305
Meat...
and the Need for Adequate
Protein in Therapeutic Nutrition
Liberal protein intake is considered to be of therapeutic value in a
wide variety of pathologic conditions.1 Advances in the understanding
of protein metabolism indicate that dietary protein should provide
amino acids in proportions paralleling physiologic needs.2’ 3 In ex-
perimental studies with animals, low protein diets supplying amino
acids disproportionate to needs have been shown to effect physiologic
harm by depressing growth, by inducing amino acid and B-vitamin
deficiencies, and by causing deposition of fat in the liver.4
Hence not only the amount of protein but also its quality (in terms of
its amino acid proportions) is important. It has been suggested1 that
for therapeutic purposes about two-thirds of the ingested protein come
from foods of animal source, whose protein resembles human body pro-
tein in amino acid interrelationships. Depending on the needs of the
patient, the therapeutic diet may supply 1 .0 or more grams of protein
per kilogram of body weight. Adequate caloric intake is required to
protect the dietary protein from dissipation for energy purposes.
Meat, with its high content of top-quality protein, holds a prominent
place among foods which supply this essential for establishing satis-
factory levels of amino acids in physiologic proportions. It also con-
tributes valuable amounts of B vitamins and essential minerals —
nutrients which play a basic role in intermediate metabolism.
1. Proudfit, P. T., and Robinson, C. H.: Nutrition and Diet Therapy, ed. 11, New York, The Mac-
millan Company, 1955, pp. 314-320.
2. Harper, A. E.: Amino Acid Imbalance, Toxicities and Antagonisms, Nutrition Rev. 74:225 (Aug.)
1956.
3. Amino Acid Requirements of Adult Man, Nutrition Rev. 74:232 (Aug.) 1956.
4 Amino Acid Imbalance and Supplementation, Editorial, J.A.M.A. 767:884 (.June 30) 1956.
Council on Foods and Nutrition, American Medical Association: Importance of Amino Acid
Balance in Nutrition, J.A.M.A. 756:655 (June 25) 1955.
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nutri-
tion of the American Medical Association and found
consistent with current authoritative medical opinion.
American Meat Institute
Main Office, Chicago... Members Throughout the United States
306
Volume XI.IV
Number 3
It will pay you well
to check
and double check
\ \
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In the hospital — and at home.
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the "do-it-
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For persons who overestimate their physical capacity
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Sigmagen therapy is encouraged in the treatment of
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Sigmagen provides doubly protective corticoid-salicyl-
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Therapy should be individualized. Acute conditions:
2 or 3 tablets 4 times daily. Following desired response,
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For best results administer after meals and at bedtime.
Precautions: Because Sigmagen contains prednisone,
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for patients who go beyond their physical capacity
protective corticoid-salicylate therapy
Sigmagen
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325 mg. Ascorbic acid 20 mg.
GO*J*BS7
AN ANNOUNCEMENT TO THE MEDICAL PROFESSION OF
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THE CHALLENGE:
Can a cigarette be made that will give sign:
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ICE NT with the I NEW I exclusive Micronite Filt
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ORTANT NEW DEVELOPMENT IN FILTER CIGARETTES
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P. Lorillard Company, makers of KENT
with the new exclusive Micronite Filter
312
Volume XLIV
Number 3
Whatever your first requi-
sites may be, we always
endeavor to maintain a
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with our reputation for fine qual-
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( Continued from Pane 302 )
new patterns for them. There is much hopeful news here
concerning the treatment of the mentally ill. Dr. Sargant
makes clear the relation of the new “mind-drugs” to
his topic and includes a chapter on how to avoid being
indoctrinated and on how to consolidate changes of be-
lief and behavior when desirable.
Dr. Sargant is now Physician in Charge of the De-
partment of Psychological Medicine at one of England’s
oldest and best known medical schools. He is present
President of the Section of Psychiatry of the Royal
Society of Medicine, and also Registrar of the Royal
Medico-Psychological Association. In 1938-1939 he spent
a year on a Rockefeller Travelling Fellowship at Har-
vard, where he was Research Fellow in Psychiatry. In
1947-1948 he was invited to become Visiting Professor of
Neuropsychiatry at Duke University. Altogether he has
visited or worked in the United States on four different
occasions in the past 18 years.
The Compleat Pediatrician: For General Practi-
tioners, Pediatricians, Interns and Students. By W. C.
Davison, M.D., and Jeana Davison Levinthal, M.D. Ed.
7. Pp. 272. Price, $4.25. Durham, N. C., Duke Uni-
versity Press, 1957.
This comprehensive summary of pediatric facts is an
invaluable guide to practical, diagnostic, therapeutic and
preventive pediatrics. In condensed form, it covers the
diagnosis, treatment and prevention of disease, and the
feeding, growth, development and guidance of children,
emphasizing (1) the recognition of ill children, their dis-
eases and what to do for them, and equally important,
(2) routine child care (physical, mental and emotional)
from conception through adolescence. This seventh edition
has been written because of the great progress in antibi-
otics, anticonvulsants, antihistaminics, electrolytes and
steroids, and the necessity of removing all of the now
obsolete “formerly accepted pediatric facts.”
In the preparation of this edition, the distinguished
senior author was joined by his daughter as co-author.
She is now an Instructor in Pediatrics at the University
of Michigan School of Medicine. Dr. Davison, Professor
of Pediatrics at Duke University School of Medicine,
writes in the Preface: “This book represents an effort to
compile and condense those practical pediatric facts,
which though essential, usually slip from memory ; it is
an attempt to combine in one volume the information
usually found in several, which should be consulted for
more complete study. It is hoped that this book may
serve as a ready reminder to be carried, like a stetho-
scope, in a physician’s pocket or bag to jog his mem-
ory on possibilities, but it cannot do his thinking for
him. Memory is treacherous, a mere reminder often
makes a physician the master of a situation.” It should
be an essential for any practitioner caring for children,
and has aptly been described as a world almanac of {
pediatrics.
Drugs in Current Use 1957. Edited by Walter
Modell, M.D., F.A.C.P. Pp. 152. Price, $2.00. New
York, Springer Publishing Company, Inc, 1957.
This is the third volume of an annually revised listing
of drugs in common use. It includes well established
drugs, some still on trial, old ones of questionable or
purely traditional value but still likely to be encountered
and, in addition, some drugs seen only as the cause of
poisoning and some that are obviously doomed but which,
for sentimental reasons, one is reluctant to discard. The
purpose is to provide a concise statement of the principal
pharmacologic characteristics of drugs in current use;
major uses; physical properties; absorption; actions, both
therapeutic and toxic; mode of administration; prepara-
tions; dosage; and specific antidotes against poisoning
when these are available. In other words, the book pro-
vides a capsule account of the data essential to the sen-
sible exploitation and safe handling of a drug. In most
cases some special warnings are issued which draw atten-
tion not only to dangerous reactions and contraindications
Florida, M. A.
:rtf.mber, 1957
313
Current Concepts in
Infant Carbohydrate
Metabolism
JLhe adequately balanced diet must con-
tain carbohydrate as an essential nutrient.
Though some carbohydrate becomes available
to the body from the transformation of protein
and fat, these sources contribute minor amounts
of the total carbohydrate requirement.
Body energy comes from the oxidation of
carbohydrate and fat but carbohydrates are oxi-
dized preferentially. The brain derives its supply
of energy exclusively from the oxidation of car-
bohydrate. Besides, the infant’s requirement for
energy is unusually high and can be most readily
satisfied by carbohydrate.
All tissues of the body constantly require and
use carbohydrate under all conditions. Even a
temporary fall of the blood sugar below critical
levels is accompanied by serious disability. How-
ever, the amount of carbohydrate in the body
at one time is very small. It would sustain life
for only a fraction of a day. Consequently, the
infant must be offered carbohydrate frequently
to yield a generous proportion, usually over half,
of the total caloric intake.
The breast-fed infant receives about 12 gms.
of carbohydrate per kilo body weight, while the
artificially fed infant receives about 8 to 14 gms.
per kilo. In the choice of an added carbohydrate,
we must consider adaptability, tolerance, di-
gestability, absorption, fermentability, and irri-
tation to the intestines.
The same problems of infant feeding recur
from generation to generation, but solutions may
differ with each era. The carbohydrate require-
ment for all infants is as completely fulfilled by
KARO® Syrup today as a generation ago. What-
ever the type of milk adapted to the individual
infant, KARO Syrup may be added confidently
because it is a balanced mixture of low-molecular
weight sugars, readily miscible, well tolerated,
palliative, hypoallergenic, resistant to fermenta-
tion in the intestine, easily digestible, readily
absorbed and non-laxative. It is readily available
in all food stores.
MEDICAL DIVISION
CORN PRODUCTS REFINING CO.
17 Battery Place, New York 4, N. Y.
INFANTS’ CALORIC
CALS.
Per Pound
CALS.
Per Kilo
CALS.
Per 24 hrs
AGE
(Months)
500
625
725
750
800
825
850
875
900
950
000
200
Produced by
Corn Products Refining Co.
314
Volume XL
Number 3
”
in bronchial asthma and respiratory allergies
specify the buffered “predni-steroids”
to minimize gastric distress
combined steroid-antacid therapy
‘Co-Deltra’ or ‘Co-Hydel-
tra’ provides all the bene-
fits of “predni-steroid”
therapy and minimizes the
likelihood of gastric distress
which might otherwise im-
pede therapy. They provide
easier breathing— and
smoother control— in bron-
chial asthma or stubborn
respiratory allergies.
supplied: Multiple Compressed
Tablets ‘Co-Deltra’ or 'Co-Hy-
deltra’ in bottles of 30, 100, and
500.
Multiple
Compressed
Tablets
Co Delira
(Prednisone buffered)
2.5 mg. or 5.0 mg.
of prednisone or
prednisolone, plus
300 mg. of dried
aluminum
hydroxide
gel and 50 mg.
of magnesium
trisilicate.
(Prednisolone buffered)
MERCK SHARP & DOHME
DIVISION OF MERCK & CO.. INC.
PHILADELPHIA 1. PA.
•CO-DELTRA* and ’CO-HYDELTRA* are
registered trademarks of Merck & Co.. Inc*
r. Florida, M. A
September, 1957
315
but also to instability, special requirements for storage
mci for prevention of deterioration, and time limits be-
fore significant loss in potency or change in pharmaco-
logic properties.
Short essays on pharmacologic groups of drugs are
llso included in the alphabetic listing. These essays deal
with the problems of use, and actions and dangers
characteristic of drugs as a group. Therapeutic groups
of drugs in common use are also listed. Drugs are de-
I scribed under their official names wherever these have
been established. Because of widespread usage, proprie-
tary names and synonyms could not be ignored in a real-
istic presentation, the more common ones are usually
included.
The Fight for Fluoridation. By Donald R. Mc-
; Veil. Pp. 246. Price, $5.00. New York, Oxford University
Press, 1957.
The American Dental Association, the American Med-
cal Association, the American Public Health Association,
the United States Public Health Service, the National
Research Council, and almost every national scientific
body are among more than 200 nationally known organ-
izations which have endorsed fluoridation. Yet fluorida-
Ition remains a controversial subject, even in some of the
cities where it has been adopted. In fact, the impact of
the fluoridation struggle has had far-reaching effects on
the social and political equanimity of hundreds of towns
and cities in the nation. Local arguments are hot and
heavy, and for years to come many communities will go
to the polls to decide the question of fluoridation.
For this accurate and absorbing history of fluorida-
tion, Donald R. McNeil, Associate Director of the Wis-
onsin State Historical Association, studied all the
important published literature on the subject from 1916
to 1956 as well as original manuscripts and the corre-
spondence of the leading figures. The research that
preceded fluoridation and the struggles that have sur-
rounded it as a public health measure are his story, one
that suggests parallels with the fights for vaccination and
pasteurization. It is a dramatic tale of trial and error,
enthusiasm and skepticism, seriousness and humor, and,
above all, success.
Ciba Foundation Symposium on Bone Struc-
ture and Metabolism. Editors for the Ciba Founda-
tion, G. E. W. Wolstenholme, O.B.E., M.A., M B.,
B.Ch., and Cecilia M. O’Connor, B.Sc. Pp. 299. Illus. 121.
Price, $8.00. Boston, Little, Brown and Company, 1956.
“Bone Structure and Metabolism” covers the subject
from fundamental knowledge of anatomy and histology
through biochemistry and physiology to clinical medicine.
Here one can find much basic information on bone and,
“rather surprisingly, much lamentation about our igno-
rance of many clinical problems.” The book presents in
full, with only a minimum of editing, the proceedings of
a symposium on Bone Structure and Metabolism, which
was among the small international conferences organized
at the Ciba Foundation in London in 1955.
A partial table of contents includes: structure of bone
from the anatomic to the molecular level; structure of
bone salts; the histologic remodeling of adult bone, an
autoradiographic study; fibrogenesis and the formation
of matrix in developing bone; the mucopolysaccharides
of bone; autoradiographic studies of the formation of the
organic matrix of cartilage, bone, and tissues of teeth ; in
vitro uptake and exchange of bone citrate; the mag-
nesium content of bone in hypomagnesaemic disorders of
livestock; the mechanism of nutrition in bone and how
it affects its structure, repair, and fate on transplanta-
tion; studies on the repair of fractures using’'2 P; meta-
bolic studies on vitamin D ; variations in sensitivity to
vitamin D; present knowledge of parathyroid function,
with especial emphasis upon its limitations; vascularity
of bone in relation to pathologic studies; some observa-
tions on experimental bone disease, and bone as a critical
organ for the deposition of radioactive materials.
when anxiety and tension "erupts” in the G. I. tract...
in spastic
and irritable colon
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.} tlie most widely prescribed tranquilizer. . . helps control the
“emotional overlay” of spastic and irntaole colon — without fear of barbiturate loginess, hangover or
habituation . . . j with PATHILON (25 ?n<r.) anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
let t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark tor Tridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
Dosage: 1
316
Volume XF.IV
Number 3
for “This Wormy World”
Pleasant tasting
‘ANTEPAR!
brand
PIPERAZINE
SYRUP - TABLETS - WAFERS
Eliminate PINWORMS IN ONE WEEK
ROUNDWORMS IN ONE OR TWO DAYS
PALATABLE • DEPENDABLE • ECONOMICAL
‘ANTEPAR' SYRUP “ Piperazine Citrate, 100 mg. per cc.
‘ANTEPAR' TABLETS -Piperazine Citrate, 250 or 500 mg., scored
‘ANTEPAR’ WAFERS — Piperazine Phosphate, 500 mg.
Literature available on request
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.
k
T. Florida, M. A.
September, 1957
317
The Official American Medical Association
Book of Health. Edited by Dr. W. W. Bauer. Ed. 1.
Pp. 320. Price, 35 cents. New York, Dell Publishing
Company, Inc., 1957.
This pocket size book on health is a Dell first edition
popularly priced and compiled for the laity from recent
irticles and editorials in Today’s Health, of which Dr.
\V. W. Bauer is Chief Editor. The approach is through
he modern concept of health having three separate
omponents — the physical, the mental or emotional, and
he spiritual. The book contains material from a wide
; . ariety of sources — medical, dental, public health, edu-
ational, sociological, governmental, and lay. «
“It is not a solemn book,” explains Dr. Bauer in the
[Introduction. “Health, in our view, is not a solemn sub-
lect. It is — or ought to be — a happy one. But physical
liealth alone does not assure happiness. With emotional
[balance and spiritual strength added, however, an indi-
1 .idual can be happy even in adversity. We have tried
I o select material for happy people. We have included
,ome light material which may entertain you and help
rou to keep your perspective on health ; perhaps it will
Ijdso serve to brighten a dark moment in a dreary day.
\s you read the pages which follow, we hope you will
■ome to regard good health as a means to a fuller, richer
jife, and not as an end in itself.” Certainly the laity will
-profit by reading this comprehensive little volume.
Liver, Biliary Tract and Pancreas, Part III
>f Volume 3, Digestive System, The Ciba Col-
ection of Medical Illustrations. By Frank H.
JINetter, M.D. Pp. 165. Color plates 133. Price, $10.50.
Summit, N. J., Ciba Pharmaceutical Products, Inc., 1957.
Publication of the third volume in the estimated nine
olume. 20 year project to create for medicine the first
lefinitive collection of authentic, full color illustrations of
very significant segment of the human body and dis-
ases that affect it has just been announced by Ciba
I ’harmaceutical Products, Inc. The artist for the entire
leries is the country’s leading medical illustrator, Dr.
•'rank H. Netter of Norwich, Long Island.
Volume 3 is being developed in three parts. “Liver,
iiliary Tract and Pancreas,” now available, is actually
’art III of this third volume. The decision to publish this
ection before Parts I and II was based on a survey
which showed that the subject covered in Part III was
econd only to the nervous system in interest to the
aedical profession. The topics included in Part III are:
lormal anatomy of the liver, biliary tract and pancreas,
igns and symptoms of disease, diagnostic tests, congeni-
tal anomalies, host/parasite relationships and blood
upply to tissues. Part I will deal with the upper diges-
ive tract; Part II with the lower digestive tract. Part
III also incorporates a new feature designed to enhance
the book’s value as a versatile, multipurpose aid to
clinicians, teachers, researchers and students, namely,
literature references for the convenience of those wishing
to follow up any topics discussed in the text.
According to Dr. Ernst Oppenheimer, editor of The
Ciba Collection, all anatomic details, “whether essential or
bordering on the trivial,” are recapitulated by Dr. Netter.
“All available texts and other publications, particularly
the pertinent literature of the past 25 years, are read,
checked, rechecked and compared.” All volumes in the
Collection are sold at cost as a service to the medical
profession and medical students.
Allens Invalid Home
I MILLHDGHVILLE, GA. |
; lisltiblisbctl I H'JI) j
l or the treatment of
NIBVOGS AND MFN’TAL DISliASliS
Grounds 600 Acres
Buildings Brick Fireproof
! Comfortable Convenient !
Site High and Healthful
E. VV. Allen, M.D., Department lor Men
II I). Allen, M.D., Department for Women
Terms Reasonable
4. — 4-
SUN RAY PARK
HEALTH RESORT
SANITARIUM IN MIAMI
Medical Hospital American Plan
■lotel for Patients and their families.
?EST, CONVALESCENCE, ACUTE and
CHRONIC MEDICAL CASES. Elderly
People and Invalids. FREE Booklet!
Acres Tropical Grounds, Delicious Meals,
Res. Physician, Grad. Nurses, Dietitian.
125 S.W. 30TH COURT, MIAMI, FLORIDA
PHONE:
HI 6-1659
Under New Medical
Direction and Man-
agement.
MEMBER, AMERICAN HOSPITAL ASSOCIATION
MEMBER, FLORIDA HOSPITAL ASSOCIATION
318
Volume XI, I\
Number .3
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the sc?nic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
-
Westbrook Sanatorium
RICHMOND- • • 6$tabLish?d I<)U ■ • • V 1 RG 1 N i A
§00$$!
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin. psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff
PAUL V. ANDERSON. M.D., President
REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR.. M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and J/ietvs Sent On Request • P. O. Box 1514 - Phone 5-3245
J. Florida, M. A.
September, 1957
319
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association of
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D.
Medical Director
P. O. Box 218
ALBERT F. BRAWNER, M.D.
Assistant Director
Phone 5-4486
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
320
Volume XLIV
Number 3
mim
Information
Brochure
Ratet
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
• Modern Treatment Facilities
• Psychotherapy Emphasized
• Large Trained Staff
• Individual Attention
• Capacity Limited
• Occupational and Hobby Therapy
• Healthful Outdoor Recreation
• Supervised Sports
• Religious Services
• Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WAITER H. WELLBORN, Jr.. M L)
PETER J. SPOTO.
M.D.
ZACK RUSS, Jr., M.D.
Consultants in Psychiatry
ARTURO G.
GONZALEZ, M.D
SAMUEL G. WARSON,
M.D.
ROGER E. PHILLIPS, M.D.
WAITER
H. BAILEY, M.D
TARPON
SPRINGS •
FLORIDA
• ON THE GULF OF MEXICO
• PH. VICTOR
2- 1 8 1 1
5226 Nichol St. DON SAVAGE P. O. Box 10368
Telephone 61-4191 Owner cmd Manage: Tampa 9. Florida
BALLAST POINT MANOR
Safety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
J. Florida, M. A.
September, 1957
INDEX TO ADVERTISERS
321
Abbott Laboratories
218a,
218b
• Lakeside Laboratories
213
Allen’s Invalid Home
317
• Lederle Laboratories
. 268, 269, 281, 282,
285, 291, 303, 315
American Meat
303
Ames Co., Inc
Third Cover
• Lewal Pharmaceutical Co.
222
Anclote Manor
320
• Eli Lillv & Co.
226
Anderson Surgical Supply Co.
300
• P. Lorillard Co.
. 310, 311
Appalachian Hall
319
♦ Medical Protective Co.
312
Armour Laboratories
296
297
• Medical Supplv Co.
298
Ayerst Laboratories 284,
294, 294a,
294b
• Merck Sharp & Dohme
280, 301, 314
Baker Laboratories, Inc.
306
• Miami Medical Center
323
Ballast Point Manor
320
* Parke-Davis & Co.
Second Cover, 211, 215,
Bayer Co
219
216, 217
Brawner’s Sanitarium
319
• Pfizer Laboratories
279
Brayten Pharmaceutical Co.
292
• Picker X-Ray Corp.
299
Burroughs Wellcome & Co
214, 220
316
• Quincy X-Ray & Radium Labs.
276
Convention Press
312
0 Riker Laboratories
290
Corn Products Co
313
• A. H. Robins & Co
293, 307
Drug Specialties, Inc
218
• Roerig & Co
223
Duvall Home
276
• Schering Corp.
224, 225, 308, 309
Emory University School of Medicine
274
• G. D. Searle Company
275
Endo Laboratories
295
• Smith, Kline & French Labs.
Back Cover
Fort Lauderdale Beach Hospital
322
• E. R. Squibb & Sons
286
Geigy Pharmaceuticals
221
• Sun Ray Park Health Resort
317
Guild of Prescription Opticians
304
° Surgical Supply Co.
302
Highland Hospital, Inc.
318
• Tucker Hospital, Inc.
322
Hill Crest Sanitarium
321
• Wallace Laboratories
286a, 286b, 287
Chas B. Knox Gelatine Co.
283
• Westbrook Sanatorium
318
L. & B. Laboratories, Inc
. 278
• Winthrop Laboratories, Inc.
288, 289
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
Out-Patient Clinic and Offices
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrlh 1-1151
322
Volume XI.TV
Number 3
*
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Du. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
FORT LAUDERDALE BEACH HOSPITAL
125 N. Birch Rd., Ft. Lauderdale, Florida
f
A modern hospital for general
medical care, with excellent
diagnostic, therapeutic and re-
habilitation facilities.
Patients under care of private
physicians.
For information write to the
Medical Director or Kenneth A.
Dahl, Administrator, Fort Lau-
derdale Beach Hospital, 125 N.
Birch Road, Fort Lauderdale,
1
a, M. A.
er, 1957
SCHEDULE OF MEETINGS
323
ORGANIZATION
PRESIDENT
SECRETARY
ANNUAL MEETING
Medical Association
Medical Districts
rthwest
rtheast
ithwest
jtheast
Specialty Societies
y of General Practice
Society
siologists, Soc. of
hys., Am. Coll., Fla. Chap.
ind Syph.. Assn of
Officers’ Society
ial and Railway Surgeons
1 Gynec. Society
1. & Otol., Soc. of
■die Society
gists, Society of
ic Society
& Reconstructive Surgery
)gic Society
trie Society
igical Society
is, Am. Coll., Fla. Chapter
cal Society
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Joel V. McCall Jr., Daytona Beach
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Burns A. Dobbins Jr., Ft. L’d’dale
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
Miami Beach, May 10-14, ’58
Panama City, Oct. 28, ’57
Orlando, Oct. 30, ’57
Clearwater, Oct. 29, ’57
Fort Pierce, Oct. 31, ’57
St. Petersburg, Oct. 31-Nov. 2, 57
Miami Beach, May 1958
11 »
11 11
11 11
11 11
>> 11
Nov. 30-Dec. 1, ’57
Jan. 58
Miami Beach, May 1958
11 11
W. Palm Beach, Oct. 31-Nov. 3, ‘57
Miami Beach, May 1958
Nov. ’57
Miami Beach, May 1958
Miami Beach, May 11, ’58
Miami Beach, May 1958
Science Exam. Board
i Banks, Association
Cross of Florida, Inc
Shield of Florida, Inc
er Council
etes Assn
al Society, State
t Association
ital Association
cal Examining Board
cal Postgraduate Course
e Anesthetists, Fla. Assn.
es Association, State
maceutical Assoc., State
ic Health Association
eau Society
rculosis & Health Assn.
Ian’s Auxiliary
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
Edward R. Smith, Jacksonville
Bryant S. Cattoll, D.D.S. Jax.
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal.
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Joseph J. Lowenthal, Jacksonville
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Clarence L. Brumback, W. P. B.
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
Gainesville, Nov. 9, ’57
Ponte Vedra, May 1958
Miami Beach, May 1958
11 11
Gainesville, Oct. 24-26, ’57
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
Clearwater, Nov. 21-22, ’57
Miami, Nov. 24-26, ’57
Clearwater, Oct. 17-19, ’57
Jacksonville, May 18-21, ’58
Ft. Lauderdale, Oct. 31-Nov. 2, ’57
Miami Beach, May 10-14, ’58
an Medical Association
A. Clinical Session
rn Medical Association
ta Medical Association
i, Medical Assn, of
lospital Conference
astern Allergy Assn
astern, Am. Urological Assn.
astern Surgical Congress
'oast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. 0. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala.
Geo. F. Lull, Chicago
Mr. V. 0. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala.
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Miami Beach, Nov. 11-14, ’57
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Charleston, S.C., Nov. 1-2, ’57
Hollywood, Jan. 12-16, ’58
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin, Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Memoer American Hospital Association
324
Volume XLIV
Number 3
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
BLUE SHIELD LIAISON
WILLIAM C. ROBERTS, M.D., President Panama City
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RAl PH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D..
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . Jacksonville
SHALER RICHARDSON, M.D., Editor. .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR., M.D. . . AL-58 Ocala
GEORGE S. PALMER, M.D. A-58 Tallahassee
CLYDE O. ANDERSON, M.D. C-59 St. Petersburg
REUBEN B. CHRISMAN JR., M.D. D-60. Cora! Gables
MEREDITH MALLORY, M.D. B-61 Orlando
JOHN D. MILTON, M.D. . PP-58 Miami
FRANCIS H. LANGLEY, M.D...PP-59. .St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. Jacksonville
EDWARD JELKS, M.D. (Public Relations) Jacksonville
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A 58 .... Tallahassee
JOHN J. CHELEDEN, M.D. B 58 Daytona Beach
JOHN M. BUTCHER, M.D. C-58 Sarasota
PAUL G. SHELL, M.D. D-58 . . Fort Lauderdale
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
HENRY L. HARRELL, M.D. B 59 Ocala
JAMES R. BOULWARE JR., M.D. C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 IV. Palm Beach
MERRITT R. CLEMENTS, M.D. A 60 Tallahassee
ROBERT E. ZELLNER, M.D B-60 Orlando
WHITMAN C. McCONNFLL, M.D C-60 St. Petersburg
RALPH S. SAPPENFIELD, M.D. I) 60 Miami
HAROLD E. WAGER, M.D. A-6I Panama City
CHARLES F. McCRORY, M.D. B 61 Jacksonville
JOHN S. STEWART, M.D C-61 Fort Myers
DONALD F. MARION, M.D. D61 Miami
CANCER CONTROL
ASHBF.L C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
SAMUEL B. D. RHEA, M.D. A 59 Pensacola
ALFONSO F. MASSARO, M.D. C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D. B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm. D 58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D. AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D A-60 Tallahassee
J. K. DAVID JR., M.D. B-61 Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
CIVIL DEFENSE AND DISASTER
Stibcont mittees
1. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D. Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) - Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
I. ROCHER CHAPPELL, M.D., Chm. AL-58 Orlando
WILLIAM W. TRICE JR., M.D. C-58 Tampa
JOHN V. HANDWERKER JR., M.D D 59 Miami
WALTER C. PAYNE JR., M.D. A-60 Pensacola
W. DEAN STEWARD, M.D B-61 Orlando
CONSERl'ATION OF VISION
CARL S. McLEMORE, M.D., Chm. AL-58 Orlando
HUGH E. PARSONS, M.D. C-58 Tampa
CHARLES C. GRACE, M.D. B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D. D 61 W. Palm Beach
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL-58 Brooksville
First— ALPHEUS T. KENNEDY, M.D. 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D 3-58 Jacksonville
Fourth— DON C. ROBERTSON, M.D 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D....6-58 Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
FOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm. Orlando
THOMAS II. BATES, M.D. "A” Lake City
FRANK I.. FORT, M.D. '‘B” Jacksonville
ALVIN L. MILLS, M.D. “C" St. Petersburg
JOHN D. MILTON, M.D “D” Miami
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D St. Petersburg
JOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D Orlando
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59...._ Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D. D-60 W. Palm Beach
GEORGE H. GARMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
BLOOD
MATERNAL WELFARE
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
LEO F.. REILLY, M.D AL-58 Panama City
ROBERT B. McIVER, M.D. B-58 Jacksonville
GRETCHEN V. SQUIRES, M.D... . A-59 Pensacola
DONALD W. SMITH, M.D D-60 Miami
E. FRANK McCALL, M.D., Chm B-60 ....
WILLIAM C. FONTAINE, M.D AL-58
I. LLOYD MASSEY M.D. A-58
RICHARD F. STOVER, M.D D 59
S. L. WATSON, M.D C.61
... Jacksonville
Panama City
Quincy
Miami
Lakeland
r. Florida, M. A.
September, 1957
325
MEDICAL ECONOMICS
IOBERT E. ZEELNER, M.D., Chm. AL-58 Orlando
1EW1TT C. DAUGHTRY, M.D. I)-58 Miami
, CARNES HARVARD, M.D. C-59 Brooksville
vlERRITT R. CLEMENTS, M.D. A-60 Tallahassee
LOYD K. HURT, M.D B-61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL .JR., M.D. Chm. B 60 Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD REESER JR., M.D. C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D. A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
ACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
>AUL ). COUGHLIN, M.D. AL-58 Tallahassee
VILLIAM G. MERIWETHER, M.D. C-59 Plant City
FALTER E. MURPHREE, M.D. B 60 Gainesville
iAYMOND B. SQUIRES, M.D. A 61 Pensacola
Subcommittee
Medical Schools Liaison
VALTER E. MURPHREE, M.D., Chm. AL-58. Gainesville
vlERRITT R. CLEMENTS. M.D., A 60 Tallahassee
IENRY H. GRAHAM, M.D. B 58 Gainesville
AMES N. PATTERSON, M.D. C-61 Tampa
DWARD W. CUI.LIPHER, M.D. D 59 Miami
IOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 - Miami
3EORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm. A 60 Chattahoochee
NELSON H. KRAEFT, M.D AI.-58 Tallahassee
WILLIAM L. MUSSER, M.D. B 58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D. D 61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. R 61 Jacksonville
HENRY I LANGSTON, M.D. AL-58 Marianna
JOHN G. CHESNEY, M.D. D-58 Miami
HAWLEY H. SEILER, M.D C 59 Tampa
HAROLD li. CANNING, M.D. A 60 Wewahitchka
Special Assignment
1 . Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURSE
URNER Z. CASON, M.D., Chm. B-59 Jacksonville
EO M. WACHTEL, M.D AL 58 Jacksonville
FRANK CHUNN, M.D. C-58 Tampa
VILLIAM D. CAWTHON, M.D. A-60 _D eFuniah Springs
. MARKLIN JOHNSON, M.D D 61 W. Palm Beach
MENTAL HEALTH
ULLIVAN G. BEDELL, M.D., Chm. B-61 Jacksonville
VILLIAM M. C. WILHOIT, M.D. AL 58 Pensacola
LLOYD MASSEY, M.D A-58 Quince
V. TRACY HAVERFIEI.D, M.D. D 59 Miami
1ASON TRUPP, M.D C-60 Tampa
NECROLOGY
BASIL HALL, M.D., Chm AL-58 Tavares
VALTER W. SACKETT JR., M.D D-58 Miami
EO M. WACHTEL, M.D B-59 Jacksonville
LVIN L. STEBBINS, M.D A 60 Pensacola
AYMOND H. CENTER, M.D C-61 Clearwater
NURSING
HOMAS C. KENASTON, M.D., Chm. B 59 Cocoa
ARL M. HERBERT, M.D AL-58 Gainesville
(FRBERT L. BRYANS. M.D. A 58 Pensacola
I0RVAL M. MARR SR., M.D. C-60 St. Petersburg
AMES R. SORY, M.D D 61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
ICHARD G. SKINNER JR., M.D., Chm B-59 Jacksonville
)HN J. BENTON, M.D AL-58 - Panama City
EORGE S. PALMER, M.D A-58 Tallahassee
DWARD W. CULLIPHER, M.D. 1)60 Miami
RANK H. LINDEMAN JR., M.D. C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
ASCAL G. BATSON JR., M.D., Chm. A 60 Pensacola
/ILLIAM J. HUTCHISON, M.D. AL-58 Tallahassee
HAS. L. FARRINGTON, M.D C-58 St. Petersburg
HOMAS N. RYON, M.D. D-59 Miami
AYMOND R. KILLINGER, M.D. B-61 Jacksonville
pedal Assignment
Industrial Health
C. W. SHACKELFORD, M.D., Chm. A-61 Panama Citv
FRANK V. CHAPPELL, M.D. AL-58 Tampa
A. BUIST LITTERER, M.D. D-58 ' Miami
LINUS W. HEWIT, M.D C-59 Tampa
I.ORF.NZO L. PARKS, M.D. B 60 Jacksonville
WOMAN'S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
IOHN H. TERRY, M.D. AL 58 Jacksonville
WILEY M. SAMS, M.D. D-58 Miami
G. DEKLE TAYLOR, M.D. B-59 Jacksonville
CHARLES McC. GRAY, M.D. C 61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
IOHN C. VINSON, M.D., 1924 Fort Myers
JOHN S. McEWAN, M.D., 1925 Orlando
FREDERICK J. WAAS, M.D., 1928 Jacksonville
1ULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT. M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valiev, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
lOSEPII S. STEWART. M l).. 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M l)., 1951 Tampa
ROBERT B. McIVER. M.D., 1952 Jacksonville
FREDERICK K. HERPF.L, M.D, 1953 IV. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
IOHN D. MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M l)., Secy., 1956 St. Petersburg
County Medical Societies of Florida
326
Volume XUV
Number 3
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the power of gentleness
allays anxiety and tension
without depression, drowsiness, motor incoordination
Nostyn is a calmative— not a hypnotic-sedative — unrelated to any available
chemopsychotherapeutic agent • no evidence of cumulation or habituation • does
not increase gastric acidity or motility • unusually wide margin of safety
— no significant side effects
dosage : 1 50-300 mg. (Vz to 1 tablet) three or four times daily,
supplied: 300 mg. scored tablets, bottles of 48 and 500.
*Ferguson, J. T., and Linn, F. V. Z.: Antibiotic Med. & Clin. Therapy 3 : 329, 1956.
AMES COMPANY, INC • ELKHART, INDIANA ^
AMES COMPANY OF CANADA. LTD.. TORONTO
i
Gertrude L. Annan, Librarian
The New York Academy of Medicine
2 East 103rd St. {'
New York 29, N.Y.
• over IO r
, F. M. A.
Medical District Meeting*
October
y^=> 0 ^
r^CT3C'57< ^^ _
= c
— I.D. i3i3oal
treated in the United States
• over 6700 articles published
throughout the world
THORAZINE*
chlorpromazine, S.K.F.
one of the fundamental drugs in medicine
O
*T.M. Reg. U.S. Pat. Off.
OCTOBEF
Vol. XLIV
OFFICIAL PUBLICATION OF THE
FLORIDA MEDICAL ASSOCIATION
I \Vm ill W- 1
mm
T! W
for greater specificity
and flexibility
in treatment
for convulsive disorders
PARKE -DAVIS
now offers
a comprehensive group
of anticonvulsants
for grand mal and psychomotor seizures
Sodium (diphenylhydantoin sodium, Parke-
■ ■ jk ^ ■■■■ ^ m® Davis) is supplied in a variety of forms —
ILsP I La 1^1 □ including Kapseals® of 0.03 Gm. and of 0.1 Gm.
in bottles of 100 and 1,000.
PHELANTIN
Kapseals (Dilantin 100 mg., phenobarbital 30
mg., desoxyephedrine hydrochloride 2.5 mg.),
bottles of 100.
CELONTIN"
for the petit mal triad
Kapseals (methsuximide, Parke-Davis) 0.3 Gm.,
bottles of 100.
MILONTIN
Kapseals (phensuximide, Parke-Davis) 0.5 Gm.,
bottles of 100 and 1,000.
MILONTIN Suspension, 250 mg. per 4 cc.,
16-ounce bottles.
PARKE, DAVIS & COMPANY- DETROIT 32, MICHIGAN
C A /If
tout
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
volume xliv, No. 4 ♦ October ; 1957
CONTENT S
Scientific Articles
Progress in Cancer Control, John R. Heller, M.D. 347
A Brief Preliminary Report on a New Anticholinergic:
Hexocyclium Methosulfate, Gordon H. Ira, M.D. 356
Hazards in the Management of Peptic Ulcer with
Anticholinergic Drugs, Hyman J. Roberts, M.D. 357
Neglected Phase of Management of Bronchial Asthma,
George Gittelson, M.D. 364
The Treatment of Cardiac Arrhythmias by Drugs,
Clifton B. Leech, M.D. 367
Abstracts
Drs. William S. Hatt, Roger E. Phillips, John H. Terry, T.
Vernon Finch, Arthur R. Nelson, Wiley M. Sams, John I.
Williams, Russell B. Carson and W. Dotson Wells 372
Editorials and Commentaries
Asiatic Influenza Epidemic — Fact or Fancy 375
Association Program to Combat Possible Asian
Influenza Outbreak in Florida 377
Small Business Administration New Loan Policy 377
Environment of Good Cheer and Hope for the Mentally 111 378
Medical District Meetings — October 28-31 38C
Graduate Medical Education
Florida Clinical Diabetes Association, Gainesville,
October 24-26, 1957 381
Florida Clinical Diabetes Association Program 382
Florida Academy of General Practice
St. Petersburg, October 3 1 - November 2 382 ;
Florida Academy of General Practice Program 3831
Southern Medical Association, Miami Beach, November 1 1-14 384
General Features
President’s Page 37^
Others Are Saying 38f
State News Items 38(
Component Society Notes 39^
New Members 39^
Classified 396
Births and Deaths 39(
Medical Officers Returned 39t
Obituaries 398
Books Received 42’. 1
Schedule of Meetings 44.
Florida Medical Association Officers and Committees 44- }
County Medical Societies of Florida 44(
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville. Florida. Price $5.00 a year: single numbers. 50 cents. Address Journal of Florid
Medical Association, P.O. Box 2411. 735 Riverside Ave., Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail
ing at special rate of postage provided for in Section 1103. Act of Congress of October 3. 1917: authorized October If
1918. Entered as second-class matter under Act of Congress of March 3. 1879. at the post office at Jacksonville
Florida. October 23. 1924
J. Florida, M. A.
October, 195 7
333
your patients with generalized gastrointestinal
complaints need the comprehensive benefits of
Tridal
CDACTIL® + PI PT AL® — in one tablet)
rapid, prolonged relief throughout the G.I. tract
with unusual freedom from antispasmodic
and anticholinergic side effects
One tablet two or three times a day and one at bedtime. Each TRIDAL tablet
contains 50 mg. of Dactil, the only brand of N-ethyl-3-pipendyl
AKESIDE diphenylacetate hydrochloride, and 5 mg. of Piptal, the only brand
of N-ethyl-3-pipendyl-benzilate methobromide.
14)67
334
Volume XLI\
Number 4
for “This Wormy World”
Pleasant tasting
‘ANTEPAR!
brand
PIPERAZINE
SYRUP - TABLETS - WAFERS
Eliminate PINWORMS IN ONE WEEK
ROUNDWORMS IN ONE OR TWO DAYS
PALATABLE • DEPENDABLE • ECONOMICAL
‘ANTEPAR' SYRUP “ Piperazine Citrate, 100 mg. per cc.
‘ANTEPAR' TABLETS “ Piperazine Citrate, 250 or 500 nig., scored
‘ANTEPAR' WAFERS "■ Piperazine Phosphate, 500 mg.
Literature available on request
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.
J. Florida, M. A.
October, 195 7
335
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs !
BELLADONNA AL.KAl.OID0
ALONE
LD 90%*
* 1 5 mg. dose
of spasmolytic
proved lethal
in 90% of
test animals
BELLADONNA ALKALOIDS
WITH
ALUMINUM HYDROXIDE
Al(OH),
w/spasmolytic
substantially
reduces spasmolytic
drug effect
LD 17%
BELLADONNA ALKALOIDS WITH
DIHYDROXY ALUMINUM AM I NO AC ET ATS
(alolyn®. brayten)
Alglyn
adsorbed only
LO 83%
Malglyn Compound
provides maximal
spasmolytic effect
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked or/sorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
each tablet contains
dihydroxy
aluminum
aminoacetate,
N.N.R.
belladonna
alkaloids
(as sulfates)
phenobarbital
o.» mi
o.iaa ms.
«a.a ms.
For both rapid and prolonged antacid effect, with consistently
effective spasmolytic and sedative action, rely upon Malglyn
for treatment of peptic ulcer and epigastric distress.
Also supplied: ALGLYN* (dlhydroiyaluml-
num aminoacetate. N.N I 0.5 Cm per tablet).
BEIGIYN* (dihydroxy aluminum aminoacetate,
N.N.R., 0 5 Gm and belladonna alkaloids. 0.162 m*.
per tablet).
Speciality for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA 9, TENNESSEE
336
Volume XLIV
Number 4
an incomparable protectant
and healing agent
for the SKIN of the AGED
DESITIN
ointment
sustained soothing, lubricating, antipruritic —
and healing — effects in . . .
rash and excoriation due to
• incontinence
• senile pruritus
• external ulcers
• stasis dermatitis
• excessive dryness
DESITIN OINTMENT— rich in cod liver oil— has a 30 year clinical background of
success in the treatment of many skin conditions.
SAMPLES and literature on request
DESITIN CHEMICAL COMPANY
812 BRANCH AVE., PROVIDENCE 4, R. I.
J. Florida, M. A.
October, 195 7
337
Tastiest way to dissolve sore throat symptoms
TROCHES
HYDROZETS
(hydrocortisone-bacitracintyrothricin-
NEOMYCIN-BENZOCAINE TROCHES)
Adult or juvenile, your patients with sore throats
will welcome a course of HYDROZETS. These
newest Merck Sharp & Dohme troches offer anti-
inflammatory, anti-infective and analgesic proper-
ties that promptly alleviate distressing mouth or
throat irritation whether caused by infection,
mechanical injury or allergic reaction. And
HYDROZETS taste so good, it's hard to believe
they’re medicine.
Formula: Each HYDROZETS Troche contains —
2.5 mg. ‘H YDROCORTONE1 to reduce pain, heat
and swelling; 50 units Zinc Bacitracin, 1 mg.
Tyrothricin and 5 mg. Neomycin Sulfate to com-
bat gram-positive and gram-negative bacteria; and
5 mg. Benzocaine for rapid soothing analgesia.
Other indications: As adjunct therapy in aphthous
ulcers, acute and chronic gingivitis and Vincent's
Infection.
Supplied: Vials ol 12 troches.
MERCK SHARP 8c DOHME
DIVISION OF MERCK & CO , INC.. PHILADELPHIA 1. PA
338
Volume XF.I V
Number 4
Avoid “BOTTOM OF THE VIAL” reactions
Of the intermediate-acting insulins,
only Globin Insulin is a clear solution.
24-hour control for the majority
of diabetics
GLOBIN INSULIN
‘B. W. & CO.’*
JZ.4 BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
J. Florida, M . A.
October, 195 7
339
kids really like ...
SQUIBB IRON. B COMPLEX AND B12 VITAMINS ELIXIR.
■ to correct many common anemias
■ to correct mild B complex deficiency states
■ to aid in promotion of growth and stimulation of appetite in poorly nourished children
Squibb
Squibb Quality—
the Priceless Ingredient
Each teaspoonful (5 cc.) supplies:
Elemental Iron 38 mg.
(as ferric ammonium citrate and colloidal iron)
(equivalent to 130 mg. ferrous sulfate exsiccated)
Vitamin B12 activity concentrate 4 meg.
Thiamine mononitrate 1.0 mg.
Riboflavin 1.0 mg.
Niacinamide 5 mg.
Pantothenic acid (Panthenol) 1.5 mg.
Pyridoxine hydrochloride 0.5 mg.
Alcohol content : 12 per cent
Dosage: 1 or 2 teaspoonfuls t.i.d.
Supply: Bottles of 8 ounces and 1 pint.
IBUBAATON'IS) IS A SQUIBB TRADEMARK
340
Voi.u.v. ALIV
Number 4
simple, well-tolerated routine for " sluggish" older patients
one tablet t.i.d.
DECHOLIN
“therapeutic bile”
Establishes free drainage of biliary system— effectively combats bile stasis and
improves intestinal function.
Corrects constipation without catharsis — copious, free-flowing bile overcomes tendency
to hard, dry stools and provides the natural stimulant to peristalsis.
Relieves certain G.I. complaints — improved biliary and intestinal function enhance
medical regimens in hepatobiliary disorders.
Decholin Tablets: (dehydrocholic acid, Ames) 33A gr.
* ^ 23757
AMES COMPANY, INC • ELKHART, INDIANA • Ames Company of Canada, Ltd., Toronto
J. Florida. M. A.
October, 195 7
341
NO PAIN
NO MEMORY...
IN PEDIATRIC ANESTHESIA
How important — and yet how simple— it is
to spare the child the emotional shock of
the operating room. With Pentothal by
rectum, you can put the patient to sleep in
his own bed, where he awakens untroubled
after surgery. As a basal anesthetic or as
the sole agent in selected minor procedures,
Pentothal by rectum is a notably safe,
humane approach to pediatric anesthesia.
Q&frott
(Thiopental Sodium, Abbott)
342
Volume XI, IV
Number 4
sfsv^e jjo
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or V2 teaspoonful
contains:
Pentylenetetrazol . 100 mg.
Nicotinic Acid 50 mg.
1. Levy, S., JAMA., 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J., 15:596. 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
:i
J. Florida, M. A.
October, 195 7
343
%
*
LIN I CAL
experience in the
reatment of respiratory tract infections with
ANDOMYCIN TETRACYCLINE-PHOSPHATE BUFFERED
ite pharyngitis
eumonia
urisy
tis media
mchitis
•usitis
mchiectasis
isillitis
iuenza
mchopneumonia
nsinusitis
■yngitis
icheitis
imoiditis
eptococcal pharyngitis
sopharyngitis
icheobronchitis
cterial pneumonia due to
resistant pneumococci,
staphylococci, or mixed flora
al or nonspeciflc
pneumonia not responsive
to other therapy
ig abscess
Uicular tonsillitis
ar yngitis caused by
resistant staphylococci,
Streptococcus viridans,
or hemolytic Streptococcus
>ar pneumonia
ml URI
934
875
38
21
th
914
patients with
respiratory
infections
treated with
Signemycinf1
patients showed
an excellent
or good response
patients had
fair response
patients had a
poor response
patients had
no side effects
'ferences: 1. Case reports in the Pfizer Medical
apartment Files from fifty-three clinicians, and
e following published reports: Shubin, H.:
rttibiotic Med. & Clin. Therapy 4:174 (March)
57. Carter, C. H., and Maley, M. C.: Antibi-
ics Annual 1956-1957, New York, Medical En-
clopedia, Inc., 1957, p. 51. Winton, S. S., and
lesrow, E.: Ibid., p. 55. LaCaille, R. A., and
*igot, A.: Ibid., p. 19.
VademArk
Increasing use of Signemycin V and other Signemycin formulations has eon-
firmed the value of this agent in the armamentarium of the physician treating
antibiotic-susceptible infections, particularly those seen at home or in office
where susceptibility testing may not be practicable and where
immediate institution of the most broadly effective therapy is
necessary.
World leader in antibiotic development and production
344
VOLUME XI. IV
Number 4
just one specific
therapeutic purpose
to curb the appetite
of the overweight patient
GEIGY
Ardsley, New York
(brand of phenmetrazine hydrochloride)
Preludin makes reducing:
Effective because it provides potent appetite suppres-
sion, while minimizing the undesirable effects on the
central nervous system which may be encountered
with certain other weight-reducing agents.1
Comfortable because it virtually eliminates nervous
tension, palpitations and loss of sleep.2
Notably safe because it is not likely to aggravate
coexisting conditions, such as diabetes, hypertension
or chronic cardiac disease.3
References: (1) Holt, J.O.S.,Jr.: Dallas M. J. 42: 497, 1 956. (2) Gelvin,
E. P.; McGavack, T. H., and Kenigsberg, S.: Am. J. Digest. Dis. 1:155,
1956. (3) Natenshon, A. L.: Am. Pract. & Digest Treat. 7:1456, 1956.
Preludin® (brand of phenmetrazine hydrochloride). Scored, square,
pink tablets of 25 mg. Under license from C. H. Boehringer Sohn,
Ingelheim.
PRELUDIN
thousands of physicians
confirm daily in practice
the overwhelming evidence
in hundreds of publications
METICORTEN'
prednisone
overwhelmingly favored by physicians in rheumatoid
arthritis and bronchial asthma
increasingly favored by physicians in intractable hay fever,
nephrosis, disseminated lupus erythematosus and acute
rheumatic fever
Meticorten, 1, 2.5 and 5 mg. white tablets.
346
when your findings include anemia
TRINSICON
(Hematinic Concentrate with Intrinsic Factor, Lilly)
serves a vital function in your total therapy
Just 2 Pulvules ‘ Trinsicon ’
0 daily dose) provide:
Special Liver-Stomach
Concentrate, Lilly
( containing Intrinsic
Factor) 300 mg,
*Vitamin Bn with
Intrinsic Factor
Concentrate, U.S.P.
1 U.S.P. unit (oral)
Vitamin Bn Activity
Concentrate,
N.F 15 meg.
Ferrous Sulfate,
Anhydrous 600 mg.
Ascorbic Acid. . . . 150 mg.
Folic Acid 2 mg.
Potent ‘Trinsicon’ offers complete and conven-
ient oral therapy; provides therapeutic quanti-
ties of all known hematinic factors. Just two
Pulvules ‘Trinsicon’ daily produce a standard
response in the average uncomplicated case of
pernicious anemia (and related megaloblastic
anemias) and provide at least an average dose
of iron for hypochromic anemias, including
nutritional deficiency types.
Available in bottles of 60 and 500.
“Intrinsic Factor Concentrate, Lilly,
Enhances . . . Never Inhibits Vitamin B12 Absorption
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.
719083
Volume XLIV
Number 4
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, October, 1957 No. 4
Progress in Cancer Control
John R. Heller, M.D.
BETHESDA, MD.
The importance of controlling cancer by ev-
ery possible means is indicated by one fact alone:
that is, that cancer is now the second leading
cause of death in the United States. The advance
of neoplastic diseases from eighth to second place
among the leading causes of death since 1900
makes it a public health problem of national im-
portance.
At the turn of the century when tuberculosis,
pneumonia, diarrhea and other infectious and
communicable diseases were taking their high toll
of lives, 78,000 people a year were dying from
cancer. There was but one specifically designated
cancer hospital in America. There was no sup-
port from the federal government of programs for
research or control and only one state recognized
its responsibility in this respect. No word of
cancer appeared in the media of public informa-
tion. Nowhere was cancer a reportable disease.
Today, cancer is striking one in every four of
our population and is the cause of one in every six
deaths, taking an annual toll of more than
245,000 lives. Official agencies in all the states,
the District of Columbia, Alaska, Hawaii, Puerto
Rico, and the Virgin Islands have cancer control
programs. In the District of Columbia and more
than half the states and territories, cancer has
been made a reportable disease. Professional
educational programs for public health workers,
general practitioners, dentists, and nurses are un-
der way. Intensive public educational campaigns
are being carried on, and substantial improve-
ments have been made in the treatment facilities
and diagnostic services available to the individual
citizen.
I make this brief comparison merely to show
that in a short period of time — almost two genera-
Director, National Cancer Institute, National Institutes of
Health, Public Health Service, Department of Health, Education,
and Welfare.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 6, 1957.
tions, in fact — the rise of cancer has brought
about a tremendous growth in the supporting ele-
ments which are necessary in a nationwide effort
to control a disease of this magnitude.
Further, research of the past 10 years has
remarkably expanded knowledge of carcinogenesis
and of the diagnosis and treatment of cancer.
As a consequence, both laymen and research in-
vestigators can now approach the problem of
cancer and its curability from a more optimistic
point of view. There is tremendous public con-
cern about cancer and the necessity for bringing it
under adequate control. Recently publicized data
compiled by National Cancer Institute statisti-
cians show that the annual number of persons in
whom cancer is diagnosed is expected to increase
from 530,000 in 1953 to 753,000 in 1975 — unless
cancer is bridled more extensively by control
measures.
The National Cancer Institute, under the Pub-
lic Health Service, Department of Health, Educa-
tion, and Welfare, is charged with the respon-
sibility for carrying out a comprehensive attack
on the cancer problem. The Institute is supported
by annual appropriations made by the Congress.
The appropriation for fiscal year 1957, for in-
stance, is $48,432,000. About one third of this
amount is appropriated for research at the In-
stitute. The remaining two thirds is appropriated
for grants-in-aid to nonfederal institutions
throughout the nation. A major portion of these
grant-in-aid funds goes to support research, and
the remainder is granted to states for use mainly
at the local level to support activities in the con-
trol of cancer. It is through these local activities
that the cancer program most directly reaches the
individual citizen and aids the private physician.
Cancer control is concerned with the actual
prevention of cancer whenever possible, with the
discovery of the disease in its earliest stages, and
348
HELLER: PROGRESS IN CANCER CONTROL
Volume XLIV
Number 4
with the provision of adequate services and facili-
ties for diagnosis and treatment. To be effective,
an ideal cancer control program requires: ( 1 ) an
alert and trained medical profession; (2) an in-
formed public; (3) suitable methods for preven-
tion of the disease; (4) case-finding, screening, or
diagnostic procedures which can be applied on a
mass basis to sort out individuals with the disease
from the remainder of the population; and (5)
adequate services and facilities for diagnosis and
treatment.
The control program of the National Cancer
Institute is designed to meet some of the needs
which exist in these requirements and to demon-
strate appropriate methods for fulfilling some of
these conditions.
Before discussing our control program in de-
tail, however, I should like to show a few slides
to emphasize the extent and nature of the cancer
problem.
Cancer Assumes Increasing Importance As a
Cause of Death
Slide 1. — This chart may help to explain why
the Public Health Service was directed to enter
this field. Here we see the position of cancer, in
relation to other diseases as a cause of death.
Following the red arrow, we see that cancer was
in seventh place in 1900, in third place in 1925,
and in second place in 1950. As we watch the
decline of the infectious and communicable dis-
eases, it is clear why medical and public health
emphasis must shift to cancer and other chronic
and degenerative diseases. Cancer has become a
national health problem.
Cancer Death Rates for Selected Sites
White Males 1914-1950
Slide 2. — This shows the trends between 1914
and 1950 in death rates for several leading types
of cancer in white males. The mortality rate for
stomach cancer has declined, but the mortality
rate for lung cancer has gone up steadily and
alarmingly.
Cancer Death Rates for Selected Sites
White Females 1914-1950
Slide 3. — During the same period, the mortal-
ity rate for lung cancer in white females increased
but not as markedly as in the males. Death rates
for stomach and uterine cancer declined.
Parallel with the increase of cancer as a cause
of death, there has been an astonishing increase in
survival rates, especially for cases with reasonably
early diagnosis and competent treatment. The
gastrointestinal tract is the only major site for
which our present knowledge and resources are
not adequate to save the patient in at least half
the cases. For some sites, we are already able to
salvage the patient in considerably more than
half. To bring survival rates closer to 100 per
cent will require more knowledge, which, of
course, is the object of research.
The National Cancer Institute's control pro-
gram complements the extensive research pro-
grams under way. The steady growth of this
program is a result of interest that public health
agencies and other groups have taken in attempts
to reduce mortality from cancer through early
suspicion, accurate diagnosis, and effective treat-
ment. The purpose is to translate findings of re-
search investigations into clinical applications with
the ultimate objective of reducing mortality from
cancer. Toward this broad objective the program
has two general aims: first, to find ways to short-
en the dangerous time intervals between the onset
of the disease and diagnosis, and between diag-
nosis and the start of treatment; and second, to
improve the level of cancer diagnosis and man-
agement.
In the nine years our control activities have
been in progress, a well rounded program of ac-
tion has developed, both within the National
Cancer Institute and through grants of funds to
state health agencies, hospitals, medical schools,
and other institutions.
State Cancer Control Programs
Grants for the support of cancer programs of
the official state and territorial health agencies are
made by the Institute directly to these agencies.
These funds are granted on a formula basis which
takes into account the size and density of the
population, the number of cancer deaths, and the
per capita income of the state or territory. The
funds must be matched by state and local funds
in the ratio of $1 for each $2 received from the
government. The amount allotted to this program
is about $2,250,000 annually.
More and more, the impetus for cancer con-
trol is coming from the states and local agencies
and institutions. The national program is largely
a reflection of these successful state and local pro-
grams that have pioneered in new directions.
These programs have special implications for
practicing physicians.
Since the cancer patient is usually seen first by
the family doctor, his diagnostic training and ex-
perience often determine the outcome of the case.
J. Florida, M. A.
October, 1957
HELLER: PROGRESS IN CANCER CONTROL
349
It is important, therefore, that future doctors be-
gin their practice of medicine equipped with the
most recent knowledge in this field. Toward this
end, the Institute administers a grant-in-aid pro-
gram to assist medical schools in developing ex-
panded and better integrated instruction in cancer.
Over $15,000,000 in training grants have been
awarded to 83 medical, 42 dental, and six osteo-
pathic schools since July 1947. Approved medical
schools offering full four year instruction may re-
ceive up to $25,000 for a one year grant. Medical
schools offering two years of work, and four year
dental schools may receive up to $5,000 for a one
year grant.
We have good reason to believe that this pro-
gram is accomplishing its original objectives,
which include: developing an awareness of cancer
among medical students; improving the medical
service to cancer patients, stimulating student in-
terest in cancer research or control, and increas-
ing the participation of the internist in cancer
teaching.
Clinical Traineeships
The Institute has supported, since 1938, a
program of postgraduate training for young prac-
ticing physicians. These trainees are placed in
medical schools, hospitals, and training centers
where suitable cancer teaching material, as well as
qualified professional staffs, is available.
Since 1938, over 600 physicians have received
support under this program. Consequently, the
Institute staff believes that the program has been
helpful in partially meeting the tremendous need
for physicians trained in the various specialties
vitally important to adequate management of the
cancer case.
Research Training Grants
A new type of professional training grant was
established by the Institute last year. Under this
program, institutions receiving funds select and
appoint the persons to be trained and determine
the stipends they are to be paid. This program
extends and supplements, but does not replace,
the research training opportunities available
through our regular research fellowships program.
Initial funds appropriated by the Congress
for this program totalled $1,200,000, of which
slightly more than half was earmarked especially
for training in fields of chemotherapy and steroid
hormones. The first grants recommended by the
National Advisory Cancer Council represented
research fields of cancer chemotherapy, steroid
biochemistry, research medicine, pharmacology,
biochemistry, immunology, research surgery, his-
tochemistry, electron microscopy, genetics, cytol-
ogy, radiobiology, and cancer biology.
Nursing Schools
Public health nurses and other registered
nurses have come into cancer control to such an
extent that much of the success of the control
programs is shared by them. Five schools of nurs-
ing have received grants to support pilot studies
for the development of better methods for teach-
ing nurses about cancer.
Educational Aids
Among the many cancer educational aids for
physicians in general practice is a series of six
motion pictures which carry the over-all title of
“Cancer — The Problem of Early Diagnosis.” This
professional series was produced jointly by the
National Cancer Institute and the American
Cancer Society. The first film in the series is a
general orientation to the subject. The others deal
separately with breast cancer, gastrointestinal
cancer, uterine, oral, and lung cancer. An oral
cancer exhibit and a set of projection slides show-
ing oral cancer lesions are also available to
dentists.
Public Educational Programs
Cancer educational programs for the public
are carried on largely by such agencies as state
and local health departments and state and local
divisions of the American Cancer Society. We
do contribute, however, to these programs by sup-
plying educational materials and information of
various kinds. Either alone, or in cooperation
with other organizations, we have produced edu-
cational motion pictures, exhibits, and printed
materials describing cancer of the various sites of
the body.
Search for a Cancer Test
Cancer diagnosis at present depends on direct
visual observation and identification of cancer
cells either in removed tissues or in fluids collected
from body orifices which communicate with the
possible sites of cancer. If our present knowledge
is to have completely effective application in the
control of cancer, we must have a practicable
case-finding method. The search for such a meth-
od is well under way and is directed along two
lines — attempts at case finding by screening the
general population by conventional clinical meth-
350
HELLER: PROGRESS IN CANCER CONTROL
Volume XLIV
Number 4
ods, and a program to find a suitable clinical test
for cancer. By a suitable test we mean one which
will be successful in identifying persons with can-
cer in an early localized stage, will not give false-
positive results too often, and is simple and cheap
enough for mass screening use.
The National Cancer Institute is supporting
a variety of studies in this field. Through grants-
in-aid we established in 1949 a program to deter-
mine the value of cancer diagnostic tests for case
finding. This program is still being carried on at
the five medical schools where it was begun. In
addition, the Institute has supported studies at
10 universities and clinics to evaluate case-find-
ing procedures.
Although the ideal serodiagnostic test has not
been found, some advances have been made in
other technics for the early discovery of cancer
of specific sites. The most widely applicable and
best developed of these is the cytologic test of
Papanicolaou and Traut.
This test was first suggested by Papanicolaou
as a diagnostic tool for detecting cancer some 30
years ago. and its use has become widespread only
in the last 10 years. The method embodies the
study of cells exfoliated from the surface of the
epithelial lining of certain body organs. These
cells are collected by aspiration and examined
microscopically.
Uterine Cancer
The most significant and fruitful use of the
cytologic technic has been in the diagnosis of
uterine cervical cancer in its earliest stages. As a
result of intensive study, the Public Health Serv-
ice and other medical authorities believe that the
uterine cervical lesion called intraepithelial car-
cinoma— or carcinoma “in situ’’ — is in fact cancer,
and that the relatively long latent period between
this stage and invasive cancer can be used to ad-
vantage in control programs. It is also believed
that “in-situ" carcinoma is in reality early cancer
and that invasive cancer is late cancer.
Memphis Cytology Survey
The most impressive results yet obtained in
the early diagnosis of cervical cancer by the cy-
tologic tests have been provided by a large scale
study carried on in Memphis by the University of
Tennessee College of Medicine, with the assistance
of local medical societies, the National Cancer
Institute, and other groups.
In this project, which was begun in 1952, vag-
inal cytology was applied in a mass screening
survey for cervical cancer among 165,000 women
20 years of age and older who reside in Memphis
and Shelby County.
This study produced a case-finding rate 40
times that observed in the community prior to
establishment of the project. In addition to un-
covering many unsuspected cancers, the study
corroborated the observation that carcinoma-in-
situ lasts long enough — several years, in fact — to
permit effective curative treatment in practically
100 per cent of cases if discovered at the yearly
check-up.
Results of Cytologic Screening
Slide 4. — This slide shows the highly encour-
aging findings obtained in the first 108,000 wom-
en tested. A total of 906 new cases of neoplasm
was diagnosed. In the first screening 819 cases
were found; of these 399 were intraepithelial, 346
invasive cancers of the cervix, 48 invasive cancers
of the corpus, and 26 cancers of other organs,
such as tubes and ovaries.
On the second screening 87 cancers were un-
covered: 75 intraepithelial, nine invasive cervical
cancers, two invasive cancers of the corpus, and
one invasive cancer of another organ.
These findings indicate that cytologic screen-
ing has effectively reduced the case-finding rate
for invasive carcinoma of the cervix from 434 per
100,000 in the first screening, to 43 per 100,000 in
the second screening. One significant fact I should
like to call to your attention is that the majority
of these carcinomas were unsuspected either by
the physician or the patient.
Age Distribution of Cervical Carcinoma
Slide 5. — These data are also based on the
first 108,000 women tested. Here we see that the
median age for intraepithelial lesions uncovered
in the Memphis study was 36 years, while the
median age of early invasive cancer was 51 years.
This suggests that cancer of the cervix may exist
for an interval of about 15 years in a noninvasive
form when it is practically 100 per cent curable.
Since intraepithelial carcinoma presents no
signs or symptoms, our alternative is clear; we
must examine apparently healthy women at fre-
quent intervals as a mean of eliminating or reduc-
ing cervical cancer mortality.
On the basis of this concept, and with addi-
tional funds made available by the Congress, the
National Cancer Institute is now widening its
studies of the cause, development, and course of
uterine cervical cancer by establishing field pro-
J. Florida, M. A.
October, 195 7
HELLER: PROGRESS IN CANCER CONTROL
351
jects in different parts of the country in cooper-
ation with local health and medical authorities.
Seven such research projects are now in operation
and plans are under way to establish others.
These projects will provide comparative data for
the establishment of true incidence rates, and
more information on the natural history of car-
cinoma-in-situ. They will also help to determine
the relationship of carcinoma-in-situ to invasive
cancer and the usual period of latency for this
transformation, if it usually takes place. The
Public Health Service believes that these addi-
tional projects represent positive steps toward the
ultimate goal of totally eliminating this form of
cancer as a health problem.
Variations of the cytologic method to aid in
the diagnosis of cancer of other tissue sites are
also under study. The usefulness of this technic
is limited to symptomatic individuals because of
the difficulty in obtaining and processing speci-
mens for examination. Encouraging results, how-
ever, are being obtained with the cytologic exami-
nation of repeated sputum specimens in broncho-
genic carcinoma. Also, in gastric carcinoma, re-
cent developments have been reported for obtain-
ing more representative specimens, such as the
use of specific hormones and enzymes to obtain
better specimens of exfoliated cells in greater
numbers; the mechanical abrasion of the gastric
mucosa with a balloon studded with silk threads;
and the use of lavage solutions containing an
enzyme to accomplish mucolysis.
An electronic device being tested will auto-
matically search for and detect cancer cells in
smears spread on microscope slides. This instru-
ment— the cytoanalyzer — will enable the cytology
technic to be more rapid and efficient in the
screening of the population for certain types of
cancer. This instrument classifies cells on the
basis of certain optical values for size and density
of the nucleus.
Field Research Projects
Field research projects — studies conducted
directly by the Institute — have increased to where
there are now over 60 such studies under way.
These projects, conducted by our Field Investi-
gations and Demonstrations Branch, seek to find
causes, diagnostic procedures, effective therapy,
and adequate methods for the control of cancer
of all sites.
Epidemiologic Studies
We also have a number of epidemiologic in-
vestigations in operation, which provide much
knowledge on the prevalence, incidence, distribu-
tion, and mortality of cancer in the population.
Such data are essential to developing a means of
controlling or preventing the disease. Typical of
these studies are a project on the epidemiology of
bronchogenic carcinoma in Pittsburgh; a study
of childhood leukemias, lymphomas, and other
malignant disease; and studies in geographic and
racial distribution of cancer. Our project to
gather data on smoking habits of World War I
veterans, being carried out in cooperation with
the Veterans Administration, is both a statistical
analysis of available data and an etiologic study
of the possible correlation between smoking and
lung cancer.
Cancer Morbidity Surveys
Probably the most comprehensive undertaking
of its kind ever attempted in the United States
was our cancer morbidity study in which we sur-
veyed 10 metropolitan areas in 1937. These same
areas were resurveyed in 1947 to obtain current
information and to determine what changes had
taken place during the 10 year interval. The
method used was to canvas all the diagnostic
sources within a community — hospitals, clinics,
laboratories, practicing physicians — and to ob-
tain data on all persons coming for diagnosis or
under treatment, so that an unduplicated count of
persons ill with the disease might be made. At
the time of the resurvey the population covered
was 14,600,000, about 10 per cent of the total
population of the United States.
These surveys have yielded much new infor-
mation for evaluating the size and nature of the
cancer problem. They indicate that, in the United
States, cancer morbidity has increased even more
than has cancer mortality.
The surveys indicate also that the magnitude
of the cancer problem may be expected to con-
tinue to increase for years to come. The estimated
annual increase in the number of persons in whom
cancer is diagnosed, from 530,000 in 1953 to
753,000 in 1975, is based solely on two factors:
the forecast increase in the number of persons
in the United States, and the forecast increase
in the proportion of older people in the popula-
tion.
The first principle of cancer control — that
early diagnosis offers the most hope for successful
treatment — is borne out by data collected through
follow-up of cancer patients in these surveys.
Chances for survival in cases of cancer diagnosed
while the lesion is localized at the site of origin
352
HELLER: PROGRESS IN CANCER CONTROL
Volume XLIV
Number 4
are much better than in cases in which the dis-
ease is diagnosed after the tumor has spread to
adjacent tissues. In view of the demonstrated
benefits of early diagnosis, it is unfortunate that
in only half of cancer cases discovered today is
the lesion being diagnosed while localized at the
site of origin.
This record could be improved materially, be-
cause half of all cancers originate in organs or
sites accessible to direct examination by the phy-
sician in his own office. This estimate excludes
skin cancer. These sites are: the mouth and
pharynx, thyroid, breast, skin, prostate, uterus,
and rectum.
A comprehensive analysis of data from these
surveys was published last year as Part I of a
Public Health Service monograph. Part II of this
publication is now in preparation.
Environmental Factors
Environmental cancer is an area of research
in which we are most active. The different car-
cinogens that form a part of our environment are
practically the only known causes of human can-
cer. For this reason public health and industrial
groups are giving more and more attention to the
investigation of suspected environmental canceri-
genic hazards.
It is not surprising that most of the known
carcinogenic agents have been found in industry,
where workers suffer exposure to more agents, and
in greater concentration, than the average person
encounters in a nonindustrial environment. The
growth of known exogenous causes, such as radia-
tion, chemicals, and so forth, closely parallels the
growth of those industries and professions in
which cancerigenic agents are involved in serv-
ices or industrial processes. The long latent per-
iod, however, ranging anywhere from one to 40
years, tends to hinder the recognition of causal
relations between exposure to agents and the de-
velopment of cancer. This delay occurs because
many of the known environmental carcinogens are
not particularly toxic and thus do not produce
any striking symptoms. As injurious agents have
made their appearance with the changing pattern
of modern living, ‘‘environmental cancers” have
developed among exposed people under different
circumstances.
Environmental Cancer
Slide 6. — The work of Dr. W. C. Hueper and
his associates in the field of environmental cancer
has been extensive and outstanding. Here we see
some of the results of their studies, showing the
more important environmental carcinogens and
the sites they attack in the body. Of the chemical
agents, arsenicals cause cancer of the skin; proc-
essing of asbestos, chromium ores, and nickel
may be associated with cancer of the respiratory
tract; the carcinogenic substances in coal tar,
pitch, soot, petroleum and shale oils, and crude
paraffins are mostly of the types known as poly-
cyclic hydrocarbons. These are complex molecules
consisting of carbon and hydrogen, and they
usually produce skin cancer.
Fumes of benzol, a chemical widely used in
modern industrial processes, may affect the blood-
forming tissues and lead to the development of
leukemia.
A few aromatic amines — nitrogen-containing
compounds — are included among the carcinogenic
agents. Beta-naphthylamine, 4-aminodiphenyl,
and benzidine have been associated with cancer
of the urinary bladder occurring among workers
in factories handling dyes and rubber antioxidants
derived from coal tar products. Skin contact, in-
halation, and ingestion are known to be the routes
of exposure to these chemicals, but the manner
in which they act is not yet known.
The carcinogenic physical agents are radiations
of various kinds. The most important natural
physical carcinogen is, of course, solar radiation.
Cumulative exposure to solar radiation produces
a relatively high incidence of skin cancer in sailors
and farmers. Since it is believed that much of
the effect of sunlight in producing skin cancer
lies in the ultraviolet region of the spectrum, we
suspect that ultraviolet light is an important caus-
ative agent for this type of cancer in man. The
carcinogenic effect of ultraviolet radiation in lab-
oratory animals has been confirmed.
X-rays, radium, and radioactive substances are
other carcinogens in this class. They produce
leukemia and cancer of the skin, bone, lung, and
nasal cavities and sinuses. An example of the
carcinogenicity of radium is the high incidence of
leukemia among those survivors of the Hiroshima
atom bomb attack who were within one mile of
the center of the blast.
Preventive Measures
Industry is becoming increasingly aware of
the challenge presented by environmental and oc-
cupational cancer hazards. Some industries have
instituted preventive measures, such as the regular
wearing of respirators and sealed clothing when-
ever exposure is likely; adequate ventilation as
J. Florida, M. A.
October, 195 7
HELLER: PROGRESS IN CANCER CONTROL
353
well as the testing of certain industrial dusts
which may be carcinogenic; periodic examination
of the urine of dye industry workers; and protec-
tion against radioactive substances by shielding
devices.
Treatment of Cancer
Since no real cure is as yet available for all
cancers, physicians have defined the results of
their treatment in the practical and understand-
able terms of years free from clinical evidence of
the disease. It has become customary, therefore,
to speak of “five year cures” and to make com-
parisons of one form of treatment with another
form on the basis of results expressed in terms of
five year cures.
Surgery and radiation still are the only effec-
tive technics for curative therapy. They are cura-
tive, however, only when the tumor cells have
remained localized to areas from which they can
all be removed by surgery or destroyed by radia-
tion.
They have become more effective for cancer
therapy because other scientific and medical ad-
vances have permitted them to be used more ex-
tensively. Better management of infections,
hemorrhage, shock, anemia, faulty nutrition, and
other secondary problems have made more exten-
sive surgery practical. As a result of these im-
provements, the surgeon and the roentgenologist
are now able to extend both curative and pallia-
tive surgery to tumors previously considered in-
operable. The operative mortality rate has gone
down, and the five year surgical cure rate for
some types of cancer is improving.
In the last few years great advances have
been made in knowledge of the relative sensitivity
of different types of cancer. Radiation therapy
has been improved by the development of accurate
technics for the administration of predetermined
doses of radiation to cancer-bearing tissue, wheth-
er by x-rays or radium. The armamentarium of
the radiotherapist has been expanded from ra-
dium, radon, and medium voltage x-ray machines
to supervoltage x-ray generators, and new types
of powerful radiation, such as the cyclotron and
betatron, and radioactive isotopes.
Supervoltage therapy now has an established
place in the radiologic treatment of cancer, based
on adequate clinical experiences gained during
the last two decades. It, however, does not rev-
olutionize the treatment of cancer patients. If
used with proper adjustment of the technic to the
physical peculiarities of the quality of radiation
used, with clinical judgment, skill, well considered
indications, and in particular with an understand-
ing and appreciation of the risks, the higher volt-
ages represent small but definite progress in the
treatment of patients with certain types of cancer.
Let me stress, too, that supervoltage and meg-
avoltage therapy have not made the use of me-
dium voltage treatment obsolete. A larger machine
is not always a better machine any more than a
larger knife would be considered better for the
operation of a cataract. In many situations, me-
dium voltage therapy still has preference even
when higher voltages are available.
A large part of research in the field of radia-
tion is devoted to studies of the biologic effects
of radiation in laboratory animals. Studies on
radiation sickness are especially important. It
has recently been found that injections of bov
marrow into mice and guinea pigs exposed to
normally fatal dose of radiation can prevent >j
counteract many of the usual results of such € s-
posure. It was also established that lead shieldi lg
of the spleen or certain other parts of the body
increases the survival rate in animals exposed to
high doses of radiation. These findings may prove
valuable in radiation therapy of cancer, and in
preventing radiation sickness or in counteracting
its effects. Much remains to be learned in this
area of cancer research.
It is estimated that one fourth of cancer pa-
tients who receive proper medical care are being
cured today. The most optimistic estimates of
results that could be obtained with the earliest
application of surgery or radiation in all patients
would perhaps double that figure. To save t le
remaining one half, we must look to the advant
of future research.
Chemotherapy
Much emphasis is being put on chemotherapy,
as this field offers probably the most promising
approach to the treatment of disseminated can-
cer. The few therapeutic chemicals now available
are not cures for any form of cancer. They have
shown effectiveness, however, in temporarily halt-
ing the progress of certain cancers, alleviating
pain, and rehabilitating the body in preoperative
and postoperative stages to provide greater chance
for survival.
The first evidence of a malignant tumor show-
ing apparent suppression in patients by drug
treatment was reported recently by National
354
HELLER: PROGRESS IN CANCER CONTROL
Volume XLIV
Number 4
Cancer Institute scientists. The cancer is chorio-
carcinoma. a rare tumor which occurs in the
uterus after pregnancy. The drug used was
methotrexate. This compound, developed in the
last decade, has been successfully used to increase
the survival time of children suffering from acute
leukemia. In this study, four women patients with
advanced choriocarcinoma were given methotrex-
ate under an intense dosage regimen. Three pa-
tients showed suppression of cancer and disappear-
ance of metastases for 12, 13, and 17 months, re-
spectively. It is notable that metastases included
secondary lesions in the lungs. The fourth wom-
an’s cancer, treated more recently than the others,
was similarly suppressed.
True, this is a small number of patients.
Nevertheless, it represents the first marked regres-
sion of a malignant solid tumor in patients by a
drug.
Another new result reported recently was
noted improvement, including a decrease in the
size of metastatic lesions, in patients with acute
leukemia treated with 6-Azauracil. an antimetab-
olite.
Similar promising results are appearing more
and more in the literature. Already the list of
compounds which have some place in the treat-
ment of one or another type of metastatic cancer
is long and includes estrogens, androgens, ACTH,
cortisone, p3:, I'-”, thiouracil. urethane, thioTEPA,
TEM, nitrogen mustards, myleran. amethopterin.
aminopterin, 6-mercaptopurine and azaserine.
Each of these has shown palliative effects or
some degree of remission against some type of
cancer. Ultimately, however, the cancer becomes
resistant to the drug. Nevertheless, much in-
formation is being accumulated on how these
drugs work.
Interest in the chemotherapy of cancer has
increased so much that it now ranks as one of
the major areas of cancer research. The cure of
cancer still remains with surgery and radiation,
but in contrast to the dismal outlook of only a
few years ago, chemotherapy is today regarded
as a valuable adjunct to these methods.
Chemotherapy Cooperative Integrated Program
Slide 7. Cancer Chemotherapy Integrated
Program. — Research in the chemotherapy of
cancer was expanded and intensified under a na-
tionwide program begun in 1954 by the Com-
mittee on Cancer Chemotherapy of the National
Advisory Cancer Council. Joint sponsors of the
program are the National Cancer Institute, the
American Cancer Society, the Damon Runyon
Memorial Eund, the Food and Drug Administra-
tion, the Veterans Administration, and the Atomic
Energy Commission. The impetus for this ex-
pansion was provided when the Congress increased
support for research in chemotherapy in its ap-
propriation to the National Cancer Institute for
fiscal year 1954.
The program is guided by the Cancer Chemo-
therapy National Service Center, established and
staffed by the sponsoring agencies and located
at the National Cancer Institute in Bethesda, Md.
Essentially, there are two aspects to the pro-
gram: the support of basic research throughout
the country, by research grants, training grants,
and fellowships; and the screening, pharmaco-
logic work-up, and chemical evaluation of new
drugs or drugs w'hich have previously shown ac-
tivity.
For the routine anticancer screening program,
the pharmaceutical industry and university lab-
oratories are furnishing at present some 25,000
chemicals and antibiotic filtrates annually to the
Service Center. These materials are screened in
one of six contract screening laboratories against
three types of mouse cancer — Sarcoma 180, Car-
cinoma 755, and Leukemia L1210 — especially
chosen for their ability to indicate anticancer
agents.
If a compound is found active, studies are
made in animals of the blood and other body
tissues and fluids to see what happens to the
drug in the body. In addition, the proper dosage
and any toxicity are determined before trial in
humans is initiated.
If found safe, the agents are evaluated in
volunteer patients, and the anticancer effects
compared with one or more agents known to be
active. In other studies such compounds are
evaluated in conjunction with surgery and/or
radiation. For these clinical trials nine coopera-
tive study groups and two cooperative groups in
the Veterans Administration have been formed
representing more than 75 medical schools and
hospitals located in different parts of the coun-
try. Analysis of data on end results is being
accomplished through tumor registries set up
to provide data annually on all types of cancer,
and to undertake special studies on the effect of
various treatments.
Research sponsored by the Center’s grant
program in the screening area covers the develop-
J. Florida, M. A.
October, 195 7
HELLER: PROGRESS IN CANCER CONTROL
355
ment and evaluation of new compounds and of
new screening technics, such as microbiologic
methods, tissue culture, and human tumors in
animal hosts, as well as the search for reliable
biochemical technics for indicating the cancer-
destroying properties of chemicals, hormones, and
antibiotics.
Studies of a more fundamental nature, such
as a search for biochemical differences, studies
of mechanism of drug action, and studies of drug
resistance, are being sponsored in the pharmacol-
ogy area.
Contract work, in addition to the screening
operation, concerns chemical synthesis, mouse
breeding to insure an adequate supply of mice,
the establishment of a mouse pox diagnostic lab-
oratory, and hormone assay.
It is our sincere hope that this program will
achieve its desired objective of accelerating the
trial of promising anticancer compounds in hu-
man beings, when the safety and usefulness of
the drugs have been established.
Although the subject is too broad for discus-
sion here, I should like to mention briefly, for the
sake of completeness, the postoperative rehabilita-
tion of cancer patients. The serious psychologic
and physical effects of mutilating operations, such
as mastectomies, amputations, and radical head
and neck surgery, make adequate rehabilitation of
the cancer patient extremely important.
Many therapeutic procedures employed in this
field are of such a radical nature that they cause
manifold problems. Emotional and psychologic
issues emerge which call for capable counseling as
much as does the actual physical adjustment. Ev-
eryone coming in contact with the cancer patient
— members of the hospital staff, the patient’s
family, his friends, and especially his employer
and co-workers — must be educated to give en-
couragement and support to the cancer patient
in his rehabilitation.
Aside from the frequent need to provide spe-
cial appliances, such as colostomy irrigation sets,
breast prostheses, and other similar devices, peo-
ple working with the patient must appreciate the
psychologic reactions to these aids. Some persons
are able to accept such compromises and are
grateful to science for providing substitutions
which make possible continued activity and inde-
pendence, both financial and personal. Other per-
sons accept these appliances with feelings of de-
feat, frustration, and loss of status in their social
group.
The size of the rehabilitation problem in sur-
gical cancer patients can be gauged by the fact
that, at Memorial Hospital in New York City,
an average of 580 radical mastectomies is per-
formed each year.
The number of patients with cancer of the
larynx who have a total laryngectomy is in the
thousands. The necessity for speech rehabilitation
after this operation is now more widely recog-
nized. Formerly it was believed essential only to
operate and save a life. Now it is realized that
the laryngectomy is just the beginning and that
the restoration of speech must follow. The emo-
tional and psychologic disturbances following this
type of operation are considerable, sometimes re-
quiring the aid of a psychiatrist, in addition to
the all-important social worker. Nearly all of
these patients can, however, by proper training
in esophageal speech, resume their former occu-
pations or other employment requiring the use
of the voice.
The use of prosthetic appliances to restore
cancer patients to normal appearance is increas-
ing as more rehabilitation centers are established
in the United States. This is especially true in
the case of head and neck cancers, in which den-
tists play a highly important part in the con-
structing of facial prostheses.
Summary
To sum up, cancer control is a problem of
integration, bringing current knowledge of the
disease to the ultimate point of application —
the cancer patient. Cancer control complements,
but does not supplant, the extensive research
programs now under way. Control measures can-
not be separated from research. In fact, experi-
ence shows clearly that they are so closely related
that for optimal results in either field they must
be suitably integrated. Control methods, then,
must continue to be applied to those points where
research has opened another wedge of knowledge
about the carcinogenic process in terms of diag-
nosis, treatment, and prevention. More and more
knowledge, however small, is constantly becoming
available for the prevention and control of cancer.
Substantial headway in controlling the disease can
be made if this knowledge is put to practical use.
Bibliography
American Cancer Society, Cancer Rehabilitation, The Cancer
News, 2:3-7, 1948.
Cutler, S. J., and liaenszel, \\\ M.: Magnitude of Cancer Prob-
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Dorn, H. F., and Cutler, S. J.: Morbidity from Cancer in the
United States: Variations in Incidence by Age, Sex, Race,
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13, 1957.
Gilliam, A. G. : Opportunities for Application of Epidemiological
Method to Study of Cancer, Am. J. Pub. Health 43:1247-1257
(Oct.) 1953.
Heller, J. J. Jr.: Cancer — A Public Health Problem, J. Internat.
Col. Surgeons 23:463-468 (April) 1955.
Hueper, W. C.: Recent Developments in Environmental Cancer.
A. M. A. Arch. Path. 58:360-399 (Oct.), 475-523 (Novj,
645-682 (Dec.), 1954.
Kaiser, R. F. : Cancer Control Activities of the National Cancer
Institute, Pub. Health Rep. 70:1029-1033 (Oct.) 1955.
Levin, N. M.: Speech Rehabilitation After Total Removal of
Larynx, J. A. M. A. 149:1281-1286 (Aug. 2) 1952.
A Brief Preliminary Report on a New
Anticholinergic: Hexocyclium Methosulfate
Gordon H. Ira, M.D.
JACKSONVILLE
The ideal anticholinergic, one which would be
effective in the gastrointestinal tract but free
from side effects in other parts of the body, seems
likely to remain just an ideal. Nevertheless, re-
search has been developing anticholinergics which
are more and more specific in their actions. One
of the newest of such drugs is hexocyclium meth-
osulfate, marketed under the trade name TRAL.*
Hexocyclium methosulfate is a quarternary
ammonium salt with the following structural
formula:
postganglionic blocking action of hexocyclium
methosulfate is more potent than that of atropine
against gastric secretion in the histamine-treated
rat and against the development of ulcers in the
pylorus-ligated (Shay) rat. In the unanesthetized
dog, hexocyclium methosulfate has an antimotility
effect comparable to that of atropine, yet produces
less tachycardia.
The specific pharmacodynamic action of hex-
ocyclium methosulfate in animals implies the pos-
sibility of a similar action in the treatment of hu-
man gastrointestinal conditions. With the hope
*TRAL (Hexocyclium Methosulfate, Abbott) for this study
was provided by the manufacturer, Abbott Laboratories, North
Chicago, 111.
that this new anticholinergic would prove highly
effective with a minimum of side effects, the pres-
ent investigation was undertaken.
Procedure and Results
Hexocyclium methosulfate, 25 mg., was given
four times a day to 22 patients with a variety of
gastrointestinal conditions. All patients were on
soft diets, all but one received antacids, and 12
were under sedation or tranquilization. Diagnoses
and results obtained with this drug in the treat-
ment of 10 cases of ulcer, seven cases of gastroin-
testinal inflammation, and five cases of miscel-
laneous gastrointestinal conditions are summar-
ized in the accompanying table. No side effects
were observed.
Diagnosis
Cases
Results
Excellent
Good
Fair Poor
Duodenal ulcer
8
6
1 1
Pyloric ulcer
1
1
Gastric ulcer
1
1
Gastroenteritis
4
2
2
Duodenitis
2
1
1
Gastritis
1
1
Hyperacidity
2
2
Duodenal diverticulum
and hiatus hernia 1
1
Hiatus hernia
Prolapsed
1
1
gastric mucosa
1
1
Totals
22
12
6
3 1
Conclusions
In 18 out of 22 cases of various gastrointesti-
nal conditions, treatment with hexocyclium meth-
osulfate, a new anticholinergic, was followed by
good or excellent results, with no side effects. Such
results warrant extensive further investigation of
this new drug.
451 St. James Building.
J. Florida, M. A,
October, 195 7
357
Hazards in the Management of Peptic Ulcer
With Anticholinergic Drugs
A Re-Emphasis and Re-Evaluation
Hyman J. Roberts, M.D.
WEST PALM BEACH
The purpose of this report is to re-emphasize
several infrequently considered complications of
anticholinergic drug therapy in peptic ulcer that
should be kept in mind prior to its administration
on a routine basis. Specifically, these consist of
complete pyloroduodenal obstruction, ileus, and
unrecognized ulcer activity leading to subsequent
perforation. This consideration is all the more
important if a chronic partial obstruction has not
been specifically excluded. Ileus can also ensue
on such therapy in the presence of massive gastro-
intestinal bleeding due to causes other than ulcer.
While it is admitted that these observations may
be ‘‘nothing new,” the frequency with which these
complications recur and are not appreciated or
recognized by internists, gastroenterologists and
surgeons alike justifies this clinical report. A
number of recent and pertinent concepts relating
to the pharmacologic and the clinical aspects of
anticholinergic therapy will also be alluded to
briefly.
Complications in Unrecognized Pyloric
Obstruction
In dealing with patients suffering from active
peptic ulcer, I have been repeatedly impressed
with the following train of events. The patient,
varying in age from the second decade onward,
had been complaining of moderate to severe long-
standing ulcer pain. Although the pain retain-
ed its characteristic pattern of prompt relief by
milk, foods and antacids at all times, it had re-
cently become more frequent and troublesome.
On no occasion did the patient experience nausea
or vomiting. If vomiting had occurred, it was
present on only one or two occasions sometime
previously and had relieved the patient’s distress
temporarily. The attending physician would then
often make the diagnosis of “intractable” ulcer
pain and would forthwith order the necessary
laboratory and gastrointestinal roentgen studies.
Read before the Florida Medical Association, Kighty-Third
Annual Meeting, Hollywood, May 7, 1957.
In the interim, some modification of an acute
ulcer regimen was instituted, consisting of an
ulcer diet, antacids, sedation, limitation of activ-
ity, abolition of smoking, and nightly feedings.
To this treatment would be added full doses o,
one of the more recently available powerful anti-
cholinergic drugs, most notably methantheline
(Banthine), propantheline (Pro-Banthine), me-
piperphenidol (Darstine), or methscopolamine
(Famine). These agents were administered either
orally or intramuscularly in an attempt “to stop
acid production.”
At this point, one of two complicated clinical
courses occasionally ensued. Either the patient
manifested complete pyloroduodenal obstruction
clinically within several days or he became symp-
tom-free. In the latter instance, the clinician
found himself unexpectedly chagrined in the
presence of his radiologic and surgical colleagues
when the three to six hour roentgenogram of the
stomach following barium ingestion revealed little
or no emptying. Decompression would then be
carried out with frequent aspirations, but usually
to no avail, especially if the anticholinergic agents
were inadvertently continued.
It is probable that the aforementioned se-
quence of events, which has confronted me at
frequent intervals in the past several years,
can be duplicated by most physicians deal-
ing with the ulcer problem.1-2 In fact, I have
come to regard the seemingly clearcut condition
of partial obstruction complicating benign pre-
pyloric or duodenal ulcer as one of the more
commonly misdiagnosed disorders of the gastro-
intestinal tract. One need only consult the hos-
pital records of patients who have recently under-
gone surgery for obstructed ulcers to be made
much more aware of the magnitude of this prob-
lem. Since this theme has been practically the
same in nine patients with unrecognized obstruc-
tion who have personally come to my attention
358
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
Volume XLIV
Number 4
within the last two years, 1 shall limit the brief
case presentations to the following four.
Report of Cases
Case 1. — A 34 year old salesman had complained of
recurrent epigastric distress for 10 years, radiating lateral-
ly and through to the back. It was cyclic, occurring
with the stomach empty and during the night, and was
always relieved immediately by either food, antacids or
milk. One year previously, a duodenal ulcer had been
noted on roentgenograms. There had been no obvious
bleeding. The patient had only vomited on two occa-
sions several months previously. Physical examination
revealed a well developed and apparently well nourished
white man. The abdomen was flat; neither significant
tenderness nor a gastric succussion splash was elicited.
A healed right inguinal herniorrhaphy incision and small
external hemorrhoids were present. The complete blood
count, sedimentation rate, urinalysis, liver studies, stool
examinations, blood urea nitrogen, serum electrolytes,
serologic determinations, serum amylase and chest roent-
genogram were within normal limits.
Initially, an ulcer regimen was instituted, consisting of
a bland diet, several nightly feedings, sedation, an antacid
mixture, and oral Pro-Banthine, 30 mg. three times daily.
There ensued a complete amelioration of the distress.
The roentgen examination of the upper part of the
gastrointestinal tract two days later unexpectedly reveal-
ed an almost complete retention of the barium in the
stomach at four hours, with a markedly deformed duo-
denal cap. The cholecystogram demonstrated a normally
functioning gallbladder without stones. After the anti-
cholinergics were withdrawn, repeated fasting aspirations
produced decreasing amounts of gastric volume from the
initial one of 300 ml. to less than 50 ml. The ulcer pro-
gram was continued for several weeks, during which
time he remained completely asymptomatic. A repeat
upper gastrointestinal series again showed poor emptying
of the stomach with a stenosis at the duodenal cap, but
at the end of four hours the stomach had now completely
emptied. The patient refused surgical intervention and
continued without further complication on the diet, feed-
ings at night, antacids, complete abstinence from smoking
and drinking, and no anticholinergic drug therapy when
heard from last.
Case 2. — A 61 year old man, when seen for the first
time, complained of epigastric symptoms since 1919. Ex-
cept for becoming more frequent and requiring more
medication, the distress had been essentially the same
over the previous 30 years. It consisted primarily of a
cyclic epigastric pain which did not radiate, occurring
between meals and at bedtime, and frequently awaken-
ing him at night. Prompt relief was experienced from
milk, food and antacids. He had been hospitalized in
1943, at which time roentgenograms revealed the pres-
ence of a duodenal ulcer. Repeat roentgenograms were
taken which were interpreted as showing an old duodenal
ulcer with a partial degree of stasis. On no occasion had
there been evidence of bleeding, perforation or frank
obstruction. Physical examination revealed a fairly well
developed and well nourished white man in no acute
distress, but who appeared to be chronically ill. The
heart was slightly enlarged beyond the midclavicular line,
and a grade II harsh aortic systolic murmur was pres-
ent. The blood pressure was 200 systolic and 90 diastolic.
The abdomen was not remarkable except for some sen-
sitivity to pressure in the epigastrium; no attempt was
made to elicit a succussion splash. The complete blood
count, blood urea nitrogen, urinalysis, chest roentgeno-
gram and electrocardiogram were not remarkable.
Treatment consisted of a first stage ulcer diet and
nightly feedings at 1 a.m. and 4 a.m., along with an
antacid mixture on the half hour during the day. He
was also given Pro-Banthine intramuscularly thrice daily
in doses of 15 mg. Two days later, a routine diagnostic
gastric intubation yielded 1,000 ml. of gastric secretions.
Accordingly, a modified feeding aspiration regimen was
begun with the patient receiving 60 ml. of boiled milk
on the hour during the day. Gastric aspirations were per-
formed several times daily. He was also given parenteral
intravenous fluids and electrolytes, including potassium
chloride. On this regimen, complete obstruction continued
for the next several days until the Pro-Banthine was dis-
continued, after which the gastric residue promptly de-
creased. He was subsequently subjected to an elective
subtotal gastrectomy with a gastroenterostomy, at which
time an almost complete duodenal stenosis was found.
Case 3. — A 62 year old bus driver was admitted to
the hospital, his main difficulty consisting of recurrent,
cyclic, nonradiating epigastric discomfort of approximately
15 years’ duration. It frequently awakened him during
the night. The distress had always been promptly re-
lieved by the ingestion of milk. Roentgenograms taken
15 years and two years previously were interpreted as
being consistent with a duodenal ulcer. There was no
history at any time of vomiting or hemorrhage. During
the previous two years, the discomfort had increased, but
was still responsive to milk. Other complaints consisted
of increasing generalized headaches, dizziness, lack of am-
bition and easy fatigability. During this time, he had
lost approximately 20 pounds in weight. The past history
was significant only in that he had experienced a perfor-
ated appendix approximately 40 years ago and three epi-
sodes of pneumonia.
Physical examination revealed a well developed but
undernourished white man, who appeared to be somewhat
depressed. Persistent rhonchi were audible throughout the
left lower lung field. On the abdomen there was a ragged,
healed incision in the right lower quadrant without hernia-
tion. There was some tenderness on firm palpation
throughout the abdomen but no definite localization of
the discomfort or a succussion splash. The complete
blood count, sedimentation rate, urinalysis, serologic de-
terminations, blood chemistry determinations and electro-
cardiogram were within normal limits. Examination of
the gastric secretions revealed the presence of a consider-
able amount of free hydrochloric acid. A roentgenogram
of the chest demonstrated the lung fields to be emphy-
sematous. Only diverticulosis was noted on examination
by barium enema.
It was the initial clinical impression on admission that
the patient probably had a chronic duodenal ulcer with-
out complication and was also experiencing an anxiety
state with depression. A modified ulcer diet with an ant-
acid between meals and at bedtime was prescribed. Sev-
eral nightly feedings of milk were also given. Other
medication consisted of oral Pro-Banthine, 15 mg. four
times daily, and phenobarbital. An upper gastrointestinal
series performed several days later revealed a complete
obstruction in the region of the pylorus and duodenal
cap. No emptying of the stomach was noted in the three
hour roentgenogram. A modified feeding-aspiration regi-
men was accordingly instituted. Such a high degree of
obstruction persisted, however, that within two weeks sub-
total gastrectomy and gastroenterostomy were required.
Case 4. — A 52 year old broker was first seen in the
office complaining of long-standing bloatedness, flatus and
vague postprandial upper abdominal distress which had
become more uncomfortable the previous several weeks.
There was no vomiting or gastrointestinal bleeding. In-
tolerance for fatty foods had always been present. The
patient had also recently been under considerable emo-
tional duress. A duodenal ulcer had been demonstrated
by roentgenogram two years previously. Physical exam-
ination revealed an obese white man in no acute distress.
Aside from a slightly elevated diastolic pressure and some
tenderness on firm pressure in the epigastrium, no sig-
nificant findings were noted. A gastric succussion splash
was definitely not present. The examination of the blood,
urine, stools and chest roentgenogram was noncontribu-
tory. An electrocardiogram revealed a left ventricular
strain pattern.
The patient was presumed to have a chronic pyloric
or duodenal ulcer with an acute flareup and an added
J. Florida, M. A.
October, 195 7
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
359
anxiety state. In addition to the usual ulcer regimen, he
was given elixir of Donnatal four times daily. At the
time of an upper gastrointestinal roentgen study five days
later, he volunteered that he felt “wonderful” and that
all his distress had abated. An upper gastrointestinal
series unexpectedly revealed an almost complete pyloric
obstruction in the initial roentgenograms, but with com-
plete emptying after three hours. Consequently, even
though he exhibited the partial obstruction, it was elected
to continue the same therapy in view of both his clinical
response and the complete emptying of the stomach at
three hours. Following one more asymptomatic week,
however, he began to vomit, and a succussion splash was
present. Gastric aspiration produced 1,100 ml. of fluid.
A subsequent subtotal gastrectomy was required, at which
time chronic duodenal scarring and an active ulcer at the
pyloric ring were found.
Comment
The lesson to be learned and re-emphasized
from these case presentations is that physicians
should anticipate the presence of partial obstruc-
tion in every patient with chronic benign pre-
pyloric, pyloric or duodenal ulcer who is expe-
riencing more frequent and intense pain, whether
nausea and vomiting are present or not. Although
figures relating to its occurrence have been re-
ported at considerably higher levels and are some-
what influenced by the type of clientele seen, an
incidence of this complication of between 10 and
15 per cent of all ulcer cases seems to be generally
accepted.
As was pointed out earlier, the clinical history
may give little indication as to the presence of
this complication. Persistent pain with but partial
relief by food or antacids is often the only lead
in the patient with long-standing ulcer. The past
history of either a hemorrhage or a perforation
is frequently obtained. It has been noted that
not only may patients with obstruction not vomit,
but patients not experiencing obstruction can do
so most impressively.2 When atypical pain and
significant loss in weight dominate the clinical
picture in the more acute “pyloric channel ulcer,”
this entity may be readily mistaken for psychic
vomiting, carcinoma of the stomach, or gallblad-
der and pancreatic disease.3
In an admirable discussion of this subject,
Ingelfinger and Sanchez1 stressed the factor of
unrecognized or ignored partial obstruction in the
so-called intractable ulcer, and the neglect of the
useful sign of “clapotage” (the gastric succussion
splash) in making this diagnosis. It is pointed
out that the amount of barium retained is not
only an index of the pyloroduodenal stenosis but
also of the gastric tone and motor power. Con-
sequently, if the gastric tone is good and peristal-
sis is most active, there may be no significant
fasting gastric residual volume.4 Similarly, one
may see no retention at three to six hours, even
in the presence of a considerable degree of ste-
nosis. 5-6 Bockus, Glassmire and Bank5 found
that in 77 cases with clinical and aspiration evi-
dence of obstruction, radiographic evidence of
retention at six hours was present in only 43 per
cent. The determination of the free hydrochloric
acid concentration of the gastric juice, both in the
fasting state and after stimulation by histamine
or insulin, is of no value in determining the pres-
ence of obstruction.
The hazard of intensive anticholinergic ther-
apy with the induced postganglionic parasympa-
thetic inhibition lies in the apparent fact that in
such an instance the major effect of this treat-
ment is to produce further paresis of the already
distended and partially atonic gastric muscula-
ture. This has also been clearly demonstrated by
Kramer.7 The precipitation of complete obstruc-
tion was undoubtedly noted when belladonna and
atropine were the only significant anticholinergics
available. It was encountered less frequently,
however, because of the more graduated doses, the
greater stress on the limiting factor of side effects
as the criterion of desired anticholinergic activity,
and the availability of less potent and concentrat-
ed preparations.8 Chapman and his colleagues9-12
have made comparative studies of the effect of
the oral administration of Banthine, in 100 mg.
doses, and of tincture of belladonna, in doses of
0.4 and 0.6 ml., on the changes in propulsion, total
contractions and tone of the upper portion of
the intestinal tract by means of multiple balloon-
kymograph recording methods. Banthine pro-
duced a striking decrease in propulsion and total
contractions, along with a slight to moderate de-
crease in tone. The greater rapidity of this action
and the greater inhibition of motility, as contrast-
ed with tincture of belladonna in either dose, was
pronounced. In essence, this has proved to be
the observation of other investigators employing
the same or other technics, and has been invoked
as the most significant basis for the relief of pain
by anticholinergic therapy.13-15
The important fact is often overlooked that
even though most of these dynamic studies have
been carried out on normal “control” subjects,
diverse results are always encountered. These
may consist of either no effect, delayed emptying,
or an increased rate of gastric evacuation. Patho-
physiologic experiments carried out in the pres-
ence of pyloroduodenal obstruction have shown
360
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
Volume XLIV
Number 4
even more striking evidence of pharmacologically
induced adverse effects on motility. In controlled
radiologic studies, for example, profound degrees
of retention were induced by either atropine, 0.6
mg. subcutaneously, Bellafoline, 0.5 mg. subcu-
taneously, or tincture of belladonna, 12 to 15
drops by mouth, administered 15 to 30 minutes
before the barium swallow. This response oc-
curred both in symptom-free patients with chronic
stationary retention and in patients in whom de-
compression had previously been carried out.7 It
is fortunate that minor degrees of this inhibitory
effect are probably counteracted by the stimulus
of the meal-bulk itself.9-12
The current concept of the actual degree of
anticholinergic effect desired in the treatment of
peptic ulcer will probably have to be modified. It
has been shown by various in vivo and in vitro
studies, as in those dealing with chromodacryor-
rhea, that a specific anticholinergic effect can be
elicited by very small amounts of the drug long
before the muscular relaxing effects take place.16
Obviously, one cannot accept the spasmolysis not-
ed in the balloon-kymograph record as a measure
of the desired therapeutic activity since this
would be practically tantamount to considering as
best that agent producing complete paralytic
ileus. It is because of just such a possibility that
anticholinergic drugs should be avoided both
when surgery is shortly contemplated and in the
immediate postoperative period.17 Severe consti-
pation is also apt to ensue. 18-19 Similarly, mis-
leading radiographic appearances can be induced
if they are administered just prior to the barium
studies.
Concerning the acid inhibition produced by
these agents, several observers have shown that
a sizeable number of patients have but a slight
decrease in acid output, even when other evidences
of parasympathetic inhibition are striking.20-21
Recent observations have denied the premise that
the inhibitory effect upon gastric secretion and
acid may be more important than the inhibition
of gastric motility. In this regard, it has been
demonstrated that in patients with pyloric ob-
struction, atropine inhibits the gastric emptying
more effectively than the gastric secretion.22
The attitude towards the production of anacid-
ity by drugs must also be modified by the demon-
stration that proteolytic neutralization cannot be
considered complete if the pH of the gastric con-
tents is less than five. Shay23 clearly pointed
out that the titration for free hydrochloric acid
with Tbpfer’s reagent and phenolphthalein can be
misleading. Outside of specially equipped centers,
it is only by the direct measurement of the pH
that one is usually able to detect low levels of
gastric acid.23,24 This superiority of the pH
over the measurement of free acid units stems
from the fact that for every one unit change in
pH, there is a tenfold increase in hydrogen ion
concentration. Most cases of “benign gastric ulcer
with achlorhydria” have been so diagnosed on the
basis of the added Topfer’s reagent remaining
yellow. In reality, there is often ample free acid
in these instances, but the pH may not drop be-
low 4.0 or 4.5 because of the large amount of
buffering mucus or serum exuding from the ulcer.
It is also pointed out that since the expression
“combined acid” has no clinical value whatever,
both this term and the procedure should be dis-
carded by clinicians.24
The therapeutic problem here being consider-
ed is paradoxically enhanced by the fact that
many patients with partial obstruction are given
anticholinergic drugs and are undoubtedly bene-
fited by them, in large measure because of the
promotion of ulcer healing by acid inhibition.
Short of a therapeutic trial under close clinical
observation, I know of no way in which it is
possible to separate these patients from those in
whom complete gastric atony will be produced.
The patient gradation of the therapeutic dose
of belladonna in previous decades has become
somewhat of a lost art with the availability of the
newer and more potent agents. In a study of the
relative effectiveness of various anticholinergic
drugs on basal gastric secretion. Sun, Shay and
Ciminera25 concluded that the proper dosage of
these agents requires tailoring to the individual
patient and that these amounts cannot be read-
ily correlated with either body weight or any
recommended uniform dose. It is fortunate in-
deed that most of the “antispasmodics” hereto-
fore prescribed have not exhibited much signifi-
cant pharmacologic activity.26 This is becoming
more of a problem, however, as improved tech-
nical means are being devised for producing
sustained and high grade anticholinergic effect.1
with the administration of as little as one delayec
action preparation every 12 or 24 hours.
Complications In Gastrointestinal Hemorrhage
Less commonly a problem — but equally a;
significant — is the patient with massive hema
temesis or melena from an undetermined site oi
of unknown etiology who is placed on anticho
J. Florida, M. A.
October, 195 7
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
361
linergic drugs as a matter of routine. The ration-
ale of this therapy usually pursues the following
lines: Since most cases of gastrointestinal hemor-
rhage are statistically related to acid-pepsin-
linked disease in the form of gastric ulcer, duo-
denal ulcer, gastritis or hiatus hernia with ulcer-
ation, vigorous antacid therapy may be beneficial.
Consequently, since milk, cream and antacids
merely neutralize preformed hydrochloric acid,
the anticholinergics would seem to be preferred
in order to “stop acid production.”
Although this reasoning appears to be proper
superficially, one must not lose sight of the fact
that the blood itself functions as an effective
antacid.27 Furthermore, the patient is probably
already experiencing partial ileus of a chemical,
mechanical and reflex nature, related in large
measure to the presence of blood in the gastro-
intestinal tract. Quigley, Bavor, Read and Brof-
man28 have also shown that gastric atony is
readily induced by emotional apprehension. It is
recalled that at least 40 per cent of patients with
active duodenal ulcer have some form of function-
al disorder involving the small and large intes-
tine.29
It is apparent from these observations and
from those relating to the effects of the anti-
cholinergic drugs on gastrointestinal motility that
if this type of therapy is vigorously administered
in such a situation, profound ileus is apt to ensue.
On the several occasions I have encountered this
problem both in practice and in consultation, the
patients had fortunately ceased bleeding and were
readily compensated for their blood loss. Even so,
a significant degree of added morbidity resulted.
The history of three of these patients will be
briefly presented, in one of whom (case 7) the
induced ileus undoubtedly contributed to a fatal
outcome. Gunn and Allen30 reported five simi-
lar instances of paralytic ileus following the ad-
ministration of either Banthine or Pro-Banthine
during the treatment of gastrointestinal hemor-
rhage. In the presence of active hemorrhage, par-
enteral anticholinergics might even potentiate the
degree of shock by interfering with the com-
pensatory sympathetic activity as a result of the
autonomic ganglionic block. A similar potential
hazard exists in impending nonhemorrhagic shock,
as might be encountered in the management of
acute pancreatitis.
An additional pharmacologic observation ref-
erable to the anticholinergic effect of Demerol
and the opiates is in order. With the use of the
protection study technic, my colleagues and
I31’32 have previously evaluated the anticholin-
ergic and antihistaminic activity of most of the
therapeutic substances commonly employed for
the relief of bronchospasm in asthmatic patients.
Under these controlled and reproducible condi-
tions, Demerol was studied in doses of 100 mg.
intramuscularly. “Significant” protection was ob-
served in five subjects against intravenous metha-
choline; this effect was observed for an average
of 140 minutes. Others 33,34 have demonstrated
the influence and untoward effects of the various
opiates and related drugs upon gastric function.
Accordingly, since most patients with hemorrhage
from ulcer actually have but little pain and since
morphine may actually deepen the degree of
shock, the use of parenteral barbiturate prepara-
tions is to be preferred to the opiates in this
condition.35
Report of Cases
Case 5. — A 27 year old man, whose illness had been
previously diagnosed as moderately advanced, inactive
pulmonary tuberculosis, was admitted to the hospital be-
cause of recurrent ulcer symptoms and persistent melena.
No hematemesis had occurred. On previous occasions,
sedation and antacid therapy had produced prompt re-
lief of both the distress and the bleeding. Physical exam-
ination revealed a thin, pale, white man with epigastric
tenderness and the presence of tarry stools in the rectum.
The hemoglobin estimation was 10.1 Gm.; the hemato-
crit reading was 33 per cent. All examinations of sputum,
both by smear and culture, for tubercle bacilli gave
negative results. A large crater in the duodenal cap was
seen. The small intestine and ileocecal area appeared
normal.
The usual ulcer regimen was instituted with added
Pro-Banthine in doses of 30 mg. intramuscularly, thrice
daily. Shortly after the first injection, the patient began
to complain of severe constipation, abdominal distention
and difficulty in urinating. This state persisted for sev-
eral days, even with the use of laxatives and decreased
doses of the Pro-Banthine. He was profoundly distressed
because of these symptoms, which he had previously ex-
perienced with similar therapy for the melena, but with-
out the anticholinergic drugs. Following the discontinu-
ance of this drug, his symptoms completely abated. Sub-
sequently, a conservative program was continued, follow-
ing which an elective and uneventful subtotal gastrectomy
was performed.
Case 6. — A 54 year old policeman was admitted with
a two day history of black stools. He had experienced in-
frequent epigastric distress since the diagnosis of a duo-
denal ulcer had been made radiographically 10 years
previously. The only other pertinent aspects of his history
were a chronic asthmatic bronchitis and external hemor-
rhoids. Physical examination revealed an obese, pale,
middle-aged white man with moderate emphysema and
some tenderness in the right upper quadrant of the ab-
domen. Large hemorrhoids and tarry stools were present.
The hemoglobin and hematocrit values on admission were
10.1 Gm. and 32 per cent, respectively. An upper gastro-
intestinal series revealed an active duodenal ulcer.
In addition to the usual ulcer program, the patient
received transfusions and was given subcutaneous in-
jections of atropine around the clock. Although the
bleeding subsequently ceased, he exhibited pronounced
distention of the abdomen and required both enemas and
362
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
Volume XI. IV
Number 4
rectal tubes for relief. The parasympathomimetic drugs
were avoided in view of the chronic asthmatic bronchitis.
Shortly after discontinuing the anticholinergic medication
in favor of hot water, small meals and parenteral fluids,
the abdominal distress and distention subsided. The pa-
tient was subsequently discharged symptom-free.
Case 7. — A 64 year old salesman was admitted to St.
Mary’s Hospital for massive gastrointestinal hemorrhage
of 18 hours’ duration. This was manifested by massive
tarry stools, hematemesis, and loss of consciousness when
he attempted to get out of bed. He had previously had a
bleeding peptic ulcer 20 years before. His condition was
also complicated by the fact that he was a long-standing
diabetic patient who refused to take insulin. Furthermore,
he had apparently been in mild heart failure for the
previous five months as evidenced by dyspnea on exer-
tion, but without pain. He was a well developed, some-
what overweight man appearing markedly pale. The
pulse rate was 104 and regular. The blood pressure was
174 systolic and 80 diastolic. There was moderate angio-
sclerosis of the fundal arterioles. He had dislocated sev-
eral teeth as a result of falling while attempting to get
up. Examination of the heart, lungs, and abdomen was
not remarkable.
The patient was immediately given transfusions, along
with milk and antacids orally in small amounts. The
blood sugar was 518 mg. per hundred cubic centimeters
on admission. Small doses of regular insulin proved to
be most effective in controlling the diabetes. An electro-
cardiogram revealed extensive depression of the ST seg-
ments, indicative of active currents of injury; a tachy-
cardia was also present. With repeated transfusions, he
appeared to be holding his own over the next two days.
The pulse was regular at a rate of approximately 96 per
minute. The level of the hemoglobin stabilized at 9.4
Gm. and the hematocrit value at 31 per cent. The fourth
blood sugar determination was 94 mg.
A surgical colleague then saw the patient in consul-
tation because of the possible necessity for surgical in-
tervention, notwithstanding the extremely precarious med-
ical state. In addition to the procedures named, it was
recommended that he be given Pro-Banthine, 15 mg.
every six hours. Two hours after the first dose, ileus of
considerable degree and tachycardia with a pulse rate
of 140 to 160 per minute were present. Complete urinary
retention ensued, with 950 ml. of urine being subsequently
obtained by catheter. Rapid digitalization was promptly
instituted over the next several hours. No further gastro-
intestinal bleeding was apparent. In spite of these efforts,
acute pulmonary edema developed, and the patient died
several hours thereafter.
Other Potential Hazards
Anticholinergic drugs should be regarded as
an adjunct to, but never as a replacement for.
the dietary-antacid-physical and mental rest pro-
grams which have been time-proved in promoting
ulcer healing. The premature liberalization of
such regimens that is based solely on the sub-
sidence of pain can be fraught with danger,
particularly that of perforation. The same ad-
monition applies to the alteration of the patient’s
previous symptom complex when “interval” anti-
cholinergic therapy is maintained, leading to a
false sense of security.36 This issue is especially
important if the patient is not aware of the fact
that ulcer recurrence cannot be positively pre-
vented by such therapy. The physician is re-
minded of the fact that these drugs interfere only
with the vagal phase of gastric secretion, but not
the gastric or intestinal hormonal phases. If
considerable pain persists after several days of
a regimen combining stomach rest and anti-
cholinergic drugs, the probability of a confined
perforation or a deep penetration looms large.36
The use of these drugs is advised with caution
in the presence of heart failure or coronary insuf-
ficiency because of the tachycardia that is fre-
quently induced, as occurred in case 7. In addi-
tion to this effect, it is not generally appreciated
that a profound postural hypotension may ensue
following full atropinization. This has been re-
cently demonstrated in a large group of normal
adult males by Kaiser, Frye and Gordon.37 The
parenteral route of anticholinergic administra-
tion, in particular, is fraught with the danger of
inducing myocardial ischemia.38
Finally, to complete the spectrum of the pos-
sible hazards of intensive anticholinergic therapy,
brief mention is made of the several others that
are commonly encountered. Xerostomia and im-
paired visual accommodation occur most frequent
ly. The former is not as benign a complication in
some patients as one might believe; it can, in fact,
cause considerable difficulty in the preoperative
management of certain patients. Because of the
potential increase in the intraocular pressure,
these drugs are generally contraindicated in the
presence of known glaucoma and should be used
cautiously in the aged. Symptoms of urinary
retention are frequent in full doses, even in young
men who have no obvious prostatic obstruction,
as occurred in case 5. Drowsiness, headaches and
abnormal behavioral manifestations suggesting
central nervous system stimulation have been
reported.39 I have witnessed the “alert reaction’
following the use of many therapeutic agents
and have come to expect its occasional occurrence
from practically any effective drug, including the
sedatives and tranquilizers. Drug rashes and
other idiosyncratic reactions have also been noted.
In view of the disruption of the esophageal para-
sympathetic innervation, the anticholinergics are
contraindicated in the presence of cardiospasm.40
A curare-like reaction to oral methantheline has
been observed to result from the blocking of the
nicotinic effect of acetylcholine, as manifested
by asthenia, muscle flaccidity , are flexia and
coma.41
Summary
Anticholinergic drug therapy should not be
instituted in the routine management of the pa-
J. Florida, M. A.
October, 195 7
ROBERTS: HAZARDS IN MANAGEMENT OF PEPTIC ULCER
363
tient with peptic ulcer unless the presence of
chronic pyloroduodenal obstruction has been spe-
cifically ruled out. Several important observations
and pitfalls relating to the diagnosis of partial
pyloroduodenal obstruction are emphasized.
Anticholinergic drugs should be used most
cautiously in the initial management of patients
with significant gastrointestinal hemorrhage.
Clinicians must be aware of the fact that a
high degree of anticholinergic activity during the
interval” phase of ulcer therapy might alter the
patient’s symptom complex to an unrecognized
recurrence and lead to further complications, par-
ticularly perforation.
The pathophysiologic and pharmacologic con-
siderations relating to the observed adverse side
effects are cited and discussed.
The practicing physician is urged to maintain
a constant appreciation of the significant side
effects of these potent drugs which he frequently
employs. He should avoid using them ritualisti-
cally and still maintain his reliance on the time-
proved staples of ulcer therapy.
References
1. Ingelfinger, F. J., and Sanchez, G. C. : Indications for
Surgery of Upper Gastrointestinal Tract, New England J.
Med. 250:445-452 (March 18) 1954.
2. Roth, H. P., and Liebowitz, D. : Pyloric Obstruction in
Peptic Ulcer, Ann. Int. Med. 40:11-25 (Jan.) 1954.
3. Ruffin, J. M.; Johnston, D. H.; Carter, D. D., and Baylin,
G. J.: Clinical Picture of Pyloric Channel Ulcer: Analysis
of One Hundred Consecutive Cases, J. A. M. A. 159:668-
671 (Oct. 15) 1955.
4. Berkman, D. M.: Gastric Retention, Its Treatment and
Surgical Mortality, Trans. Am. Gastroenterol. Assn.
26:89, 1923.
5. Bockus, H. L. ; Glassmire, C., and Bank, J. : Fractional
Gastric Analysis of 200 Cases of Duodenal Ulcer, Am. J.
Surg. 12:6-1/ (April) 1931.
6. Piatt, A. D., and Erhard, G. A.: Lesions with Chronic
Symptoms Producing Pyloric Obstruction and Gastric De-
compensation, Radiology 65:503-517 (Oct.) 1955.
7. Kramer, P. : Adverse Effects of Belladonna Alkaloids in
Benign Pyloric Obstruction; Experimental Study, New
England J. Med. 251:600-605 (Oct. 7) 1954.
8. Frank, II., and Gray, S. J.: Symposium on Specific Meth-
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Med. Clin. North America 36:1323-1340 (Sept.) 1952.
9. Chapman, W. P. ; Rowlands, E. N., and Jones, C. M.:
Anti spasmodic Drugs: Evaluation of Their Effects on
Motor Activity of Upper Portion of Small Intestine in
Man, J. A. M. A. 143:627-630 (June 17) 1950.
10. Chapman, W. P., and others: Barium Studies of Com-
parative Action of Banthine, Tincture of Belladonna and
Placebos on Motility of Gastrointestinal Tract in Man,
Gastroenterology 23:234-243 (Feb.) 1953.
11. C hapman, W. P. ; French, A. B.; Hoffman, P. S., and
Jones, C. M.: Multiple- Balloon-Kymograph Recording of
Effect of Banthine, Belladonna, and Placebos on Upper-
Intestinal Motility, New England J. Med. 246:435-443
(March 20) 1952.
12. ( hapman, W. P., and others: Gastrointestinal Motility in
Man; Influence of Standard Meal on Effect of Banthine,
New England J. Med. 251:965-970 (Dec. 9) 1954.
13. Anderson, W. F. : Action of Belladonna on Gastric Mo-
tility in Man, Lancet 2:255-258 (Aug. 9) 1952.
14. Lepore, M. J. ; Golden, R., and Flood, C. A.: Oral Ban-
thine, Effective Depressor of Gastrointestinal Motility,
Gastroenterology 17:551-559 (April) 1951.
15. Legerton, C. W.; Texter, E. C. Jr., and Ruffin, J. M.:
Mechanism of Relief of Pain in Peptic Ulcer by Banthine,
South M. J. 45:310-319 (Aprii) 1952.
16. C hild, G. P. : Pharmacological and Clinical Studies with
Antispasmodics and Local Anesthetics on Upper Digestive
Tract, Gastroenterology 19:126-136 (Sept.) 1951.
17. Ruffin, J. M. ; Texter, E. C. Jr.; Carter, D. D.. and Bazlin,
G. J.: Role of Anticholinergic Drugs in Treatment of
Peptic Ulcer, J. A. M. A. 153:1159-1161 (Nov. 28) 1953.
18. Kern, F. Jr.; Almay, T. P. ; Abbot, F. K., and Bogdonoff,
M. D. : Motility of Distal Colon in Non-Specific Ulcerative
Colitis, Gastroenterology 19:492-503 (Nov.) 1951.
19. Kupperman, H. S., and Silberner, H. B.: Pharmacology
and Therapeutic Application of Agents or Drugs Used in
Functional Disorders of Colon, Am. J. Surg. 93:57-61
(Jan.) 1957.
20. Kirsner, J. B., and Palmer, W. L. : Newer Gastric Anti-
secretory Compounds, J. A. M. A. 151:798-805 (March 7)
1953.
21. Liebowitz, D. ; Raisin, A.: Berry, C., and Roth, H. P. :
Treatment of Intractable Peptic Ulcer with Methantheline
(Banthine) Bromide, T. A. M. A. 150:672-677 (Oct. 18)
1952.
22. Crocker, S. : Cited by Piatt, A. D., and Erhard, G. A.6
23. Shay, H.: Importance of Appraising True Gastric Acidity
After Subtotal Gastrectomy, J. A. M. A. 155:1131-1133
(July 24) 1954.
24. Spiro, H. M.: Present-Day Concepts of Anacidity, J. A.
M. A. 161:9-12 (May 5) 1956.
25. Sun, D. C. ; Shay, H., and Ciminera, J. L. : Relative Ef-
fectiveness of Anticholinergic Drugs on Basal Gastric
Secretion, J. A. M. A. 158:713-718 (July 2) 1955.
26. Irigelfinger, F. J.: Evaluation of Antispasmodics, Bull.
New England M. Center 13:193, 1951.
27. Alvarez, Walter C. : An Introduction to Gastro-Enterology.
ed. 4, New York, Paul B. Hoeber, Inc., 1948, p. 445.
28. Quigley, J. P. ; Bavor, 11. J. ; Read, M. R., and Brofman,
B. L. : Evidence That Body Irritations or Emotions Retard
Gastric Evacuation, not by Producing Pylorospasm, but
by Depressing Gastric Motility, J. Clin. Investigation
22:839-845 (Nov.) 1943.
29. Seigle, S. P., and White, B. V.: Colonic Symptoms with
Active Duodenal Ulcer, New England J. Med. 251:693-694
(Oct. 21) 1954.
30. Gunn, C. G. Jr., and Allen, M. S.: Paralytic Ileus Fol-
lowing Use of Banthine During Gastrointestinal Bleeding,
New England J. Med. 251:705-707 (Oct. 21) 1954.
31. Herschfus, J. A., and others: Evaluation of Therapeutic
Substances Employed for Relief of Bronchial Asthma, A
Review, Internat. Arch. Allergy 2:97-147, 1951.
32. Herschfus, J. A.; Salomon, A., and Segal, M. S. : Use of
Demerol in Patients with Bronchial Asthma, Ann. Int.
Med. 40:506-515 (March) 1954.
33. Veach, H. O. : Antagonistic Action of Morphine and
Atropine on Human Stomach, J. Pharmacol. Exper. Tlierap.
16:230-239 (Nov.) 1937.
34. Folley, J. H., and Abbott, W. O. : Influence of Certain
Commonly Used Drugs on Rate of Gastric Emptying in
Normal Human Subjects as Determined by Intubation
Technique, Am. J. Digest. Dis. 9:202-205 (June) 1942.
35. Rogers, T. M. : Patient with Upper Gastrointestinal Tract
Hemorrhage, J. A. M. A. 150:473-477 (Oct. 4) 1952.
36. Roth, J. L. A.; Wechsler, R. L., and Bockus, H. L. :
Hazards in LTse of Anticholinergic Drugs in Management
of Peptic Ulcer Disease, Gastroenterology 31:493-499
(Nov.) 1956.
37. Kaiser, M. H.; Frye, C. W., and Gordon, A. S. : Postural
Hvpotension Induced by Atropine Sulfate, Circulation
10:41 3 :422 (Sept.) 1954.
38. Cummins, A. J.: Use and Abuse of Anticholinergic Drugs
in Management of Gastrointestinal Disease, Ann. Int. Med.
46:352-359 (Feb.) 1957.
39. Asher, L. M., and Cohen, S.: Effect of Banthine on Cen-
tral Nervous System, Gastroenterology’ 17:178-183 (Feb.)
1951.
40. Kramer, P., and Ingelfinger, F. J.: Cardiospasm, General-
ized Disorder of Esophageal Motility, Am. J. Med. 7:174-
179 (Aug.) 1949.
41. McHardy, G.: Banthine Idiosyncrasy: Case Report of
Curare-Like Reaction, Gastroenterology 22:636-637 (Dec.)
1952.
6618 South Dixie Highway.
Discussion
Dr. Winston K. Shorey, Miami: This comprehensive
and well documented paper certainly leaves little for a
discussant to add regarding the difficulties a physician
may encounter when using anticholinergic drugs in the
treatment of peptic ulcer. I heartily congratulate Dr.
Roberts for bringing to us this timely reminder that in
our therapy of ulcer we must not proceed under the
illusion that anticholinergic drugs have provided a real
answer to this disease.
To emphasize further that one must expect a high
frequency of gastric retention when these drugs are given
to patients with partial pyloric obstruction, I would
point out that significant gastric retention occurred under
the influence of anticholinergic drugs in 50 per cent of
patients who had no reported evidence of pyloric ob-
struction in a study conducted by Texter and his associ-
ates.
In regard to the matter of precipitating a complete
obstruction by administrating an anticholinergic drug to
a patient with partial obstruction, I have a comment
364
GITTELSON: MANAGEMENT OF BRONCHIAL ASTHMA
Volume XLIV
Number 4
and a question. As Dr. Roberts has already pointed out,
a patient may have a considerable degree of pyloric sten-
osis and yet not have significant gastric retention as long
as the stomach retains sufficient muscular ability to drive
its content through the narrowed outlet. If we then
depress gastric motility with an anticholinergic drug,
gastric retention occurs, and may be complete. In doing
so, however, we have not changed the actual degree of
organic obstruction at the pylorus. To be sure, a high
grade organic pyloric stenosis may be first recognized
when the patient receives an anticholinergic drug, as
vividly demonstrated by cases presented by Dr. Roberts
today. Nevertheless, in other cases there may appear to
be pronounced organic stenosis when actually muscle
atony is the major problem. My question to Dr. Roberts
is, “If a patient with partial obstruction is given an
anticholinergic drug, does not the greatest hazard lie in
the possibility that the degree of organic obstruction will
appear greater than it actually is and thereby result in
the committing of a patient to surgery when it is not
really necessary?”
I certainly agree with the essayist regarding the un-
desirability of administering these drugs to patients with
bleeding ulcer. The presence of glaucoma and an ob-
structing lesion at the outlet of the urinary bladder are
unquestionably contraindications to their use.
The hazard which in my opinion is the greatest of all
has been adequately discussed by Dr. Roberts, and I have
already referred to it myself. That is the placing of
reliance upon these drugs to cure peptic ulcer to the
extent that the time-honored therapeutic measures used
in the treatment of this disease are not adequately ad-
ministered. Evidence is developing to substantiate the
belief that these drugs cannot be relied upon to alter the
long term course of peptic ulcer. Complications may
occur during their administration even though the pa-
tient is symptomatically improved.
Dr. Roberts, closing: You are correct in pointing
out that a major discrepancy between the clinical
picture and the radiographic obstruction may occur while
these patients are kept on anticholinergic therapy. I
try, of course, not to use these drugs until proper
roentgen studies are made. If the patient has been re-
ceiving anticholinergic therapy, I usually request discon-
tinuance of the treatment for at least several days prior
to the roentgen studies of the stomach. When there is
doubt, as is always the case with laboratory procedures,
the roentgenograms should be repeated. Dr. Shorey
has again properly re-emphasized the potentially mislead-
ing roentgenograms of the stomach in pyloroduodenal
stenosis wherein they may not show any overt obstruc-
tion when it is present if the gastric tone persists.
Now what has happened in these patients by administer-
ing anticholinergic drugs in the presence of partial ob-
struction has merely been in most instances to precipitate
gastric decompensation more readily, making surgical
intervention truly mandatory. I have no time to go into
the whole philosophy of anticholinergic drug therapy as
related to the management of ulcer. Suffice it to say
that I honestly believe we may have to revise our
concept of the degree of anticholinergic therapy us-
ually required in these patients, both as a result of
clinical and in vivo and in vitro studies. I personally
regard it as unwise to push these drugs too much in
most patients with ulcer.
Thank you once again, Dr. Shorey, for your kindness
in discussing this paper.
Neglected Phase of Management
Of Bronchial Asthma
George Gittelson, M.D.
MIAMI
Experience with asthmatic patients in the
allergy clinic and private practice indicates that
the single most effective weapon in the manage-
ment of these patients is the one usually over-
looked. Asthmatic patients armed with a battery
of proprietary drugs, puffing on nebulizers, and
starved on rigid elimination diets still come seek-
ing help. A few have been treated with steroids
and a few have had allergy surveys and hyposen-
sitization. Practically none, however, know about
the causes of their trouble and how to avoid them.
This ignorance among patients is no doubt
a reflection of the inertia of the physicians who
advise them. The tragedy is that the concept of
the management of the asthmatic patient should
differ but little from the concept of the manage-
ment of the patient with poison ivy dermatitis or
Clinical Instructor in Medicine, University of Miami School
of Medicine, Miami.
From the Department of Medicine, Jackson Memorial Hos-
pital, Miami.
ragweed hayfever. Few physicians will not agree
that the best treatment for poison ivy dermatitis
is not to walk in the poison ivy. Few will not
agree that the best treatment for ragweed hay-
fever is to spend the hayfever season in a pollen-
free section of the country or in an air-condi-
tioned home. While it is true that Rhus hyposen-
sitization and ragweed hyposensitization give pro-
tection if exposure should occur, by far the best
relief is obtained by the patient who is not ex-
posed at all.
This method of treatment is available to the
family physician as well as to the allergist. It
should be the responsibility of the family physi-
cian to institute elimination measures and to
educate his patients even before he refers them
for allergic diagnostic surveys. Also, it should be
the responsibility of the family physician to fol-
low up his instructions with home inspection visits
after hyposensitization has begun.
J. Florida, M. A.
October, 195 7
GITTELSON: MANAGEMENT OF BRONCHIAL ASTHMA
365
Why then should it be so difficult for phy-
sicians to educate patients with bronchial asthma
in the ways and means of reducing exposure to
causative factors? After all, asthma is the same
allergic reaction and has the same physiologic
and pathologic basis as Rhus dermatitis and rag-
weed hayfever. The difficulty arises because the
factors involved in the production of asthma are
often multiple while the factors in dermatitis and
hayfever are easily demonstrable and individual
in nature.
Even though there may be multiple factors in-
volved in the production of asthma, these factors
are well known, and the means of avoiding them
are at hand. Only the inertia of physicians and
the ignorance of patients prevent the widespread
adoption of preventive measures.
Allergens in the Home
It is exposure to causative agents commonly
found in the home that causes trouble for the
asthmatic patient. Most of the troublemakers
are traditionally found in the home and are not
necessities at all. Most are decorative, and few
are utilitarian. Many add nothing to the joy of
living. In most instances they may be disposed
of with ease. Few of them will ever be missed.
Perhaps the worst single offender is house
dust. If it were possible to remove the source of
house dust and to eliminate the places where it
gathers, asthmatic patients would be improved.
It is obviously easy to accomplish both objectives
and avoid tragic results. House dust comes from
within the home and is made up of deterioration
products of feathers, cotton, wool and kapok, as
well as molds, and various animal hairs.
Nothing could be more simple than to remove
from the home of the asthmatic patient all of these
substances. Feathers will be found in pillows.
Foam rubber pillows are easily substituted. Feath-
ers are also found in comforters. Woven cotton
blankets may be used. Feathers may be found
in sofas and cushions. Foam rubber may be
substituted. This change may entail some expense
in the refurbishing of the sofa, but the money
is better spent on the sofa than on epinephrine.
In the same manner cotton quilts and mat-
tresses must be eliminated. Cotton fiber is not
allergenic, but it is the poor unrefined grade of
cotton used in stuffing quilts and furniture that
contains the cottonseed. It is the cottonseed, in
all probability, that helps incite the asthma.
Wool is no more of a problem than cotton.
Nylon blankets and rayon or nylon rugs are more
than adequate substitutes for wool. Nylon or
dacron clothing in many ways is superior to wool,
and certainly the former is harmless for the asth-
matic patient.
Kapok is known commonly as silk floss. It is
widely used in stuffing pillows, mattresses, furni-
ture and cushions. It rapidly becomes infested
with molds and rapidly crumbles to dust. In
this moldy, dusty state it becomes a powerful al-
lergen. Foam rubber may be substituted for
kapok in any pillow, mattress, or piece of furni-
ture.
Here then are four substances that may be
banished from the environment of the asthmatic
patient. No community effort is necessary. Con-
trast the simplicity of throwing away an old sofa
with the difficulty involved in spraying all patches
of poison ivy or ragweed in a city, and it should
be obvious that the asthmatic patient is in a good
position to do something about the control of his
environment.
The patient with asthma can also eliminate
the places where dust might settle. He may de-
sign his home so that removal of dust, like the
removal of garbage in a disposal unit, is facili-
tated. This means he will have no drapes fram-
ing his windows in great dusty cloths. He might
have easily dusted blinds or even opaque glass in
the window so that one wipe of a damp cloth
daily disposes of window dust. He will have only
essential carpeting. His floors should be bare so
that the wipe of a damp mop will remove all the
floor dust quickly and easily. Bare floors are not
unattractive. Cork, asphalt tile, parquet, and ter-
razo are all utilitarian and attractive. None re-
quire carpeting. The asthmatic patient requires no
bedspread. This seldom-laundered dust collector
deposits dust right where he will spend the longest
part of his life — in his bed. The asthmatic pa-
tient needs less wall decor, fewer plants, and less
litter on his bureau tops. He should have a smaller
collection of books and magazines. All of these
articles collect dust, or dust settles on them, and
all need to be dusted. They all hide dust in
pockets and crevices, and the patient with asthma
needs his dust in the open where he can fight it
with damp cloths.
After the dust has been mastered, he can turn
his attention to the molds. In eliminating dust,
he will have partially solved his problem with
mold, but much remains. Unfortunately, many
mold spores are blown in from the out-of-doors
as are pollen grains. It is probable, however, that
most of the molds that participate in the produc-
366
GITTELSON: MANAGEMENT OF BRONCHIAL ASTHMA
Volume XLIV
Number 4
tion of asthma come from within the home. They
grow luxuriantly on discarded shoes which lie
neglected at the bottom of a closet. They grow
on unused luggage, on cardboard boxes storing
old mementos. They grow on old books and mag-
azines, and they grow on record albums. They
thrive in junk-laden closets and in damp base-
ments as well as in souvenir-crammed attics.
The solution for the asthmatic patient lies in
breaking with sentiment. Cherished but moldy
souvenirs must go. Either they are consigned to
the trash, or they are demolded at regular inter-
vals. Nothing defeats the growth of mold so well as
light, air and dryness, and all closets in the home
of the asthmatic patient must have these in
abundance.
With the departure of the dust and mold, the
battle is nearly won. Only incidentals remain.
Beneath the rug, for instance, will probably be
found a rug cushion or pad. This is carefully
compounded from horse and hog hair, both poten-
tial troublemakers. Much of the furniture will
have horse hair in it. Much of the upholstery will
be mohair, which is goat hair. Children’s toys will
be made soft and cuddly with a potential offender,
rabbit hair. Rabbit hair will also be found mas-
querading as expensive furs. Cattle hair will be
found in rug cushions and in carpets. The more
of these incidentals that can be tracked down and
eliminated the better will the asthmatic patient
feel.
The most difficult sales job still lies ahead. I
have yet to see the asthmatic patient who could
believe that his adoring Fido or Tabby could play
a part in making asthma worse. Nevertheless, dog
hair and cat hair are powerful allergens, and the
patient with asthma should have fish, turtles, or
lizards for pets. While fewer human characteris-
tics can be attributed to them, they are generally
less of a menace.
Since the asthmatic patient will spend about
eight hours of each day, one third of the day, in
his bedroom, it follows that the bedroom is the
room which must be most spic and span. The rest
of the house must not be neglected, but if the
bedroom is above criticism, symptoms will gen-
erally improve. The more severe the asthma, the
more important it is to enforce all precautions
strictly in all parts of the home.
Once the debris has been removed, the roles
of diet, infection and emotion will become more
apparent. When inhalant factors are at a mini-
mum, the effect of diet manipulation is more
readily apparent. When inhalant factors are re-
moved, the asthmatic patient can often withstand
remarkably well the infections which previously
precipitated an attack of asthma.
As far as emotional factors are concerned, it
will be noted that emotional upset is tolerated
better just as are the infections. I believe that the
prompt relief which many asthmatic patients find
in the hospital is not related to removal from an
emotion-charged home environment. It is rather
due to their sudden removal from the autogenous
house dust, molds and incidentals. Almost all hos-
pitals are equipped with signs reading "Floor
Wet,” which are used daily, and most larger hos-
pitals are equipped with machines for washing
walls. Most hospitals have no carpeting, and few
have bedspreads, drapes, or storage in the closets.
It is for this reason that the patients improve in
the hospital without other therapy.
The place for hyposensitization is as a supple-
ment to elimination. The resistance of the patient
can be increased to allergens which he cannot
avoid. He can be helped to develop resistance to
avoidable materials in case he should be unavoid-
ably exposed. Hyposensitization may be, as many
physicians and patients believe, a magic process
which can transform an asthmatic patient from
a sick to a well person, but hyposensitization
without elimination is like prescribing glasses for
a man with no eyes.
Summary
In summary, the allergens which are potential
sources of trouble to an asthmatic patient are well
known. Elimination of these allergens from his
home, and particularly from his bedroom, is the
most important phase in the management of the
patient with asthma, and is the most neglected as-
pect of management. Diet manipulation, control
of infection and psychotherapy are important as-
pects of management, but without elimination they
will not yield much relief. Hyposensitization is
important as a supplement to elimination.
Bibliography
Hansel, French K.: Clinical Allergy, St. Louis, C. V. Mosby
Company, 195 3.
Sheldon, John M.; Lovell, Robert G., and Mathews, Kenneth
P. : A Manual of Clinical Allergy, Philadelphia, W. B.
Saunders Company, 1953.
Unger, Leon: Bronchial Asthma, Springfield, 111., Charles C.
Thomas, Publisher, 1945.
Bronchial Asthma, in Kallos, P., editor, Progress
in Allergy, vol. 2, New York, Interscience, 1952, pp. 142-
221.
Unger, A. H., and Unger. L.: Treatment of Bronchial Asthma,
GP 4:79-87 (Dec.) 1951.
123 S. W. Thirty-Seventh Avenue.
J. Florida, M, A.
October, 1957
367
The Treatment of Cardiac Arrhythmias
By Drugs
Clifton B. Leech, M.D.
FORT LAUDERDALE
The most common type of cardiac arrhythmia
is the normal physiologic phenomenom of phasic
speeding and slowing of the heart rate, usually,
though not always, dependent upon the respira-
tory phase. It is a functional condition which
never requires treatment. All other arrhythmias,
even when occurring in normal hearts, may at
times require drug therapy, a resume of which
follows.
Premature Beats
1. Auricular
2. Ventricular
Premature beats demand treatment when they
precede attacks of paroxysmal tachycardia, when
they occur during operative performances, and
when they appear after coronary occlusion.
When it can be found, the cause should be
remedied or removed, as in the case of digitalis
poisoning, hyperthyroidism, and extrinsic irritants
such as tobacco, coffee, tea and alcohol. Occa-
sionally the intake of a particular food is followed
by premature beats and other arrhythmias. This
has been noted to occur after fatty meals, and
there is now some evidence to suggest that post-
prandial lipemia has an irritating effect on an ab-
normally sensitive myocardium.1 Aside from spe-
cific therapy which may be indicated by the cause,
symptoms often can be relieved by reassurance
and simple sedation, as by phenobarbital. Some-
times a period of rest and relaxation, a vacation
with its freedom from the usual responsibilities
and tensions, is sufficient to abolish premature
beats. It is of some value to know whether the
premature beats arise in the atria or from the ven-
tricular musculature since certain drugs are more
effective in the treatment of ventricular premature
beats than in other varieties.
Quinidine sulfate may be successful in abolish-
ing premature beats of any type. The amount
required, as with all drugs, varies with the indi-
vidual, but it is seldom that more than 0.2 Gm.
every three to four hours is required for this
purpose.
Digitalis itself is sometimes useful in the pro-
phylaxis of premature beats, but when it is clear
that ventricular premature beats are due to dig-
italis, then potassium, such as the acetate, 2 to 4
Gm. (30 to 60 grains) every four to six hours is
usually of benefit. Even when digitalis is not a
factor, the addition of potassium to the other
therapy is of value sometimes.
Supraventricular Tachycardia
1.
Sinus
2.
Auricular (atrial)
3.
Nodal
4.
Auricular (atrial)
flutter
5.
Auricular (atrial)
fibrillation
Sinus, Atrial and Nodal Tachycardia. —
The statements made regarding causes and treat-
ment of premature beats are applicable to par-
oxysmal atrial and nodal tachycardia, and occa-
sionally to sinus tachycardia; in addition, vagal
stimulation often abolishes attacks of paroxysmal
tachycardia. The vagi may be stimulated by pres-
sure and massage on the carotid sinus with the
patient preferably in the prone position and with
the head turned from the side which is to be stim-
ulated, especially the right side, which has been
found to be more sensitive. Other maneuvers
such as pressure on the eyeballs, holding the
breath and lowering the head sometimes serve
the same purpose.
There are many drugs which have been used
successfully for the abolishment and prophylaxis
of tachycardia. One of these, which seems not
to have been widely used but which is effective,
is neostigmine (Prostigmine). This drug is
thought to inhibit cholinesterase, which destroys
the acetylcholine liberated at the vagal ends, thus
encouraging the vagus inhibiting effect. There is
some evidence to suggest that it is more effective
in patients who have been digitalized. This drug,
given by vein in a dose of from 0.125 mg. to 0.25
mg. every 20 to 30 minutes, will usually be effec-
tive after one or two doses.
Digitalis by vein is often sufficient. The prep-
aration which has a great reputation for this use
is lanatoside C (Cedilanid) in a dose somewhat
less than the average digitalizing amount. Any
injectable digitalis may be used.
368
LEECH: TREATMENT OF CARDIAC ARRHYTHMIAS
Volume XLIV
Number 4
Procaine amide hydrochloride (Pronestyl) is
a valuable drug, but has the disadvantage when
given by vein of producing, sometimes, pronoun-
ced hypotension. When this drug is used by vein,
it is well to inject it slowly at a rate that will in-
troduce 100 mg. every few minutes with careful
observation of the blood pressure. The dosage
when given by mouth varies from 250 mg. to 500
mg. every three to six hours.
Neo-Synephrine may be effective by vein in
doses of 0.5 mg. Its use is often accompanied by
a rise in blood pressure which seems to be due to
the drug effect on the carotid sinus reflex. It is
said to be contraindicated in patients with ven-
tricular premature beats.
Acetyl beta methylcholine (Mecholyl) is high-
ly effective, but produces such alarming concomi-
tant effects that its use should be restricted to
those cases in which all other measures have failed.
It is given subcutaneously, in 20 mg. dosage
which may be repeated in 30 minutes. It produces
salivation, diarrhea, precordial pain and bronchial
spasm. Atropine sulfate, ! to 2 mg., will relieve
the symptoms produced by Mecholyl and should
always be on hand.
Acetylcholine is another parasympathomimetic
drug which is effective sometimes when given by
vein in a dose of 50 to 100 mg.
Methoxamine hydrochloride (Vasoxyl) in 10
mg. dosage by slow intravenous injection is fre-
quently useful, but on account of its pronounced
pressor action should be used with great caution
in patients who have hypertension, cardiovascular
disease or hyperthyroidism. Other pressor drugs
may be tried with similar precautions.
Levarterenol (Levophed) has been used suc-
cessfully in the treatment of paroxysmal supraven-
tricular tachycardia in patients in whom hypo-
tension and shock developed.2 The drug was giv-
en by vein in a concentration of 8 to 16 mg. per
1,000 cc. of 5 per cent glucose in water, at a
rate of 20 to 30 drops per minute. The rate of
flow was adjusted to raise the systolic pressure to
120 to 160 mm. as quickly as possible. Upon res-
toration of sinus rhythm the infusion was slowed
to 10 to 20 drops per minute and terminated short-
ly thereafter. This technic was successful only
when the blood pressure became elevated to nor-
mal levels, which suggested that the elevation of
the blood pressure stimulated receptors in the
aorta and carotid sinus causing reflex stimulation
of the vagus.
Atrial Flutter.— When auricular flutter per-
sists after digitalization, quinidine may be used in
the same manner as in the case of auricular fibril-
lation. In persistent flutter, the drugs which
have been described may be used, frequently with
successv
Atrial Fibrillation. — Without discussion of
the role of digitalis in the treatment of persistent
auricular fibrillation but in relation only to par-
oxysmal auricular fibrillation or to the attempt to
revert the arrhythmia to sinus mechanism, the
drug of choice is quinidine, which usually may be
given by mouth.
Quinidine is so useful in the treatment and
prophylaxis of nearly all arrhythmias that it seems
wise to review its chief therapeutic actions, which
are as follows:
Prolongs the refractory time of heart
muscle
Slows the conduction time in heart mus-
cle
Exerts an antifibrillary action
Depresses the excitability of heart mus-
cle
Depresses the rhythmic function of the
sinoauricular node and the ectopic pace-
makers
Slows the electrical systole
Reduces the contractile force of the
heart muscle
Produces ventricular tachycardia (after
very large doses)
Blocks the vagus in the heart, thus when
unapposed by other effects the heart
rate is increased
Causes a fall in systolic blood pressure
(after huge doses only, perhaps by block-
ing the epinephrine action on the blood
vessels)
The toxic manifestations of quinidine include
impairment of hearing, tinnitus, blurred vision I
vertigo, tremor, nausea, vomiting, abdominal I
cramps and diarrhea. In addition, the therapeutic
action may become toxic; for example, depressior
of auriculoventricular conduction to maintain a
normally slow ventricular rate is therapeutic, bui I
it becomes toxic if the depression is sufficient tc
cause complete heart block. The toxic effect: j
which, though usually preceded by the symptom: I
mentioned, must be looked for are undue prolon
gation of the auriculoventricular conduction, vary |
ing degrees of heart block, intraventricular block «
premature beats and ventricular tachycardia.
It is important to have a definite plan, a dos
age schedule which should be adhered to in th' :
attempt to abolish the abnormal rhythm with
J. Florida, M. A.
October, 1957
LEECH: TREATMENT OF CARDIAC ARRHYTHMIAS
369
out producing serious toxic effects. The partic-
ular scheme is not so important as it is to adhere
to the schedule which has been selected and to be-
come familiar with it. There is a personal pref-
erence for the natural quinidine rather than the
synthetic drug.
Treatment may be started with a dose that is
known to be safe and increased if needed. Al-
though allergic sensitivity to quinidine is unusual,
there should be questioning and observation after
the first dose with such sensitivity in mind. The
peak effect of the oral dose develops in two to
four hours and is gone in about 12 hours; thus
the dose should be repeated every three hours, for
example, and the patient observed before each
new dose to see if the objective has been reached
and to watch for possible toxic effects. It is a per-
sonal preference not to be in a hurry to reach the
higher doses since normal rhythm is so frequently
established with smaller amounts. Thus 0.2 Gm.
may be given the first day for six doses. If neces-
sary to continue, the dose may be 0.4 Gm. every
three hours on the second day, 0.6 Gm. every
three hours the third day, and rarely 0.8 Gm.
every three hours on the fourth day. In this way
the intensity of the quinidine action gradually in-
creases until the desired result is obtained or the
attempt abandoned.
When regular rhythm has been restored, it is
wise to give prophylactic doses, usually 0.2 Gm.
or 0.4 Gm. four times daily depending upon the
amount of quinidine which has been required,
and to continue until such time as it seems wise
to attempt to reduce and perhaps eventually omit
the quinidine in the hope that the heart muscle
has established the habit of remaining under con-
trol.
It is of some practical interest to consider
what happens in the heart with atrial fibrillation
during this type of quinidine therapy, as elucida-
ted by Gold and others. Whether or not a circus
movement is present, there are in the auricles, in
this mechanism, impulses at a rate of about 400
to 500 per minute, mostly blocked at the auric-
uloventricular node so the ventricular rate is per-
haps 120 or so. As the quinidine action takes
place, the number of these impulses is reduced,
but often the quinidine simultaneously blocks
the vagus, thereby diminishing the auriculoven-
tricular block with a resulting rise in the ventric-
ular rate while the rate falls in the fibrillating
auricles.
When the rate in the auricles falls to around
300 to 350 a minute, the mechanism usually
changes from auricular fibrillation to auricular
flutter, perhaps with a 2: 1 ratio. As the quinidine
effect persists, the auricular rate continues to slow
with a fall in the ventricular rate. When the au-
ricular rate falls to about 200 per minute, the 2:1
block disappears because the auriculoventricular
node is rarely refractory to a rate of 200 and at
this point the ventricles begin to respond to all
of the auricular impulses; therefore, the ventric-
ular rate suddenly rises. Quinidine should not
be stopped at this time because while the auric-
ular rate is slowed, the refractory time is also
being prolonged, and when it becomes sufficiently
long, there occurs an abrupt end to the abnormal
mechanism. At that moment the heart tempo-
rarily is left without a pacemaker, but after a few
seconds the sinoauricular node resumes its rhyth-
mic discharge, usually at a normal rate. There
are variants of this pattern such as a pronounced
vagal depression which lifts the auriculoventricular
block while the auricular rate is very rapid. Some-
times failure of restoration of normal rhythm is
due to an unfavorable balance between the pro-
longed refractory time, which tends to abolish the
abnormal mechanism, and to slowing of conduc-
tion, which tends to promote it. Whenever the
ventricular rate appears to have been slowed, it
is wise to have an electrocardiogram to see if
sinus rhythm has been restored but kept rapid
by action of the vagus.
There are varying opinions concerning quini-
dine and digitalis combined in the attempt to re-
vert auricular fibrillation to normal sinus mech-
anism. Some have expressed opinions advising
against the simultaneuos use of the two drugs as
opposed to those who advise such usage. There
are reports of success in the use of quinidine for
this purpose following digitalization, and perhaps
an equal number of reports of success by the use
of quinidine alone.
Theoretic considerations must take into ac-
count that quinidine prolongs the refractory time
in the heart muscle and tends to slow conduction,
but usually the effect on the refractory phase is
predominant. Digitalis tends to shorten the re-
fractory time by vagal stimulation and by direct
effect on the heart muscle while it tends to accel-
erate conduction in the auricle; consequently its
effect in abolishing the abnormal mechanism
would depend upon which of these actions is pre-
dominant. If one could combine the effect of
quinidine in prolonging the refractory time with
the effect of digitalis in speeding up conduction,
370
LEECH: TREATMENT OF CARDIAC ARRHYTHMIAS
Volume XLIV
Number 4
without the other and apposing effects of the two
drugs, the result would be ideal, theoretically, in
abolishing the abnormal mechanism. It appears
that such an additive effect of the two drugs does
occur in some patients.
There are other combinations of effects, how-
ever, which may promote the arrhythmia; for ex-
ample, in the auriculoventricular node digitalis
slows the speed of conduction by reflex vagal
stimulation and by direct action on the node.
Quinidine has two conflicting actions, one to slow
conduction by direct depression of the node and
the other to accelerate conduction by block-
ing the vagus function. Thus the two drugs
may act to slow the heart rate by blocking
the auriculoventricular conduction, or the heart
rate may increase when quinidine blocks the
vagus sufficiently to erase the vagal stimula-
tion of the digitalis. The effect of the use of the
drugs in my opinion is unpredictable. If quini-
dine used alone fails in its purpose, then digitalis
may be added in the hope that the additive ef-
fect will be a beneficial one. When congestive
failure is present, one is usually obliged to use
digitalis as well as quinidine. If sinus mechanism
is not restored in such a patient, it may be proper
to omit the digitalis until much of its effect is
dissipated and then to try quinidine alone.
Ventricular Tachycardia
Unlike the supraventricular arrhythmias, ven-
tricular tachycardia rarely if ever occurs in a nor-
mal heart. It may be due to digitalis poisoning
and is often present after myocardial infarction.
It is important to abolish this tachycardia with
as little delay as possible.
Procaine amide hydrochloride (Pronestyl) is
the treatment of choice and may be given by
mouth, 500 mg. every three hours, if more rapid
action is not imperative, in which case the drug
may be given by vein in a suitable diluent at a
rate of 100 mg. per minute until an effect is ob-
tained. During administration of Pronestyl by
vein an electrocardiogram should be obtained in
order to note a change in rhythm or evidence of
toxic effect, either of which calls for cessation of
thp drug. The blood pressure should also be ob-
served, and if a decided fall occurs, it may be
countered by a vasopressor drug such as Neo-
Synephrine or Levophed. Usually, Pronestyl will
be effective with a dose less than 500 mg. by vein
if at all. The oral dose required may be as much
as 5 to 10 Gm.
Quinidine is of less value than in the treat-
ment of the supraventricular tachycardias and is
somewhat more hazardous because of its possible
toxic and depressant effect upon injured and dis-
eased ventricular tissues; but it may be given by
mouth as described for auricular fibrillation or
may be used intramuscularly in any of the prep-
arations which are now on the market such as
quinidine hydrochloride, or quinidine sulfate in
propylene glycol. The intramuscular dose is ap-
proximately the same as required by mouth. When
all else fails, quinidine may be given by vein if
the situation demands it, 0.2 Gm. each few min-
utes with electrocardiographic control.
Isopropylnorepinephrine has been used in pa-
tients with complete heart block for the prophy-
laxis of ventricular tachycardia and for ventric-
ular fibrillation in patients with recurrent Stokes-
Adams syncope due to these arrhythmias. It was
administered by continuous intravenous infusion
to accelerate the idioventricular pacemaker, thus
preventing, presumably by dominance, additional
aberrant rhythms. This drug has been reported
also to stimulate multifocal ventricular activity.
When all else fails, it may be worthy of trial.3 4
Levarterenol (Levophed) has been reported as
a useful agent similarly employed.2
Magnesium sulfate has been used successfully
and may still be tried if other measures fail. This
drug may be injected with moderate rapidity, 10
to 20 cc. in 20 per cent solution (2 to 4 Gm.).
Morphine sulfate has been found to abolish
ventricular tachycardia on occasion given by vein
in small doses, 10 mg. or more, not repeated in
less than one hour.
Ventricular Fibrillation
When a patient with ventricular fibrillation
survives sufficiently long for the diagnosis to be
evident, the occasion is apt to be during anesthesia
or other procedures during which electrocardio-
graphic control is being observed. It may follow
myocardial infarction or may be a result of drug
toxicity. When due to electric shock, it is usually
rapidly fatal, as in the electric chair. Whenever
patients with ventricular fibrillation remain alive
more than 20 to 30 seconds, there may be seizures
resembling the Stokes-Adams episode. The nature
of the underlying mechanism must be distin-
guished from the other causes of such seizures,
namely temporary asystole and complete heart
block. Drugs which are useful in the latter condi-
tions, such as epinephrine and ephedrine, may be
harmful in the case of ventricular fibrillation.
There is no dependably useful therapy. Oxygen
is imperative. Procaine or Pronestyl, or even
quinidine may be given intravenously. There have
J. Florida, M. A.
October, 195 7
LEECH: TREATMENT OF CARDIAC ARRHYTHMIAS
371
been reports of the successful use by vein of
atropine, potassium chloride and magnesium sul-
fate. The maneuver of electric defibrillation with
special apparatus should be anticipated and pre-
pared for in the operating room, but is apt to be
less effective when the arrhythmia occurs as a
result of disease than when it is an accident sec-
ondary to anesthesia and surgery.
Isopropylnorepinephrine may be used in the
same manner as mentioned in the case of ven-
tricular tachycardia.
Complete Heart Block
The treatment for complete heart block is
aimed at relief and prophylaxis of the Stokes-
Adams syndrome. Mechanical stimulation by
sharp blows over the precordial area may increase
the heart rate sufficiently to end the episode.
Stimulation by the electric cardiac pacemaker
may be useful. Epinephrine in small dosage by
vein, or in extreme emergency directly into the
heart muscle or a heart chamber, may be at-
tempted. This drug may be repeated, in the case
of recurring seizures, by the subcutaneous route,
or may be given intramuscularly in oil. Ephedrine,
25 mg., Paredrine, 30 mg. by mouth, and Isuprel,
15 mg. sublingually, have been of value. Isopro-
pylnorepinephrine may be used as described.
Sodium Lactate has recently been reported as
useful after cardiac arrest and in Stokes-Adams
seizures in patients with complete heart block.
Although the mechanism of its effects is not clear-
ly defined, the intravenous molar and half molar
solutions have been used to restore the heart beat
after attempts by other drugs proved useless. An
intravenous infusion has been maintained, with
good results, for several hours.5
Summary
The treatment of cardiac arrhythmias by
drugs has been discussed with particular reference
to quinidine therapy. Mention is made of the
usefulness of numerous drugs including some of
the more recently introduced preparations and
methods of use.
References
1. Kuo, F. T., and Joyner, C. R. Jr.: Angina Pectoris In-
duced by Fat Ingestion in Patients with Coronary Artery
Disease; Ballistocardiographic and Electrocardiographic
Findings, J. A. M. A. 158:1008-1113 (July 23) 1955.
2. McGinn, J. T., and Schluger, J. : Levarterenol Bitartrate
(Levophed) in Treatment of Cardiac Arrhythmias, Am.
Heart J. 50:625-633 (Oct.) 1955.
3. Kayden, H. J., and Stack, M.: Studies on Complete Atrio-
ventricular Dissociation with Special Reference to Stokes-
Adams Syndrome, presented at the American Heart As-
sociation 28th Scientific Sessions, New Orleans, October
1955 ; abstracted in Circulation 12:729 (Oct.) 1955.
4. Zoll, P. M., and others: Effects of Sympathomimetic
Drugs on Ventricular Rhythmicity and Atrioventricular
Conduction During Stokes-Adams Attacks, presented at
the American Heart Association, 28th Scientific Sessions,
New Orleans, October 195 5; abstracted in Circulation 12:
794 (Oct.) 1955.
5. Bellet, S.; Wasserman, F., and Brody, J. I.: Treatment of
Cardiac Arrest and Slow Ventricular Rates in Complete
A-V Heart Block; Use of Molar and Half Molar Sodium
Lactate: A Clinical Study, Circulation 11:685-701 (May)
1955.
808 N. E. Twentieth Avenue.
372
Volume XLIV
Number 4
ABSTRACTS
Analysis of the Foot in Infants. The
Radiographic Criteria and Clinical Aspects.
By William S. Hatt, M.D., and Lawrence A.
Davis, M.D. South M. J. 50:720-724 (June)
1957.
The authors describe their scientific evaluation
of the normal and abnormal infant foot in the at-
tempt to correct deformities properly. Their anal-
ysis is based on a standardized radiographic tech-
nic. The so-called normal infant foot or its neutral
position, clubfoot, rocker deformity, flatfoot and
metatarsus varus, metatarsus valgus and pes cavus
are analyzed from the standpoint of TC or talo-
calcaneal angle both in lateral and anteroposterior
projections. The inferior cortical line of the fifth
metatarsal and calcaneus, midshaft lines of the
first and fourth metatarsals and the midshaft
lines of all the metatarsals are utilized in anal-
ysis of the forefoot. Since the conditions dis-
cussed may be considered as positional changes
of otherwise normally developed bones and joints
of the infant foot, it is believed that comprehen-
sive analysis of these positional changes will
prove essential for their accurate diagnosis and
treatment as well as in future investigation.
A brief discussion of the milder deformities is
presented, and the problems of clubfoot and flat-
foot are also discussed. This analysis should be
useful in dealing with the difficult problem of
what deformities to treat and how far they should
be corrected.
Use of Meprobamate (Miltown^) for
the Treatment of Emotional Disorders. By
Roger E. Phillips, M.D. Am. Pract. & Digest
Treat. 7:1573-1576 (Oct.) 1956.
This study indicates that of the ataractic
drugs, meprobamate is probably of the greatest aid
in tension states and the like, in terms of its effec-
tiveness and low rate of side reactions. Of 135
psychiatric patients treated with Miltown in
private practice, improvement of anxiety, tension,
insomnia and psychophysiologic symptoms oc-
curred in approximately three fourths. Endoge-
nous depressions responded poorly, but when
depressions were secondary to anxiety reactions,
whether acute or chronic, these improved as
readily as the anxiety. The author found Miltown
to be the safest and most effective drug available
for the treatment of emotional disturbances in
private practice.
Injuries of the Spleen. By John H. Terry,
M.D., Milton M. Self, M.D., and John M.
Howard, M.D. Surgery 40:615-639 (Sept.) 1956.
In this comprehensive article with extensive
bibliography the authors discuss their subject from
the standpoints of history, anatomic and physio-
logic considerations, incidence, types of injury,
associated injuries, anatomic types of injury, spon-
taneous rupture of the normal spleen, rupture of
the diseased spleen, delayed rupture, diagnosis,
management with resulting morbidity and mortal-
ity, effects of splenectomy and splenosis. They
then analyze the results of therapy of 102 con-
secutive patients with splenic injury, observed in
a teaching center over a period of 10 years.
Of the 102 patients with ruptured spleens
treated from 1946 to 1955, 49 had received pene-
trating injuries and 53 blunt injuries. Associated
injuries to other organs were present in 72 per
cent of the total series. Thoracic injuries, frac-
tures, and intracranial injuries were often asso-
ciated with the splenic injury caused by blunt
trauma. With penetrating wounds, injury to the
intestinal tract was the most frequent complicat-
ing injury. Following the two types of injury, the
mortality of patients reaching the hospital alive
was the same, 24 per cent. Approximately one
third of the patients died preoperatively, chiefly
of intracranial injuries secondary to blunt trauma.
Of the total deaths in the entire period (25 pa-
tients), 48 per cent were due directly to hemor-
rhage, 28 per cent to intracranial injury, and 12
per cent to post-traumatic renal insufficiency.
Mortality rates were directly proportional to the
magnitude of injury as represented by the total
number of organs injured. When the spleen alone
was injured, the mortality rate was only 10 per
cent.
Of the patients with penetrating injuries,
bullet wounds were the most common mode of in-
jury and resulted in the highest mortality rate (44
per cent). There were no deaths among the 21
patients with stab wounds. Of the 53 patients
with blunt injuries, auto accidents comprised the
largest group (34 patients) and resulted in a 26
per cent mortality. Falls resulted in the injury
of eight patients, three of whom died (37 per
cent) .
Of the 91 patients who had immediate rup-
ture, 25 died, a mortality rate of 27 per cent.
Of 11 patients with delayed rupture, none died.
Following splenectomy for immediate rupture, the
mortality from penetrating injuries (25 per cent)
J. Florida, M. A.
October, 195 7
ABSTRACTS
373
was higher than that from blunt trauma (12 per
cent), although there was a significantly shorter
time lag prior to surgery in the former group.
The high incidence of associated injuries account-
ed for the higher mortality.
Three fourths of the patients with delayed
hemorrhage bled secondarily within two weeks of
the initial injury, a fact which suggests that pa-
tients suspected of having a splenic contusion
should be warned of this possible complication.
The authors observed that improvements in
therapy during this 10 year period resulted from
improved blood bank facilities and improvements
in emergency care by the resident surgeons. Ad-
ditional improvement, they concluded, depends
primarily upon the improvement of technics in
controlling intra-abdominal hemorrhage.
Spontaneous Rupture of a Uterine Varix
at 28 Weeks’ Pregnancy. By T. Vernon Finch,
M.D. Am. J. Obst. & Gynec. 72:1189-1190 (Dec.)
1956.
Spontaneous rupture of the veins of the utero-
ovarian system during pregnancy is an overlooked
cause of sudden maternal collapse and sudden
death. Because of its infrequency, and because
no trauma is involved, the diagnosis is seldom
made, and consequent indecision as to manage-
ment can be tragic. Most obstetric textbooks
omit mention of this clinical entity. A case of
spontaneous rupture of a uterine varix at 28
weeks’ pregnancy is reported, and the salient fea-
tures of such anomalies are pointed out.
Congenital True Esophageal Divertic-
ulum. Report of a Case Unassociated with
Other Esophagotracheal Abnormality. By
Arthur R. Nelson, M.D. Ann. Surg. 145:258-264
(Feb.) 1957.
Esophageal abnormalities take many forms,
but it would appear that a true diverticulum of
the esophagus, that is, an outpouching contain-
ing all normally present anatomic layers of
esophagus and occurring as a congenital defect,
is indeed a rare anomaly in the human. In the
case reported here the esophageal diverticulum
represents a congenital true diverticulum, un-
associated with the cricopharyngeal mechanism
and unassociated with esophageal stenosis, trach-
eal communication, or other apparent esophageal
abnormality. In this unusual case surgical treat-
ment by partial excision and endoscopic forceful
dilatation produced a satisfactory functional re-
sult.
Contact Dermatitis Due to Hydrocor-
tisone Ointment. Report of a case of Sen-
sitivity to Emulsifying Agents in a Hydro-
philic Ointment Base. By Wiley M. Sams,
M.D., and J. Graham Smith Jr., M.D. J. A. M.
A. 164:1212-1213 (July 13) 1957.
A case is reported which illustrates the im-
portance of medicaments used for topical therapy
being as nonsenitizing as possible. In this instance,
a contact dermatitis developed despite the pres-
ence of 1 per cent hydrocortisone in the hydro-
philic ointment base. The sensitivity was the re-
sult of allergy to free and sulfated higher alcohols.
These substances, especially sodium lauryl sul-
fate, are widely used in ointment bases, cosmetics,
detergents, and other preparations which come
into contact with the skin. Because of the common
occurrence of contact dermatitis, and since many
preparations contain the substances listed and
other offenders, information concerning the in-
gredients of preparations for topical use should,
in the opinion of the authors, be more readily
available.
Reflux Ureteropyelograms in Children.
By John I. Williams, M.D., Russell B. Carson,
M.D., and W. Dotson Wells, M.D. South. M. J.
50:845-851 (July) 1957.
The purpose of this paper is to stress the ease
with which cystography may be used in making a
study of the young patient suspected of having
a urologic problem. It is not only an available
diagnostic adjunct, but in the opinion of the au-
thors should be considered an indispensable diag-
nostic aid in the complete evaluation of a pediatric
urologic problem. By means of this tool, one is
able to demonstrate vesicoureteral reflux when
other diagnostic procedures have offered little in-
formation. The technic is described, and three
cases are presented to illustrate the invaluable
aid which can be given by the simple and often
unused procedure of cystography in the treat-
ment of vesicoureteral reflux in children. Phy-
sicians who carry out urologic studies in children
are urged to incorporate cystography as one of
their routine diagnostic procedures.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
374
Volume XLIV
Number 4
President* page
Progress Yet Antiquation
‘‘What was good for our forefathers is good enough for us.” This in days gone
by was an influential quotation and was strongly adhered to in opinions as well as
actions. Today, however, this philosophy draws but little water. We physicians
know that Progress is the forerunner of Antiquation. Progress does not come about
spontaneously. It demands effort. We have made great progress in recent years
scientifically and socioeconomically in our profession; yet, some seem to think that
we can continue to do so without effort and with more or less antiquated methods.
There are those who think and act as though our professional and socioeconomic
welfare will continue into the seemingly bright future with great success whether any
effort is exhibited or not on their part. They should not count their chickens before
they are hatched.
Surely we are making progress in scientific, sociomedical and economic medicine
and enjoying the product of our labors. Can we continue to so do? I think we can.
When Gen. Robert E. Lee surrendered at Appomattox, mounted Old Traveler,
and turned his head south, it was not in defeat. It was because we could not win
long enough. Yes, we are apparently winning, but can we continue to win long
enough? I hope we can.
Is our present position in the economics of medicine as well as in public rela-
tions just a holding action? I think it is. I am of the opinion that we should turn
on the steam, and do it now, in order to convert our holding action into a potent
offense.
Right now we have a formidable weapon at our disposal. This mighty weapon
is BLUE SHIELD of FLORIDA. This instrument, when it was first organized and
put into action, represented real progress. It has done more to thwart socialized
medicine than any other single measure. It has greatly aided the doctors to help
people who were unable to help themselves. It has helped to lift the charity load
from the doctor’s shoulders. It has greatly benefited the medically privileged. It
has been a haven of refuge for the medically underprivileged. Wonderful has it been
and still is; yet, it is antiquated as it exists today in serving its purpose in the econ-
omy of the individual, both patient and doctor. This antiquated instrument is only
being used now for holding action purposes and as such is fast slipping. It is time
for this weapon to be overhauled and reconditioned, or replaced by a more modern
one. Perhaps it would be better both to overhaul and replace.
Your state Association through its Advisory Committee to Blue Shield is making
a heroic effort to do just that. The Committee of Seventeen, as it is unofficially
known, is working hard to get the opinions of all the members of our Association in
order that it may come up with the best recommendations for the directors of Blue
Shield to try to comply with in their efforts to modernize this weapon. Your indi-
vidual and collective opinions are essential if this objective is to be accomplished.
If you want a voice in the affairs of your Association and its satellites, now is the
time to speak up. Your officers and committees cannot hear silence. Think before
you speak, but do both. Keep in mind that Antiquation follows in the footprints
of Progress.
J. Florida, M. A.
October, 195 7
375
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF
Assistant Editors
Webster Merritt, M.D,
Franz H. Stewart, M.D.
SHALER RICHARDSON, M.D., Editor
Editorial Consultant
Mrs. Edith B. Hill
Managing Editor
Ernest R. Gibson
Assistant Managing Editor
Thomas R. Jarvis
Associate Editors
Committee on Publication
Shaler Richardson, M.D., Chairman. . . .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman ... Jacksonville
Walter C. Jones, M.D Miami
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean. School of Medicine, University of Miami
Asiatic Influenza Epidemic — Fact or Fancy
At a recent meeting on Asian influenza Surgeon
General Burney of the U. S. Public Health Service
stated, “If we do have these epidemics and we
have not done everything possible in preparation,
we will be subject to more criticism and we will
have to face our conscience.” He added that he
hoped the public would understand the situation
without hysteria. Rather than the public becom-
ing hysterical, it is more than likely that the
comic side of the situation will make its deepest
impression on the American people. A few nights
ago, on his program. Jack Paar opened a Chinese
fortune cookie and read, “Hello American, you
now have Asiatic flu!”
Cases of Asian influenza have so far been
marked by temperatures of 102 to 104 F., head-
ache, sore throat and muscle aches. The fever
lasts three to five days followed by weakness for
several more days. The attack rate in the Far
East was approximately 20 per cent with a death
rate of two-tenths of 1 per cent. Surgeon Gen-
eral Burney went on to say: “Other respiratory
infections will occur which are virtually indis-
tinguishable from influenza except by laboratory
tests. Laboratory tests in this event only tend
to pinpoint the possibility of an epidemic being
present in a certain area.”
The Surgeon General has also announced that
the first supplies of the vaccine against Asian
influenza are expected to become available to the
public during September. It is possible that 60
million cubic centimeters (doses) will be produced
by February first. Manufacturers have been ask-
ed to produce the vaccine as rapidly as possible.
Of the projected eight million doses available
by mid-September 1957, four million doses will be
used by the military, leaving four million doses
for a country of 170 million people. It is further
a fact that there will not be enough time to pro-
duce and administer sufficient vaccine to im-
munize the majority of the population before the
influenza season begins.
The virus of Asian influenza is apparently a
new strain and people have built no natural im-
munity to it, nor is it known that one attack
confers an immunity. “There have been a few
local outbreaks in the United States this summer,
but because of its swift onset and short duration,
376
EDITORIALS AND COMMENTARIES
Volume XUV
Number 4
reports on incidence are difficult to obtain,” Dr.
Burney said. Assuming an attack rate of 10 to
20 per cent in this country, this would mean
that a city of one million persons could have
100 to 200 thousand cases, not necessarily at the
same time. Past experience, according to the
Public Health Service, has indicated that a single
injection of the vaccine will be about 70 per cent
effective. Protection develops in 10 to 14 days
and is supposed to last one year. As to whether
this is a statement of fact or prophecy remains to
be proved. The cost of the vaccine to the in-
dividual has not been determined, but in large
military orders the cost was 20 to 40 cents per
cubic centimeters.
As supplies become available to the public, the
Public Health Service will recommend that par-
ticular consideration be given to the immuniza-
tion of those whose services are imperative for
the care of the sick and those needed to maintain
other essential functions. It is further proposed
by the Public Health Service that the priorities
be issued on the basis of the various categories
of personnel involved. The American Medical
Association has assured the Surgeon General that
community resources, both public and private,
will be able to provide inoculations for persons
who are unable to pay for such protection.
Antibiotics are of no value in fighting influenza
itself, but may be helpful should unlikely compli-
cations develop. Public Health Service labora-
tories are investigating acute respiratory dis-
eases and, in addition, are testing and evaluating
the vaccine. It is planned to keep the public and
the medical and health professions informed on
nationwide developments in the influenza picture
and on the supply, distribution and use of the
vaccine.
It is possible that the advance publicity may
outstrip its own usefulness. Resentment may
develop as people are educated to the value of
the vaccine and then cannot get it, either because
the vaccine is not available, or they are not on a
high enough priority list. It is further admitted,
as stated by Dr. Cutler of the Public Health
Service, that the effectiveness of the vaccine will
not be known beyond doubt until it has been
tested in the midst of an epidemic.
To sum up the situation regarding Asian in-
fluenza at this time, it is the feeling of the Public
Health Service that: ( 1) The disease is well seed-
ed all over the country and that we are just wait-
ing for the epidemics to come. (2) The best
proposal is to handle as many of the problems
as possible on the local level with professional
and other groups cooperating. It was stated
that the Public Health Laboratories and State
Laboratories should not be overburdened and
that local laboratories should be used as much as
possible. The only possible use that can be
made of the laboratories is to establish, if pos-
sible, that Asiatic influenza is present, but more
than likely by the time the report can be re-
ceived the patient will be safely convalescing.
Care of the sick should be conducted in the
homes, admitting to hospitals only those patients
with complications. (3) Immunization should
be performed in an orderly manner, immunizing
the largest number possible, taking into account
the priorities. This naturally involves the prob-
lem of production and shortage of the vaccine.
(4) Information is being disseminated, and more
will be, on two levels: (a) the epidemiologic level
where information is being passed out to medical
and allied professions, and (b) the public level,
where the public will be informed of the true
facts. If the same obtains as that which oc-
curred during the discussion of radioactive fall
out, the public will receive very few of the facts.
Let us hope that this will not be the case.
The wisdom of so much advance warning may
negate an otherwise successful campaign to en-
courage people to receive inoculations. It is the
hope to prevent this disease, which in all aspects
is hardly much worse than a common cold, and
its morbidity rate is no greater than that
which has been experienced by similar out-
breaks all over the country during the winter
months of the year. It must be kept in mind
that this is not a disabling disease as is true with
poliomyelitis. Even with poliomyelitis the public
actually had to be rocked out of its complacency
and forced by the American Medical Association, i
through the state and county medical societies by
means of an extensive campaign, to have the
children and younger citizens inoculated.
There is one great danger in all of this pub-
licity. The public will not stand for the cry
“wolf” if something does not materialize, for, if
epidemics do not develop after all this publicity,
there may come a time when a serious epidemic
will arise and the public will pay no attention to
the warning! In addition, there should be no
jockeying for prestige among government or pri-
vate services as to who shall receive the credit (or
the blame) for warning the public and controll-
J. Florida, M. A.
October, 195 7
EDITORIALS AND COMMENTARIES.
377
ing the situation, or else receiving the blame for
something which they prophesied and which did
not come true. Already children entering col-
leges in certain parts of the country are receiving
instructions for inoculation before they return
to school when it is a known fact today that vac-
cine will not be available, and perhaps not until
the last of next year in any considerable quantity.
By that time the epidemic season will have
passed, and if there is no more damage than has
been done in the Far East, there is very little
for this country to worry about.
Association Program to Combat Possible
Asian Influenza Outbreak in Florida
As of September 1, Florida was one of at least
14 states which had reported cases of confirmed
Asian influenza. In mid-August all members of
the Florida Medical Association received a mem-
orandum from Dr. Richard G. Skinner Jr., chair-
man of the Committee on Asiatic Influenza, alert-
ing them to the known presence of the disease in
the state, pointing out its characteristics and pre-
senting the current information regarding the
prospects for vaccine.
Recently, Dr. Skinner again directed the at-
tention of Association officials to the major con-
siderations regarding possible significant out-
breaks in the state. The disease appears to be
mild, but there is always the possibility that it
could change and become lethal. Present plans
are to administer the vaccine first to physicians
and hospital personnel and then to people in
essential services. A strong drive should be made
when the vaccine first becomes available to get
the doctors to immunize themselves and their
staffs and to get the hospitals to immunize their
personnel. As more vaccine becomes available,
preference should be given to persons with
chronic debilitating disease.
How active should the Association be in push-
ing immunization of the general public? It ap-
pears now, in early September, that unless the
picture changes materially, it will be sufficient
for the individual physicians to tell their patients,
and for the Association and other sources of in-
formation to let it be known generally, that
the vaccine has become available to the general
public. Those who desire it will then turn to
their private physicians to get the measure of
protection the vaccine offers.
In general, the attack rate varies, but seems
to be from 10 to 16 per cent, or more, of the
population in affected areas elsewhere in the
world. A severe epidemic could well pose a seri-
ous economic problem in this state, even though
the disease is of relatively short duration. It is
characterized by rapid onset, fever, malaise, ach-
ing muscles and coryza, with the symptoms last-
ing from three to five days. The infective agent
is the virus Japan 507 of 1957, and the incuba-
tion period is probably from one to two days.
The contagious period, while uncertain, is esti-
mated at from one to five days. The mortality
rates have been low.
The public should be made conscious of the
importance of home care, especially in the event
of a major outbreak, however mild. The prob-
lem of hospitalization is acute enough as it is
without any unnecessary excessive overcrowding
that could easily occur in the presence of an
epidemic of Asian influenza.
Dr. Skinner and his committee members are
keeping abreast of the situation, as are the Asso-
ciation officers. They urge the membership to
watch for and heed such information as is dis-
seminated from time to time by the Association
through the component county societies and that
which comes from other official sources.
Small Business Administration
New Loan Policy
Under a recent policy change, the Small Busi-
ness Administration can now make loans to phy-
sicians, surgeons, and others engaged in profes-
sional services, according to James F. Hollings-
worth, Regional Director of SBA, in Atlanta.
Previously SBA had not been permitted to make
loans to professionals, since these were not con-
sidered strictly as qualifying within the meaning
of the Small Business Act.
With the new policy, the agency can make
loans for the following purposes: (1) To finance
constructions, conversion, or expansion of hospi-
tals, clinics, or offices to be used for professional
services; (2) to finance the purchase of equip-
ment, facilities, supplies, or materials; and (3)
to meet other operational needs.
SBA does not make loans where capital is
available on reasonable terms from banks or
other private lending agencies. Applicants, there-
fore, are advised to have letters from two banks
to the effect that the banks cannot supply the
378
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 4
capital as needed. If the local hank cannot make
the total loan, it is asked to participate in the
loan with SBA. If the bank cannot participate,
SBA may then make a loan direct.
To qualify for consideration for either a par-
ticipation or a direct loan, the applicant must
be considered as operating a small business and
must meet certain practical credit requirements.
Since any firm employing fewer than 250 persons
is considered small, applicants from the medical
professional would not ordinarily be affected by
the size provision.
To be eligible for a loan, an applicant must
be of good character, have the ability to operate
his business successfully, and have enough capital
so that, with loan assistance from SBA, it will be
possible for him to operate on a sound financial
basis. His past earnings record and future pros-
pects must indicate ability to repay the loan out
of income.
The maximum amount of a direct SBA loan,
or of SBA’s part in a participation loan, is
$250,000, with a maturity limit of 10 years. The
interest rate cannot be more than 6 per cent, and
may be less in the case of a participation loan,
if the participating bank charges a lower rate.
It is suggested that any member of the medi-
cal profession who previously inquired about an
SBA loan and was not encouraged to file an
application, on the basis that he did not qualify
as having a “small business,” should contact SBA
and ask that his application be reconsidered. The
regional office of SBA is located at 90 Fairlie
Street, N. W.. Atlanta 3, Ga., and there is a
branch office for the State of Florida located at
327 Northeast First Ave., Room 310, Miami 32.
SBA personnel at either of these offices will be
happy to give advice and assistance in the prep-
aration of an application. No appointment is
necessary. Copies of applications and a copy of
a pamphlet, “SBA Business Loans,” may be had
from the regional office on written request.
Environment of Good Cheer and Hope
For the Mentally 111
Entitled “New Hope,” a picture story about
a good public mental hospital, which was recently
published by the National Association for Men-
tal Health, will be of interest to the physicians
of Florida. Its 27 photographs trace the progress
of a mentally ill person from illness back to
health. It shows clearly and positively the kind
of care and treatment the patients, their family
and the community should expect and demand
from public mental hospitals. A free copy
awaits any physician who will request it from
his local mental health association or from the
Florida Association for Mental Health, 1016 La-
Salle St., Jacksonville 7.
This illustrated booklet can be used to help a
mentally ill person or his family obtain early
hospital treatment, to eradicate common miscon-
ceptions about the mental patient and the public
mental hospital, and to win support for better
public mental hospitals through mental health
associations. The photographs were taken in
Crownsville State Hospital, Maryland, and sev-
Scientific Papers, Exhibits and Films
Requested for Association’s Annual Meeting
The Scientific Work Committee of the Florida Medical Association has requested that members
of the Association desiring to apply for places on the scientific program of the Eighty-Fourth An-
nual Meeting contact Dr. George T. Harrell Jr., Chairman of the Committee, College of Medicine.
LTniversity of Florida, Gainesville.
The scientific program will be divided into three phases — papers, exhibits and films.
Members desiring to present papers on the program of the Scientific Assemblies should submit an
abstract of about 50 words on the subject they plan to discuss. For places on the scientific exhibit pro-
gram, a photograph or sketch of the exhibit together with a brief description of the subject should
be submitted. As for films, a short description of the content is necessary. Films should not be more
than 20 minutes in length.
Dr. Harrell has announced that the deadline for submitting applications is November 1. He and
his ( ommittee will meet in Gainesville on November 16 to select the papers to be presented and the
exhibits and films to be shown.
Serving with Dr. Harrell on the Scientific Work Committee are Drs. Franz H. Stewart and Don-
ald F. Marion, Miami; Dr. Richard Reeser Jr., St. Petersburg, and Dr. Gretchen V. Squires, Pen-
sacola.
J. Florida, M. A.
October, 1957
EDITORIALS AND COMMENTARIES
379
eral show Dr. Arnold H. Eichert, formerly head
of that hospital and now Superintendent of the
South Florida State Hospital in Hollywood.
This new Florida facility is situated on a 300
acre site 18 miles from downtown Miami, con-
veniently located to serve Southeastern Florida.
It is one of the first mental hospitals to couple
new medical and architectural concepts for a
“cure-not-care” program. It is now believed that
intensive treatment in proper surroundings with
adequate facilities can cure the majority of men-
tal patients rather than consign them to a life-
time of constant care.
The first of three phases of the building pro-
gram at the South Florida State Hospital has
been completed, and the first patients were re-
cently received. The over-all plant will eventu-
ally provide 1,600 beds and 52 buildings, and
will cost 15 million dollars. The second stage,
now under construction, will provide a multi-
purpose recreation building and adjacent play-
ing fields.
The hospital’s master plan focuses attention on
the individual as much as possible. Buildings are
planned in small, one story units to keep patient
groups small and to provide separation for quiet,
depressed, or disturbed types. Each building has
its own patio or recreation yard. Although most
patios are enclosed, an attractive lattice effect
A typical recreation field at the South Florida State
Hospital, with gymnasium in background. Physical
recreation as an aid in restoring mental health is en-
couraged. Patients live and are treated in the adjoin-
ing one story buildings which are connected by covered
walkways.
is achieved from the artful use of concrete
block, giving the appearance of a decorative
garden wall rather than a confining steel fence.
As the accompanying photographs illustrate,
throughout the grounds and in the design of the
buildings the architects have tried to provide
restful and hopeful surroundings. This archi-
tectural concept is a definite part of the mental
health program in keeping with the new theories
and practices in the treatment of the mentally
ill. The objective of this new approach is to
return discouraged, disturbed and frightened pa-
Entrance to one of several treatment and receiving buildings at the South Florida State Hospital at Holly-
wood. Interior plan of treatment and receiving sections includes physicians’ and psychiatrists' offices and ther-
apy rooms.
380
EDITORIALS AND COMMENTARIES
Volume XL! V
Number 4
tients to healthy and useful lives. Florida may
well be proud of its new mental hospital, beau-
tifully designed to demonstrate the value of
physical environment as a therapeutic aid in
helping to cure the confused mind struggling to
find reality. In this noteworthy architectural
achievement the architects are already beginning
to realize their hope “that here will be some ele-
ments of ‘that environment of good cheer and
hope’ . . . that place where a patient may ‘find a
situation in which he is acceptable’ . . . that gar-
den where a man may find himself again.”
Medical District Meetings — October 28-31
Two scientific papers on the management of
gastrointestinal bleeding, one on the medical
aspect and the other on the surgical, will be fea-
tured on the program of the scientific assemblies
of the Eighteenth Annual Medical District Meet-
ings beginning October 28 in Panama City.
The programs for the meetings have been re-
leased by Dr. S. Carnes Harvard, of Brooksville,
Chairman of the Council of the Florida Medical
Association. In arranging the programs, Dr. Har-
vard was assisted by the councilors of the partic-
ular medical district.
The scientific subjects are the same for each
meeting, however, the speakers have been se-
lected from the area in which the meeting is
being held.
Following the precedent of previous meetings,
a general session will be held after the scientific
assemblies. The programs and speakers for
these sessions are identical for each medical dis-
trict. Appearing will be Dr. Homer F. Marsh,
Dean of the School of Medicine, University of
Miami; Dr. George T. Harrell Jr., Dean of the
College of Medicine, University of Florida; Mr.
Thomas A. Hendricks, Field Director, American
Medical Association, Chicago; Drs. Edward Jelks,
Jacksonville; John D. Milton, Miami; Henry J.
Babers Jr., Gainesville; Francis T. Holland, Tal-
lahassee, and the officers of the Florida Medical
Association: Dr. William C. Roberts. President;
Dr. Jere W. Annis, President-Elect; Dr. Samuel
M. Day, Secretary-Treasurer, and Dr. Shaler
Richardson, Editor of The Journal.
Dr. Jelks will explain the purposes and func-
tion of the Florida Medical Foundation; Dr.
Milton will discuss Medicare; Dr. Babers Blue
Shield, and Dr. Holland will discuss two subjects:
the World Medical Association and Rural Health.
Following the meeting in District A at Pana-
ma City October 28 will be the meeting in Dis-
trict C at Clearwater on October 29; District B
Dr. S. Carnes Harvard, of Brooksville, Chairman of
the Council of the Florida Medical Association, who
with the assistance of the district councilors arranged
the programs for the Eighteenth Annual Medical Dis-
trict Meetings being held October 28-31. Dr. Harvard
will serve as a presiding officer at the meeting in each
medical district, assisted by the councilor of the district.
at Orlando on October 30 and District D at Fort
Pierce on October 31.
Each meeting is scheduled to begin at 2:00
p.m. At 6:00 refreshments are to be served fol-
lowed by dinner at 7:00.
Activities of the Woman’s Auxiliary at the
Medical District Meetings have been announced
by Mrs. Perry D. Melvin, of Miami, President.
The program in each district will begin at 2:00
p.m. At Panama City, the meeting is being held
in the Woman’s Club at the corner of Cove
Boulevard and 4th Street; at Clearwater in the
Fort Harrison Hotel with registration beginning
at 9:00 a.m.; at Orlando in the Orange Court
Hotel and at Fort Pierce in the Pelican Yacht
Club. A business meeting and tea is scheduled
at Fort Pierce.
J. Florida, M. A.
October, 1957
EDITORIALS AND COMMENTARIES
381
Scientific Assemblies
Panama City — A
Monday, October 28 - 2:00 p.m. (C.S.T.)
Dixie Sherman Hotel
Presiding: S. Carnes Harvard, Chairman of
Council, and Alpheus T. Kennedy, of Pen-
sacola, Councilor of District 1.
Address of Welcome, John J. Benton, President,
Bay County Medical Society.
“Diagnosis and Medical Management of Gas-
trointestinal Bleeding,” Charles J. Kahn, Pen-
sacola.
“Diagnosis and Surgical Management of Gas-
trointestinal Bleeding,” Frank E. Tugwell,
Pensacola.
Discussion
Orlando — B
Wednesday, October 30 - 2:00 p.m.
Orange Court Hotel
Presiding: S. Carnes Harvard, Chairman of Coun-
cil, and Leo M. Wachtel, of Jacksonville,
Councilor of District 3.
Address of Welcome, Frank J. Pyle, President,
Orange County Medical Society.
“Diagnosis and Medical Management of Gas-
trointestinal Bleeding,” Frank C. Bone, Or-
lando.
“Diagnosis and Surgical Management of Gas-
trointestinal Bleeding,” James M. Davis,
Jacksonville.
Discussion
Clearwater — C
Tuesday, October 29 - 2:00 p.m.
Fort Harrison Hotel
Presiding: S. Carnes Harvard, Chairman of Coun-
cil, and Gordon H. McSwain, of Arcadia,
Councilor of District 6.
Address of Welcome, Percy H. Guinand, Presi-
dent, Pinellas County Medical Society.
“Diagnosis and Medical Management of Gas-
trointestinal Bleeding,” George D. Hopkins
II, Fort Myers.
“Diagnosis and Surgical Management of Gas-
trointestinal Bleeding,” Richard A. Marto-
rell, Tampa.
Discussion
Fort Pierce — D
Thursday, October 31 - 2:00 p.m. ,,r
Flamingo Restaurant, Shamrock Village
Presiding: S. Carnes Harvard, Chairman of
Council, and Ralph M. Overstreet Jr., of
West Palm Beach, Councilor of District 7.
Address of Welcome, John M. Gunsolus, Presi-
dent, St. Lucie-Okeechobee-Martin County
Medical Society.
"Diagnosis and Medical Management of Gas-
trointestinal Bleeding,” Fred E. Manulis,
Palm Beach.
“Diagnosis and Surgical Management of Gas-
trointestinal Bleeding,” Richard M. Fleming,
Miami.
Discussion
Graduate Medical Education
Florida Clinical Diabetes Association, Gainesville, October 24-26, 1957
At the Medical Sciences Building of the Col-
lege of Medicine of the University of Florida in
Gainesville, the Florida Clinical Diabetes Associ-
ation will hold its fifth annual meeting on Octo-
ber 24-26. Registration will begin at 8:30 a.m.
on Thursday, October 24, and the fee of $10
carries with it the privilege of membership in the
association. Dr. Edward R. Smith, President,
of Jacksonville, announces that the annual
luncheon and business meeting will be held on
Friday, October 25, from 12 to 2 p.m. The final
session will be concluded at noon on Saturday,
October 26. Many registrants may wish to at-
tend the football game between Louisiana State
University and the University of Florida, schedul-
ed for Saturday afternoon at 2:30.
The scientific program will be presented in co-
operation with the Florida Medical Association,
the Florida State Board of Health, and the Di-
vision of Postgraduate Education of the College
of Medicine of the University of Florida. The
opening lecture is scheduled for 9:30 a.m. on
Thursday, October 24, and the closing feature on
Saturday morning, October 26, will be a round
table discussion.
Distinguished guests who will lecture are Dr.
William R. Jordan, Associate Professor of Clinical
Medicine, Medical College of Virginia, Rich-
382
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 4
mond, Va.; Dr. Roger H. Unger, Instructor in
Clinical Medicine, Southwestern Medical School
of the University of Texas, Dallas, Texas; and
Dr. Cornelius J. O’Donovan, Director of the Ori-
nase Research Project, Department of Clinical In-
vestigation, The Upjohn Company, Kalamazoo.
Mich. Florida physicians who will participate in
the program include Dr. William C. Thomas Jr..
Director of the Division of Postgraduate Educa-
tion of the College of Medicine of the University
of Florida, Gainesville; Dr. Sidney Davidson.
Lake Worth; and Dr. Sanford A. Mullen, Jack-
sonville. Dr. Smith, Dr. Glen O. Summerlin.
Gainesville, Dr. George H. Garmany, Tallahassee,
the incoming president, and Dr. Joseph J. Lowen-
thal, Jacksonville, the association’s secretary-
treasurer will serve as moderators.
The program is as follows:
FIFTH ANNUAL MEETING
FLORIDA CLINICAL DIABETES ASSOCIATION
MEDICAL SCIENCES BUILDING. GAINESVILLE, OCTOBER 24-26
THURSDAY, OCTOBER 24
Moderator; Dr. Edward R. Smith, President
8:30
Registration
9:30
‘‘Diagnosis of Diabetes”
Dr. Jordan
10:10
“The Management of Diabetes with Oral Drugs”
Dr. Unger
10:50
Recess
11:20
“Methods of Determining Blood and Urine Sugar
and Their Clinical Interpretation”
Dr. Mullen
11:50
“The Prognosis in Diabetes”
Moderator: Dr. Glen O. Summerlin, President
Alachua County Medical Society
Dr. Jordan
2:00
“A Re-Evaluation of Insulin — Its Action and
Mobilization”
Dr. Unger
2:40
Recess
2:50
“The Unknown Diabetic in Your Practice”
Dr. Davidson
3:30
Recess
3:40
“Renal Threshold and Bladder Residual as They
Affect the Treatment of Diabetes”
Dr. Jordan
FRIDAY
, OCTOBER 25
Moderator: Dr. George H. Garmany, Incoming President
9:30
“A New Diagnostic Test for Mild Diabetes”
Dr. Unger
10:10
“The Development of Orinase”
Dr. O’Donovan
10:50
Recess
11:20
“Diabetes in Children”
Dr. Jordan
12:00
Luncheon Meeting of the Association
2:00
(To be announced)
Dr. Unger
2:30
“Hypoglycemia”
Dr. Thomas
3:00
Recess
3:10
“The Diabetic Foot”
Dr. Jordan
3:40
“The Mode of Action of Orinase”
Dr. O’Donovan
SATURDAY, OCTOBER 26
Moderator: Dr. Joseph J. Lowenthal,
Secretary-Treasurer
9:30
“The Selection of Patients for Orinase Therapy”
Dr. O’Donovan
10:10
Recess
10:20
Round table discussion — Dr. Jordan, Dr. Unger, Dr. O’Donovan, .
Thomas, Dr. Davidson, Dr. Mullen
Dr.
J. Florida, M. A.
October, 1957
EDITORIALS AND COMMENTARIES
383
Florida Academy of General Practice
Will Meet in St. Petersburg
October 31 - November 2
The Eighth Annual Scientific Assembly of the
Florida Academy of General Practice will be held
at the Soreno Hotel in St. Petersburg. The pro-
ceedings will commence with registration at 5
p.m. on Thursday, October 31, followed by a
meeting of the Board of Directors at 7 p.m., and
will continue through November 1 and 2. The
concluding event will be a banquet at 8 p.m.
on Saturday, at which the principal speaker will
be Dr. Malcom E. Phelps, President of The
American Academy of General Practice.
Highlighting the program are Category I sym-
posiums on antibiotics, anesthesia and biochemis-
try. arthritis, and stress conducted by top men in
their respective fields. A delightful schedule has
been arranged for the wives and children of mem-
bers.
PROGRAM
EIGHTH ANNUAL SCIENTIFIC ASSEMBLY
FLORIDA ACADEMY OF GENERAL PRACTICE
OCTOBER 31 — NOVEMBER 2, 1957
SORENO HOTEL, ST. PETERSBURG
THURSDAY, OCTOBER 31
5:00 p.m. Registration
7:00 p.m. Meeting of the Board of Directors
FRIDAY, NOVEMBER 1
7:30 a.m. Registration
8:40 a.m. Invocation. Address of Welcome,
Dr. Harry R. Cushman
Recognition of Dr. Malcom E. Phelps, Presi-
dent, American Academy of General Prac-
tice, and Dr. Henry L. Harrell, President,
Florida Academy of General Practice
Symposium on Antibiotics
9:00 a.m. ‘‘Newer Antibiotics and Trends in
Therapy,” Dr. Ellard M. Yow
“Antibiotics in Pediatrics,” Dr. James
Hughes
“Untoward Reactions to Antibiotics,” Dr.
George T. Harrell Jr.
10:30 a.m. Review of Exhibits — Exhibit Hall
11:15 a.m. Symposium on Antibiotics con-
tinued:
“Steroids and Infectious Diseases,” Dr. El-
lard M. Yow
11:45 a.m. Questions to the Panel
12:00 Luncheon
1:20 p.m. Dr. William C. Thomas Jr., Director
of the Division of Postgraduate Education of
the College of Medicine of the University of
Florida
Symposium on Anesthesia and
Biochemistry
1:30 p.m. “A Simplified System Employing
Surface Area Useful for the Management of
the Majority Group of Fluid Imbalances,”
Dr. R. V. Kron
“Obstetrical Anesthesia,” Dr. Robert A.
Hingson
“Hypothermia in General Practice, j-»r.
Malcom E. Phelps
3:00 p.m. Review of Exhibits — Exhibits Hall
3:30 p.m. Symposium on Anesthesia and Bio-
chemistry continued:
“Systemic Approach to the Diagnosis of
Clinical Fluid Imbalances,” Dr. R. V. Kron
“Oxygen in the Physician’s Satchel,” Dr.
Robert A. Hingson
4:30 p.m. Questions to the Panel
Dinner
8:00 p.m. “Malpractice Litigation: Causes and
Cures,” Franklin J. Evans, M.D., LL.B.
Business Session — Dr. Henry L. Harrell,
President, in the Chair
SATURDAY, NOVEMBER 2
Symposium on Arthritis
9:00 a.m. “The Medical Management of
Rheumatoid Arthritis,” Dr. Edward F. Har-
tung
“Blackache,” Dr. Tully T. Blalock
“The Medical Management of Gout,” Dr.
Edward F. Hartung
10:30 a.m. Review of Exhibits — Exhibit Hall
11:15 a.m. Symposium on Arthritis continued:
“Physical Therapy and Rehabilitation in
Arthritis, Strokes and Injuries, with Demon-
strations,” Dr. Donald A. Covalt
Questions to the Panel
12:00 Luncheon
Symposium on Stress
1:30 p.m. “A Practical Approach to Behavior
Problems in Children,” Dr. James Hughes
“Hormones and Susceptibility to Disease ”
Dr. Hans Selye
3:00 p.m. Intermission
384
EDITORIALS AND COMMENTARIES
Volume X LI V
Number 4
3:15 p.m. Symposium on Stress continued:
“Hormones and Susceptibility to Disease."
continued, Dr. Hans Selye
4:30 p.m. Questions to the Panel
7:00 p.m. Cocktail Party
8:00 p.m. Banquet. Address by Dr. Malcom
E. Phelps, President, The American Acade-
my of General Practice. Entertainment by
Mr. George Tonak and Miss Jane Ritter.
Dancing.
Southern Medical Association Meets
In Miami Beach, November 11-14
The Southern Medical Association will con-
duct its fifty-first annual meeting in Miami Beach
on Nov. 11-14, 1957. The scientific programs
will be held in the Miami Beach auditorium
where registration and exhibits will also be
located.
The scientific assembly is composed of 20
sections representing the major medical and sur-
gical specialties. In addition to the programs of
the sections, the following conjoint societies will
also meet with the association: American College
of Chest Physicians, Southern Chapter; The
Association for Research in Ophthalmology, Inc.,
Southern Section; Southeastern and South Cen-
tral Regional Committees of the College of Amer-
ican Pathologists; Southern Electroencephalo-
graphic Society; Southern Gynecological and Ob-
stetrical Society; Southern Flying Physicians;
and Student American Medical Association (Re-
gional). The Southern Medical Association is the
largest regional meeting conducted in the South.
The Miami Beach sessions are expected to attract
more than 5,000 registrants.
The association has arranged for a Housing
Bureau at P. O. Box 1511, Miami Beach, for the
convenience of physicians desiring to attend the
meeting. Thirty hotels, conveniently located near
the municipal auditorium, are cooperating with
the Housing Bureau.
While the Southern Medical Association
places major emphasis on a topflight scientific
program, this is by no means the only attraction.
The association will bring to Miami Beach 20
outstanding guest speakers from over the nation
and from foreign countries. The program this
year will present a great variety of color tele-
vision, which will be presented on Monday. Tues-
day and Wednesday and will be sponsored by
several of the regular sections.
Another project of the association begun last
year at the Washington meeting and known as
the medical student representatives program will
be a feature this year. A student representative
Dr. Donald F. Marion, of Miami, Chairman of the
Greater Miami Committees on Arrangements for the
Fifty-First Annual Meeting of the Southern Medical
Association being held at Miami Beach.
from the University of Miami School of Medicine,
the College of Medicine of the University of
Florida, Medical College of Georgia. Emory Uni-
versity School of Medicine, Medical College of
South Carolina and Medical College of Alabama
will be the official guests of the association dur-
ing the meeting. Other interesting highlights of
the meeting will be the thirty-fourth annual golf
tournament, a fishing rodeo, sessions of the Wom-
an’s Auxiliary and finally a postconvention tour
to the Caribbean both by air and by ship.
Some of the features of the social aspects of
the meeting will be more than a score of alumni
and fraternity dinners; the President’s luncheon
on Monday, November 1 1 ; the Doctors’ Day
luncheon sponsored by the Auxiliary on Tuesday,
November 12; and finally President’s Night on
Wednesday evening, November 13. President’s
Night will feature an address by the President,
Dr. J. P. Culpepper Jr., of Hattiesburg, Miss.
Another attraction of the Wednesday night pro-
gram will be a salute to the Southern Medical
J. Florida, M. A.
October, 195 7
OTHERS ARE SAYING
385
Association by “Grand Rounds.” This national
television feature will be screened in the ballroom
during the President’s Night program when a
program titled “Frontiers of Coronary Artery
Disease” will be presented.
Among alumni activities will be the dinner
and social hour for graduates of Tulane Univer-
sity School of Medicine being held Tuesday eve-
ning, November 12, in the DiLido Hotel begin-
ning at 6:30. A luncheon of the Theta Kappa Psi
medical fraternity is also planned for Tuesday in
the same hotel.
The success of the meeting is going to be due
largely to the excellent work of the Greater Mi-
ami Committees on Arrangements of which Dr.
Donald F. Marion is chairman. Dr. Marion and
almost 300 other local physicians have been work-
ing tirelessly for the past several months in plan-
ning for the occasion.
The list of section officers of the association
includes six prominent Florida physicians as fol-
lows: Dr. John T. Stage, Secretary, Section on
Anesthesiology; Dr. Hugh B. Goodwin Jr., Secre-
tary, Section on General Practice; Dr. Sherman B.
Forbes, Chairman, Section on Ophthalmology and
Otolaryngology; Dr. William A. D. Anderson,
Vice-Chairman, Section on Pathology; Dr. Wesley
S. Nock, Vice-Chairman, Section on Pediatrics;
and Dr. Ralph F. Allen, t Vice-Chairman, Section
on Proctology. In addition to these physicians, Dr.
Joseph S. Stewart, Councilor from Florida, has
taken an active part in the planning of the meet-
ing and is serving as Chairman of the Executive
Committee on Arrangements. Dr. Walter C.
Jones, a former president of the association and
now a member of the Board of Trustees, is serv-
ing as Chairman of the Advisory Committee.
tDeceased, Aug. 9, 1957.
OTHERS ARE SAYING
The Florida Medical Foundation
This organization was founded September 24,
1956 as a non-profit group with the object of
enhancing the health and medical care of the
people of our state by fostering medical educa-
tion, disseminating scientific knowledge to the
physician and to the public. They plan to pro-
mote the principles of medical ethics and in de-
feating unmerited charge of professional mal-
practice; encouragement of medical research and
provide needed assistance to members of our asso-
ciation and of perhaps greatest importance, the
furnishing of financial aid to medical students
needing assistance.
Each year each of us should and probably
does send to his medical school a check from ten
to one hundred dollars to further the education
in his alma mater for each of us know that with-
out this aid their school would no longer be the
top ranking medical school in the country. Our
pride and part of our ego (if they may be sepa-
rated) stems from the ability to say that I grad-
uated from “the” medical school.
To attract donations to the Universities many
programs such as publicity, class competition and
other methods for raising the necessary money
have been established. Some have even allowed
one’s donation to be applied to a scholarship for
one’s son or daughter, should they at a later year
be so fortunate as to attend “the” medical school.
All considered, these programs are wholesome and
vital to the American way of life.
Any foundation that is to obtain any mark
of approval must handle considerable quantities
of money, for by this reputation they will soon
become known. If large industrial groups should
want to establish a scholarship in our state they
would first look for a well qualified organization
to do this work.
If all the money that we send to our Alma
Mater could funnel through the Florida Medical
Foundation we would then have a well function-
ing organization that could handle quantities of
money and this organization could then attract
outside capital to our state and in time they
could establish several medical scholarships,
carry on the objects of the Foundation and ulti-
mately would result in a great boon to our so-
ciety.
The Florida Medical Foundation is unknown.
It needs publicity, advertisement and to generally
let itself be known. Ten dollars from each of our
physicians funneled through the group would
soon put this organization on the map.
Why not a flat envelope sheet in each Flor-
ida Medical Journal with an addressed side and
a check sheet side so that we the physicians could
tear it out, mark the check sheet, fold it and de-
posit his check within the envelope and then our
check to “the” university is on its way through
the Florida Medical Foundation.
The Bulletin
Saraosta County Medical Society
July, 1957.
386
Volume XLIV
Number 4
STATE NEWS ITEMS
The Seventeenth Annual Convention of the
Gulf Coast Clinical Society is being held in the
Buena Vista Hotel at Biloxi, Miss., October
17-18, according to announcement by Dr. James
R. Foster, Secretary-Treasurer.
Guest speakers appearing on the program in-
clude Dr. Eugene A. Stead Jr., Duke University
School of Medicine, Durham; Dr. William Par-
sons, University of Virginia Department of Med-
icine, Charlottesville; Dr. Richard E. Wolf, Chil-
dren’s Hospital, Cincinnati; Dr. Walter H. Shel-
don, Emory University School of Medicine, At-
lanta; Dr. Robert A. Knight. Campbell’s Clinic,
Memphis; Dr. Jacob P. Greenhill. Chicago, and
Dr. Arthur L. Kretchmar, Oak Ridge Institute,
Oak Ridge, Tenn.
The 22nd Annual Convention of the American
College of Gastroenterology will be held at The
Somerset in Boston, Mass., October 21-23, and
the Annual Course in Postgraduate Gastroen-
terology the three following days.
Emory University School of Medicine
Atlanta, Georgia
Announces
SIX DAYS
CARDIOLOGY
(January 13-18, 1958)
Major Problems of Heart Disease
will be discussed by
Members of the Emory University Faculty
and the following visitors :
A. Carlton Emstene, M.D.,
Chairman, Division of Medicine,
Cleveland Clinic, Cleveland, Ohio
Dwight E. Harken, M.D.
Assistant Clinical Professor of
Surgery, Harvard Medical School;
Surgeon, Peter Bent Brigham
Hospital; Chief of Department of
Thoracic Surgery, Mount Auburn
and Malden Hospitals, Boston,
Mass.
Helen B. Taussig, M.D.,
Associate Professor of Pediatrics,
The Johns Hopkins University
School of Medicine; Director of
the Children’s Heart Clinic of
the Harriet Lane Home, The
Johns Hopkins Hospital, Balti-
more, Md.
Eugene A. Stead, M.D.,
Professor and Chairman, Depart-
ment of Medicine, Duke Univer-
sity School of Medicine, Durham,
H. C.
Ancel B. Keys, M.D.,
Professor of Medicine, University
of Minnesota; Director of the
Laboratory of Physiological Hy-
giene, University of Minnesota
School of Public Health, Minnea-
polis, Minn.
Edward S. Orgain, M.D.,
Professor of Medicine, Duke Uni-
versity School of Medicine; Di-
rector, Cardiovascular Disease
Service, Duke Hospital, Durham,
H. C.
E. Grey Dimond, M.D.,
Professor and Chairman of the
Department of Medicine; Director
of the Cardiovascular Laboratory,
University of Kansas Medical
Center, Kansas City, Kansas.
Gene H. Stollerman, M.D.,
Associate Professor of Medicine,
Northwestern University, Chicago,
III.
Tuition fee: $100.00
Write: Postgraduate Teaching Program, Emory
University School of Medicine, 69 But-
ler Street, Atlanta 3, Georgia
Many individual papers are to be presented
during the Convention, and in addition there will
be three panel discussions. Moderators for the
Annual Course will be Dr. Owen H. Wangensteen
of Minneapolis and Dr. I. Snapper of Brooklyn.
Dr. Fred E. Manulis of Palm Beach is
Governor for the state of Florida for the Ameri-
can College of Gastroenterology.
The Annual Meeting of the Florida Division
of the American Cancer Society is being held in
the Roosevelt Hotel at Jacksonville October
19-20. Dr. William C. Roberts of Panama City,
President of the Florida Medical Association, has
accepted an invitation to appear on the program.
Dr. Robert T. Spicer of Miami is serving as
President of the Miami-Dade County Chamber
of Commerce. He is the first physician to be
elected to this position.
Mr. W. Joe Stansell has been assigned as Blue
Cross-Blue Shield Professional Relations repre-
sentatives to the Florida Medical Association’s
Advisory Committee to Blue Shield. The Com-
mittee is also known as the “Committee of Sev-
enteen.”
Assignment of Mr. Stansell to the position is
in accordance with a request of the Committee in
its annual report to the Association.
A Sectional Meeting of the American College
of Surgeons will be held January 16-18 in the
Hotel Heidelberg at Jackson, Miss. Topics will
include Complications of Abdominal Surgery.
Chemotherapy, Metastasis and Limitations of
Surgery for Cancer, Errors in Management of
Fractures, Pediatric Surgery, and Management
of Multiple Injuries.
Dr. Milton C. Foard, who has been serving a
residency in internal medicine at the McGuire
Veterans Administration Hospital in Richmond,
Va., has become associated with Dr. Geoffrey H.
Binneveld at Leesburg.
The New York University-Bellevue Medical
Center Postgraduate Medical School has an-
nounced courses in Medicine, Obstetrics and
Gynecology, Ophthalmology, Otorhinolaryngology,
and Pediatrics to be given or started during the
month of November. Information about the in-
i' Continued on page 390 )
J. Florida, M. A.
October, 1957
387
NO KNOWN CONTRAINDICATIONS
ROLICTON"
permits high dosage,
more effective diuresis in more patients
The low incidence of side action with
Rolicton (brand of amisometradine) per-
mits high dosage, extending the range of
effective diuresis to a greater number of
patients than was previously possible.
Laboratory studies demonstrate that
Searle’s new oral diuretic, Rolicton,
causes positive diuresis with an essen-
tially balanced excretion of water, sodium
and chlorides.
Settel1 studied the effect of Rolicton
in forty-seven patients and found no
serious side effects. Assali, who observed
the action of Rolicton in five patients
with severe toxemia of pregnancy, states2
that side actions are essentially non-
existent. Side actions of such low inci-
dence, together with its diuretic efficacy,
suggest a high order of usefulness for
Rolicton.
One tablet of Rolicton, b.i.d., is usually
adequate to maintain patients free of
edema after the first day’s dosage of four
tablets. Some patients respond well to
one tablet daily. G. D. Searle & Co.,
Chicago 80, Illinois. Research in the
Service of Medicine.
1. Settel, E.: Rolicton® (Aminoisometradine), a
New, Nonmercurial Diuretic, Postgrad. Med.
27.186 (Feb.) 1957.
2. Assali, N. S.: Personal communication. May
28, 1956.
CNT RAVE N OUSr Compatible with common
Iv iiuiSs. Stable for 24 hours in
solution at room temperature. Aver
age IV dose is 500 mg. given at 12
hour intervals. Vials of 100 mg.,
250 mg. , 500 mg.
THERAPEUTIC BLOOD LEVELS ACHIEVED
Many physicians advantageously use
the parenteral forms of ACHROMYCIN
in establishing immediate, effective
antibiotic concentrations. With
ACHROMYCIN you can expect prompt
NTRAMUSCULAR Used to start a pa-
is regimen immediately,
r for patients unable to take oral
edication. Convenient, easy-to-use,
deally suited for administration
n office or patient's home. Supplied
n single dose vials of 100 mg., (no
efrigeration required) .
Tetracycline »
S MINUTES — SUSTAINED FOR HOURS
3ntrol, with minimal side effects,
/er a wide variety of infections -
aasons why ACHROMYCIN is one of to-
lly's foremost antibiotics.
:rle laboratories division. American cyanamid company, pearl river, new vork
s' U.S. Pol. Oil.
390
Volume XLIV
Number 4
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( Continued from page 386 )
dividual courses may be obtained by writing to
the School at New York City.
Dr. Augustus E. Anderson Jr., of Jacksonville
has been awarded a grant by the National Insti-
tutes of Health for the study of pulmonary
fibrosis.
Dr. William C. Roberts of Panama City, Pres-
ident of the Florida Medical Association, was a
principal speaker at the Fall Board Meeting and
Conference of the Woman’s Auxiliary to the Flor-
ida Medical Association held early in October at
Pensacola.
Dr. Richard A. Henry of Brooksville ha:
been presented a plaque by the Withlacoochee
District of the Gulf Ridge Council, Boy Scouts of
America, for his continued work with Scouts in
the Brooksville area.
Drs. Myron L. Habegger of Rockledge and
James F. Speers of Titusville were members of a
panel which discussed “Medical Service” at ar
industrial conference held late in August at Eai
Gallie. The conference on “How to Adjust t(
Rapid Industrial Growth” was conducted by th(
General Extension Division of the University o
Florida and was co-sponsored by the city of Eai
Gallie. the Florida Power and Light Co. and thi
Florida Development Commission.
Dr. Habegger is President of the Brevarc
County Medical Society and Dr. Speers is healtl
officer for Brevard county.
Dr. William C. Roberts of Panama City, Pres
ident of the Florida Medical Association, wa
principal speaker at a recent luncheon meetinj
of the Rotary Club of that city.
The third world tour, postgraduate clinica
course, sponsored by the International College o
Surgeons begins at San Francisco October 20 am
ends at New York December 7. Lectures am
clinical demonstrations have been arranged i
Hong Kong, the Philippines, Thailand. India
Turkey and Greece. Detailed information ma
be obtained from the International Travel Ser
vice, Inc., Palmer House, Chicago.
The annual interim meeting of the Florid
Urological Society was held September 21 at th
J. Florida, M. A.
October, 1957
in acne
“results were uniformly encouraging ”l
®
Sudsing,
nonalkaUne
antibacterial
detergent —
nonirritating,
hypoallergenic.
s.
The acne skin that is “surgically
clean” is the one most likely to clear
completely. Hodges1 found that
standard acne treatment usually re-
sults in “mediocre success” for most
patients. The addition oj pHisoHex ®
washings to standard treatment pro-
duced results that jar excel any ob-
tained previously.
pHisoHex, a powerful antibacterial
skin cleanser containing hexachloro-
phene, removes oil and virtually all
the bacteria from the skin surface.
For best results prescribe from four
to six pHisoHex washings of the
acne area daily.
1. Hodges, F. T.: GP. 14.86. Nov., 1956.
pHisoHex, trademark reg. U. S. Pat. Oft.
LABORATORIES
New York 18, N.Y.
392
Volume XUV
Number 4
Yankee Clipper in Fort Lauderdale. The pro-
gram included an address by Dr. Edward Ray of
Lexington, Ky., on ‘‘Transurethral Resection”
and discussions on subjects relating to bladder
obstruction led by Drs. Hilbert A. P. Leininger,
William A. Van Nortwick and Robert Webster.
Dr. W. Dotson Wells of Fort Lauderdale is presi-
dent of the specialty group.
Drs. Hugh A. Carithers and J. Champneys
Taylor of Jacksonville served on the faculty
of the Southern Pediatric Seminar held recently
at Saluda, N. C.
A Medico-Legal Institute sponsored by the
Florida Medical Association and The Florida Bar
is being held in the George Washington Hotel at
Jacksonville November 22-23. The program be-
gins at 9:00 a.m. and ends at noon the follow-
ing day.
Tentatively scheduled for discussion are “Re-
lationship of Cancer and Trauma;” “Relation-
ship of Trauma and Strain on the Cardiovascular
System;” “Electromyograph as an Aid in Evalu-
ating Nerve and Muscle Injury;” “Crash Syn-
drome;” “Whiplash;” “Post Concussion Syn-
drome;” “Back Injury — Its Cause and Sequelae,”
and “Disability Evaluation.”
Dr. Douglas R. Murphy of Venice has been
elected president of the Rotary Club of that city.
Dr. Murphy has been a member of the Club for
six years.
The annual scientific meeting of the Florida
Crippled Children’s Commission and its cor-
responding voluntary organization, Florida Society
for Crippled Children, is being held at St. Peters-
burg, October 11, in the Suwannee Hotel. Prin-
cipal speakers include Dr. Carlton Dean, Direc-
tor, Michigan Crippled Children’s Commission,
Lansing; Col. Maurice Fletcher, MC, Chief,
Army Prosthetic Research Laboratory, Washing-
ton. D. C., and Dr. Charles H. Franz, Chairman,
Children’s Prosthetic Committee, National Re-
search Council. Grand Rapids, Mich.
A*
The Part I Examinations of the American
Board of Obstetrics and Gynecology are to be
held in various parts of the United States and
Canada on Thursday, Jan. 2, 1958 at 2:00 p.m.
Current Bulletins outlining present requirements
may be obtained from Dr. Robert L. Faulkner,
Secretary, American Board of Obstetrics and
Gynecology, 2105 Adelbert Road, Cleveland 6,
Ohio.
Active relief
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both allergic and infectious
HYDRYLUN
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The ingredients of Hydryllin Compound are proportioned to provide high therapeutic response.
Each 4 cc. (one teaspoonful) contains:
Aminophyllin 32.0 mg. Chloroform 8.0 mg.
Diphenhydramine 8.0 mg. Sugar 2.8 Gm.
Ammonium chloride 30.0 mg. Alcohol 5% (v/v)
G. D. Searle & Co., Chicago 80, Illinois.
s
Research in the Service of Medicine
MAJOR ADVANCE IN FEMALE HORMONE THERAPY
for certain disorders of menstruation and pregnancy
With norlutin you can now prescribe truly effective oral progestational therapy. Small oral doses
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Presecretory to secretory endometrium The x-ray diffraction pattern of NORLUTIN distinguishes
after 5 days’ treatment with NORLUTIN. its crystal structure from that of other progestogens.
INDICATIONS FOR NORLUTIN: Conditions involving a deficiency in progestogen,
such as primary and secondary amenorrhea, menstrual irregularity, functional uterine
bleeding, infertility, habitual abortion, threatened abortion, premenstrual tension, dys-
menorrhea.
PACKAGING: 5-mg. scored tablets (C.T. No. 882), bottles of 30.
PARKE,
DAVIS A COMPANY
DETROIT 3 2,
M I C H I 8 A N
394
Volume XLI V
Number 4
COMPONENT SOCIETY NOTES
Alachua
The Alachua County Medical Society has
paid 100 per cent of its state dues for 1957.
Dade
Dr. William C. Roberts, of Panama City,
President of the Florida Medical Association, will
be principal speaker at the October meeting of
the Dade County Medical Association.
DeSoto-Hardee-Highlands-Glades
The DeSoto-Hardee-Highlands-Glades County
Medical Society has paid 100 per cent of its state
dues for 1957.
Escambia
The Escambia County Medical Society has
paid 100 per cent of its state dues for 1957.
Pinellas
The September meeting of the Pinellas Coun-
ty Medical Society was the first section of the
annual meeting which is scheduled for October 7.
Nominations for officers and to fill vacancies on
the Board of Governors were made from the
floor and will be held open until the annual meet-
ing.
Orange
Dr. Samuel M. Day, of Jacksonville, Secre-
tary-Treasurer of the Florida Medical Associa-
tion, was principal speaker on the program for
the September meeting of the Orange County
Medical Society.
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Dyal, John A. Jr., Perry
Gair, David R., Miami
Major. James M., Pensacola
Martin, Cornelia R. C., Gainesville
Martinez, Gerardo H., Miami
May, Lonnie C. Jr., Key Biscayne
Nardone, Robert R., South Miami
Szawlowski, Matthew W., Titusville
Weeks, Clarke B. Jr., Plant City
in
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Rutin 10 mg.
Ascorbic Acid 30 mg.
B-12 1 meg.
Molybdenum 0.5 mg.
Cobalt 0.1 mg
Copper 0.2 mg.
Vitamin A 5,000 EU.
Vitamin D 400 EU.
Vitamin E I EU.
Cal. Pantothenate 3 mg.
Thiamine Hcl 2 mg.
Riboflavin 2 mg.
Pyridoxine Hcl._ 0.3 mg.
Niacinamide 20 mg.
Manganese 1 mg.
Magnesium _ 5 mg.
Iodine 0.15 mg.
Potassium 2 mg.
Zinc..— I mg.
Choline Bitartrate.... 40 mg.
Methionine 20 mg.
Inositol 20 mg.
Write for Latest Technical Bulletins.
‘REFERENCE: J.A.M.A. 163: 359, 1957 (February 2)
5/J. TUTAG & COMPANY (iAd
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RICH COMPANY, INCORPORATED
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396
Volume XLIV
N I'MBF.K 4
EVERY WOMAN
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AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
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CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
qualifications in writing. The Miami-Battle Creek,
Miami Springs, Fla.
WANTED: General surgeon desires location alone
or with associate. Board eligible, married, Florida li-
cense. Prefer smaller city. Write 69-238, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner to join three
man group in clinic practice in Miami. Florida li-
cense necessary. Adequate salary first, followed by
partnership. Give details first letter. Write 69-241,
P. O. Box 2411, Jacksonville, Fla.
MODERN MEDICAL OFFICE FOR RENT: Aife
conditioned office in Clearwater. Ideal location m#r
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tune Beach, Fla.
WANTED: A General Practitioner, an Ophthal-
mologist, an Otolaryngologist to associate with group
in Brevard County. Florida license necessary. Write
age, training, medical experience and references. Write
Box 368, Rockledge, Fla.
BIRTHS AND DEATHS
Births
Dr. and Mrs. Jonas Carron, of Tampa, announce
the birth of a son, Lewis Marks, on June 22, 1957.
Dr. and Mrs. James K. Moss, of Jacksonville, an-
nounce the birth of a daughter, Ann Carolyn, on July
14, 1957.
Dr. and Mrs. James D. Beeson, of Jacksonville, an-
nounce the birth of a son, Richard Carl, on Aug. 5,
1957.
Deaths — Members
Allen, Ralph F., Coral Gables August 9, 1957
Lerner, Lee W., Miami July 4, 1957
Price, Cleveland J., Alford August 23, 1957
Edmunds, C. Harold, Miami August 26, 1957
Deaths — Other Doctors
Dalpe, William G., Los Angeles, Calif. August 7, 1957
Drennen, Earle, Birmingham, Ala July 4, 1957
Ehrlich, Simon D., Hollywood, Fla. May 7, 1957
Gibson, Ira M., Valdosta, Ga March 31, 1957
McElroy, Joseph D., Atlanta, Ga. April 26, 1957
Peel, George T., Anderson, S. C. July 16, 1957
Spooner, Doster S., Pahokee, Fla. July 21, 1957
Jordan, Thomas C. Jr., Lakeland, Fla. August 8, 1957
Medical Officer Returned
Dr. Robert G. Rosser Jr. who entered military
service on May 8, 1955 was released from active
duty on May 8, 1957 with the rank of major.
U. S. Army. His address is 507 Delannoy Ave-
nue, Cocoa, Fla.
J. Florida, M. A.
October, 1957
397
In keeping with its tradition of responding to the immediate
needs of the medical profession, Lederle announces the avail-
ability of “Influenza Virus Vaccine-Monovalent, Type A
Asian Strain,” produced according to N.I.H. specifications.
The vaccine is specific against the known strains of the so-
called “Far East Influenza” virus, and is supplied in a 10
immunization (10 cc.) vial. Every effort will be made to
fulfill your requirements.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
398
Volume XLIV
Number 4
Adelbert F. Schirmer
Dr. Adelbert F. Schirmer of Orlando died in
that city on April 4, 1957. He was 51 years of
age.
A native of Massachusetts, Dr. Schirmer was
born in Boston on April 29, 1905. He entered
Northeastern University in his native city in 1926
and was graduated in 1930 with a degree in en-
gineering. After pursuing that profession for three
years, he realized that his real interest was in
medicine. Accordingly, upon completion of his
premedical training at Tufts College, also in
Boston, he continued his medical training at
Tufts College Medical School, where he received
the degree of Doctor of Medicine in 1939. After
serving an internship in Newton Lower Falls,
Mass., he accepted a commission as a lieutenant
in the Navy in July 1940. Assigned to the U.S.S.
Enterprise in 1941, he saw much action in the
South Pacific aboard this famous carrier. He was
given pilot training in 1944 and, upon earning
his wings, was transferred to the Air Transport
Evacuation Squadron No. 1. In that unit he
saw duty in the naval operations at Guam and
Okinawa. He was awarded the presidential unit
citation, the Navy unit commendation and com-
mendation from Admiral Nimitz for his duty on
the Enterprise. In January 1946, he was released
from active duty with the rank of commander.
Dr. Schirmer entered the practice of his
specialty of anesthesiology in Orlando in 1947 and
became the first anesthesiologist at the Orange
Memorial Hospital. Until the time of his death
he served as Director of the Department of Anes-
thesiology there. It was through his efforts that
the specialty of anesthesiology made its imprint
on the practice of medicine in Central Florida.
Locally, he was active in the community and in
his church.
A member of the Orange County Medical So-
ciety, Dr. Schirmer served as a delegate to the
Florida Medical Association from that body for
several years. In addition to active membership
in his county and state societies during the 10
years of his affiliation, he was a member of the
American Medical Association, the Florida So-
ciety of Anesthesiologists, the American Society
of Anesthesiologists and the International Anes-
thesia Research Society.
r
PHEMAPHEM PLUS
Phenaphen Plus is the physician-requested
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each coated tablet contains: Phenaphen
Phenacetin (3 gr.) 194.0 mg.
Acetylsalicylic Acid (2 V& gr.) . 162.0 mg.
Phenobarbital (% gr.) .... 16.2 mg.
Hyoscyamine Sulfate .... 0.031 mg.
plus
Prophenpyridamine Maleate . . 12.5 mg.
Phenylephrine Hydrochloride . 10.0 mg.
J
NASAL
Anti-inflammatory—
Decongestant — Antibacterial
Topically applied hydrocortisone* in therapeutic
concentrations has been shown to afford a sig-
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suffering from various types of rhinitis. Hydro-
spray provides Hydrocortone in a concentra-
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Propadrine, and a wide-spectrum antibiotic,
Neomycin, with low sensitization potential. This
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physiologic and pathologic manifestations of
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that is often greater and achieved faster than
when any one of these agents is employed alone.
INDICATIONS: Acute and chronic rhinitis, vaso-
motor rhinitis, perennial rhinitis and polyposis.
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containing 15 cc. IIydrospray, each cc. sup-
plying 1 mg. of Hydrocortone, 15 mg. of
Propadrine Hydrochloride and 5 mg. of Neo-
mycin Sulfate (equivalent to 8.5 mg. of neo-
mycin base).
MERCK SHARP « OOHME
DIVISION or MERCK a CO.. INC*
PHILADELPHIA I, PA,
REFERENCE: 1. Silcox, L. E., A.M.A, Arch. Otolaryng. 60:431, Oct. 1954.
400
Volume XLI V
Number 4
Surviving are the widow, Mrs. Dorothy M.
Schirmer; a son, Richard, and a daughter, Kmily.
William Jesse Lancaster
Dr. William Jesse Lancaster died at his home
in Tampa on April 26, 1957, following a long
illness. He was 68 years of age.
Dr. Lancaster was born in Flovilla, Ga., in
1888, and received his elementary, academic and
professional education in his native state. He at-
tended the schools of Monroe County and in 1904
received the Bachelor of Arts degree from Banks-
Stevens Institute. For his medical training he
entered the Atlanta School of Medicine, now
Emory University School of Medicine, and was
awarded the degree of Doctor of Medicine in
1911. He interned at Grady Hospital in Atlanta.
New York Lying In Hospital in New York City,
and Allen Sanitarium in Milledgeville, Ga. He
became the first resident surgeon at Grady Hos-
pital.
In 1911, Dr. Lancaster came to Florida and
served as surgeon for the phosphate mines at
Mulberry. Two years later he made Tampa his
home and was associated with the late Dr. John
S. Helms from 1913 until he entered private prac-
tice in 1916. He was chief surgeon for the P. &
O. Steamship Company for over 20 years and also
for the Tampa Union Station Company. He was
a LT. S. Public Health officer and surgeon in
charge of Florida’s first veterans’ hospital. Dur-
ing World War I, he served in the Army Medical
Corps with the rank of lieutenant colonel.
In 1934, Dr. Lancaster was appointed chief
surgeon, medical director and superintendent of
the relief department of the Atlantic Coast Line
Railroad, with headquarters in Wilmington, X. C.
While serving in this capacity for eight years, he
was at one time chairman of the medical and
surgical section of the American Association of
Railroads, which includes Canada and Mexico. In
1942. he resigned from his important post with
the Coast Line because of ill health and returned
to Tampa.
Dr. Lancaster enjoyed the distinction of be-
ing the only American physician to receive the
certificate of merit from the King of Spain for
his work in the Centro Asturiano hospitals in
Tampa and Havana, Cuba. Locally, he was a
member of the staff of the Tampa General Hos-
pital and a former director of surgery and chief
( Continued on Page 404 )
HUGH LAUBHEIMER AND WALTER BURKHARDT
ARTIFICIAL EYE SPECIALISTS
FORMERLY WITH MAGER & GOUGELMAN
HAVE OPENED
L&B LABORATORIES, INC.
1431 N.E. 26th Street Fort Lauderdale, Florida
LOgan 6-1878
PLASTIC OR GLASS EYES • CUSTOM-MADE OR STOCK
PRIVATE FITTINGS • SELECTIONS SENT UPON REQUEST
VISITS TO OTHER CITIES TO BE SCHEDULED
PROBLEM FITTINGS ARE OUR SPECIALTY
J. Florida, M. A.
October, 1957
401
Achrocidin is indicated for prompt
control of undifferentiated upper res-
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questionable middle ear, pulmonary,
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respiratory epidemics; when bacterial
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Early potent therapy is provided
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Included in this versatile formula are
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Adult dosage for achrocidin Tablets
and new, caffeine-free achrocidin
Syrup is two tablets or teaspoonfuls of
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age for children according to weight
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Available on prescription only
Tablets
Each tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Syrup
symptomatic
relief . . . plus!
ACH
TETRACYCLINE-ANTIHISTAMINE- AN ALGESIC COMPOUND
Each teaspoonful (5 cc.) contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1
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Phenacetin
120 mg.
Salicylamide
150 mg.
Ascorbic Acid (C)
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Pyrilamine Maleate
15 mg.
Methylparaben
4 mg.
Propylparaben
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^Trademark
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
402
Volume XUV
Number 4
f
“the value of analgesic and iranquilizing agents
should be clearly recognized in the management of [ angina ] . .
new for angina
JCNTAffrYTMarrOl. ••ANO ©
rrr*A«m»ATf HvoftdXW
New York 17, New York
.
In pain. Anxious. Fearful. On the road to cardiac in-
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For fear and pain are inextricably linked in the
angina syndrome.
For angina patients — perhaps the next one who
enters your office— won't you consider new cartrax?
This doubly effective therapy combines petn (pen-
taerythritol tetranitrate) for lasting vasodilation and
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not only the anginal pain but reduces the concomi-
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1
Dosage and supplied: begin with 1 to 2 yellow tab-
lets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. This may be increased for maximal effect by
switching to pink tablets (20 mg. petn plus 10 mg.
atarax). In bottles of 100.
cartrax should be taken before meals, on a contin-
uous dosage schedule. Use with caution in glaucoma.
1. Russek, H. I.: J. Am. Geriat. Soc. 4: 877 (Sept.) 1956.
•Trademark
J. Florida, M. A.
October, 195 7
403
<- READ THIS
404
Volume XLIV
Number 4
( Continued from page 400 )
of staff there. He was also a member of the
staff of St. Joseph’s Hospital.
Prominent in the social and civic life of the
community, Dr. Lancaster was a past potentate
of Egypt Temple Shrine and a York Rite Mason;
he was also a member of Strict Observance Lodge
18, F. & A. M., at Forsyth, Ga. He was a life
member of the Tampa Exchange Club and the
Elks Lodge, and he held membership in American
Legion Post No. 5. He was a former member of
the Tampa Yacht and Country Club, the Palma
Ceia Golf and Country Club, and Ye Mystic
Krewe of Gasparilla. His church affiliation was
with the Trinity Methodist Church of Wilming-
ton, N. C.
Dr. Lancaster was a life member of the
Hillsborough County Medical Association. He
also held life membership in the Florida Medical
Association, having been a member for 43 years.
He was a fellow of the American Medical Associa-
tion, and a member of the Southern Medical As-
sociation, the Southeastern Surgical Congress, the
American Academy of General Practice, the New
York Academy of Science, and the American As-
sociation for the Surgery of Trauma.
Surviving are the widow, Mrs. Jean Lunden
Lancaster, of Tampa; two daughters, Mrs. Allen
Trask, of Wrightsville Beach, N. C., and Mrs.
Howard Sparrow, of Florence, S. C.; a sister,
Mrs. C. M. Durgin, and a brother, G. T. Lan-
caster, both of Tampa; five grandchildren,
and several nieces and nephews.
Joseph W. Eaton
Dr. Joseph W. Eaton of St. Petersburg met j
accidental death by drowning on April 23, 1957.
He was 49 years of age.
Dr. Eaton was born in Arlington, Mass., on I
Nov. 25, 1907. He received his premedical edu-
cation at the University of North Carolina and
engaged in postgraduate work at Harvard Uni- i
versity. He was awarded the degree of Doctor of
Medicine by McGill University Faculty of Med-
icine, Montreal, Canada, in 1935. After complet-
ing an internship at Monmouth Memorial Hos-
pital in Long Branch, N. J., he entered the pri-
vate practice of medicine as a general practioner
in 1936 in Manchester, N. H., and continued to
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J. Florida, M. A,
October, 195 7
405
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• Therapeutic: the true broad-spectrum action
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Achromycin Tetracycline HC1 (1%) 10.0 mg.,
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
*Reg. U. S. Pat. Olf.
406
Volume XL1 V
Number 4
FOR THE ENTIRE RANGE OF RHEUMATIC-ARTHRITIC
DISORDERS-from the mildest
to the most severe
many patients with MILD Involvement can be effectively
controlled with
WHKME
many patients with MODERATELY SEVERE involvement
can be effectively controlled with
MEPROIONE
The first meprobamate-prednisolone therapy
the one antirheumatic, antiarthritic that
simultaneously relieves: (i) musclespasm
(2) joint inflammation (3) anxiety and
tension (4) discomfort and disability.
SUPPLIED: Multiple Compressed Tablets
in three formulas: ‘MEPROLONE’-5 —
5.0 mg. prednisolone, 400 mg. meproba-
mate and 200 mg. dried aluminum hy-
droxide gel. ‘MEPROLONE’-2 — 2.0 mg.
prednisolone, 200 mg. meprobamate and
200 mg. dried aluminum hydroxide
gel. 'MEPROLONE'-i supplies 1.0 mg.
prednisolone in the same formula as
•MEPROLONE’-2.
MERCK SHARP & DOHME
DIVISION OF MERCK S CO.. INC.
PHILADELPHIA 1. PA.
*MEPROLONE’ Is a trademark of Merck & Co.. Inc.
m
.1. Florida, M. A.
October, 195 7
407
practice there until 1950. He was a member of
the staff at the Elliot, Sacred Heart and Hills-
boro County hospitals in Manchester. He was a
member of the Grace Episcopal Church of Man-
chester and of Bible Lodge, F. & A. M., of
Goffstown, N. H.
During 1950-1951, Dr. Eaton served as a resi-
dent in anesthesiology at the Baroness Erlanger
Hospital in Chattanooga. Tenn., and the follow-
ing year completed a residency in this specialty
at Charity Hospital in New Orleans. He then
spent one year in private practice in New Or-
leans before moving to St. Petersburg in 1955.
In that city he was a member of the staff of
Mound Park, St. Anthony’s and Crippled Chil-
dren’s hospitals, and was president of the St.
Petersburg New Voice Laryngectomy Club.
Dr. Eaton was a member of the Pinellas
County Medical Society, the Florida Medical As-
sociation and the American Medical Association.
He also held membership in the Hillsboro
County (New Hampshire) Medical Society,
the New Hampshire Medical Society, the Ameri-
can Society of Anesthesiologists and the Florida
Society of Anesthesiologists.
Surviving are the widow, Mrs. Hazel Alma
Eaton, of St. Petersburg; one son, Joseph W.
Eaton Jr., of Intervale, N. H.; two daughters,
Mrs. Mary Garland, and Mrs. Ivy Gile, both of
Conway, N. H.; and one brother. Chester C.
Eaton, of Manchester, N. H.
George Edwin Beckman
Dr. George Edwin Beckman of Jacksonville
died in a local hospital on March 27, 1957. He
was 77 years of age.
Born in Charleston, S. C., on Oct. 20, 1879,
Dr. Beckman was educated in his native state. He
was a graduate of the Charleston High School
and was graduated from the University of South
Carolina College of Pharmacy in 1906 and the
University of South Carolina Medical College in
1909. After completing an internship at Roper
Hospital in Charleston, he engaged in postgradu-
ate work on anesthesia in New York. He was a
member of the Phi Chi medical fraternity.
Dr. Beckman entered the practice of medicine
in Jacksonville and practiced there for 40 years
prior to his retirement a few years ago. His
specialty was anesthesiology, and in 1939 he was
(Continued on page 417)
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408
Volume XLIV
Number 4
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fluoroscopy . . . highly maneuverable inde-
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fluoroscopic screen . . . compact, simplified
control unit.
Before investing in x-ray equip-
ment, get the complete Patrician
story, including G-E financing
plans. Use this handy coupon.
X-RAY DEPARTMENT
GENERAL ELECTRIC CO.
Milwaukee 1. Wisconsin, Dept. V-101
□ Please send me your 16-page PATRICIAN bulletin
□ Facts about deferred payment
□ MAXISERVICE rental
GENERAL iH ELECTRIC
Name-
Address...
City..
..Zone..
..State
Direct Factory Branches :
JACKSONVILLE — 210 W. Eighth St. MIAMI — 704 S.W. 27th Ave.
TAMPA — 1009 West Platt St. BIRMINGHAM — 707 21st St., South
J. Florida, M. A.
October, 195 7
409
CORN OIL is a Prime Source
of UNsaturated Fatty Acid
Numerous clinical
studies emphasize
its efficacy in the
reduction and
control of serum
cholesterol levels
Physicians are quite aware of the rapidly
growing appreciation of the role of dietary
lipids in health and disease. Accumulating
metabolic studies throughout the world indi-
cate that serum cholesterol levels may be
influenced more by the kind than by the
amount of the dietary fat.
Unsaturated fats tend to depress serum cho-
lesterol levels in many patients, whereas sat-
urated fats may have the opposite effect.
Medical references on this subject, as well as
other findings concerning unsaturated fatty
acids in nutrition, may be found in the book,
“Vegetable Oils in Nutrition."
Mazola Corn Oil is an excellent source of
HMsaturated fatty acids... 85% of its com-
ponent fatty acids are unsaturated . . . average
values being 55% linoleic acid, 30% oleic
acid. Mazola is unadulterated corn oil in its
natural form . . . not flavored, not blended,
not hydrogenated. Well tolerated, easily
digested, readily absorbed, Mazola is also
an excellent carrier for fat soluble vitamins.
Mazola Corn Oil is widely used for salad
dressings, in frying, cooking and baking...
and thus may be included palatably in great
variety as a replacement for part of the daily
fat intake.
COMPARATIVE COMPOSITIONS OF FOOD FATS AND OHS
Fatty Acids o« Percentage of Total Acidt
Fat
Butter
Coconut oil
► Corn oil
Cottonseed oil
Lard
Linseed oil
Margarine
Olive oil
Peanut oil
Shortening
Soybean oil
Tallow (beef)
Saturated
Ave. Range
46-48
75-88
11-15
21-30
6-12
15-23
8-16
14-22
17-45
11-18
Oleic
Ave. Range
linoleic
Ave. Range
— — 4.0 —
Linolenic
Ave. Range
1.2 —
Iodine Value
Arachidonic
Ave. Average Range
0.2
13
26
43
23
17
25
15
53
27
46
62
54
62
25
42
5-8 — 1. 0-2.5 — — —
23-40 56 46-66 - 0.0-0.6 -
22-36 47 34-57 — — —
— 10 15.6
13-31
59-77
53-86
44-65
43-79
18-58
5.8
29
5
55
10-27
5-1 1
4-20
20-37
3-12
28-62
5.3
0.5 -
— 30-64
— 0.1 -0.9
5.1
0.5
0.2-0. 6
0.3-10
- 26-42
— 7-10
126 113-131
— 105 90-117
0.5 (2.1) — 53-77
— — 170-204
0 81 74-85
— — 80-88
— 98 90-102
0-0.5 78 59-80
- 130 100-143
0.5 — 40-48
Iodine numbers are an accepted measure of the degree of unsaturation of vegetable oils.
TO PHYSICIANS interested in the study and manage*
men! of high cholesterol blood levels, this most recent
monograph will provide helpful information. It is free
on request. Write lo: Corn Products Refining Company,
17 Battery Place, New York 4, N. Y.
CORN PRODUCTS
REFINING COMPANY
17 Battery Place,
New York 4. N. Y.
410
Volume XLIV
Numbeb 4
For Complete Nutrition
BAKER'S MODIFIED MILK
THE BAKER LABORATORIES, INC.
/ttUA ffiioducta £%c/uMSe/y ftt, tfe, MedtcaC ficofeoAtotv
Powder *'°,B Office: Cleveland 3, Ohio e Plant: last Troy, Wisconsin
INFANTS THRIVE ON BAKER’S.
And for sound reasons:
Baker’s contains all requirements for complete
infant nutrition ... It is available as an easy-
to-prepare Liquid and as a Powder, the latter
particularly adaptable for feeding prematures
and for complemental and supplemental
feedings . . .
BAKER'S MODIFIED MILK (Liquid)
NEWBORN INFANTS (Hospital)-l part
Baker's to 2 parts cool water.
FIRST WEEK AT HOME - 1 part Baker's to
1 ’/2 parts cool water.
AFTER FIRST WEEK AT HOME - 1 part
Baker's to 1 part cool wafer.
Both forms are easy to prescribe and prepare
in hospital and home . . . Both cost less than
a penny per ounce of formula, are furnished
gratis to hospitals for your use.
Liquid
J. Florida, M. A.
October, 195 7
411
The
Upjohn Company
announces
a major
corticosteroid
improvement
minor
chemical
changes
can mean
major
therapeutic
improvements
The most
efficient of all
anti-inflammatory
steroids
Supplied: Tablets of 4 mg., in bottles
of 30 and 100.
♦TRAOEMARK FOR METHYLPREDNISOtONE, UPJOHN
Lower dosage
(K lower dosage
than
prednisolone)
Better tolerated
(less sodium
retention, less
gastric irritation)
For
complete information , consult
your Upjohn representative,
or write the Medical Department,
The Upjohn Company,
Kalamazoo, Michigan.
Upjohn
!'im Chemotherapy
ARALEN
iMj
RHEUMATOID
ARTHRITIS
Extensive studies of rheumatoid arthritis and related
collagen diseases— in this country and abroad-
have shown the antimalarial Aralen phosphate to be highly effective
and well tolerated in a large percentage of patients.
Clinical Results with Aralen
ANALGESICS AND STEROIDS:
in Rheumatoid Arthritis
• Requirements usually reduced or
eliminated
iw. vii m«joi mmai
Cases Improvement Improvement
Haydn*
28
22
5
1
ltin« Sort*
25
12
4
*
Freedman3
50
43
3
4
Bagnall4
108
77
12
It
Bruckner3
36
32
0
4
Cohen and Catkim*
22
*7
3
2
Scherbel el aL7
25
•
•
•
Total 294 212(72%) 35(12%) 47(16%)
• Success dependent upon persistent treatment
• Often of benefit where other agents have failed
• Remissions on therapy well maintained
• Remission of 3 to 12 months possible even if
treatment is interrupted
• Tachyphylaxis not evident
GENERAL EFFECTS:
• Patient feels better
• Patient looks better
• Exercise tolerance increases
• Walking speed and hand grip improves
LABORATORY EFFECTS:
• E. S. R. may fall slowly
• Hemoglobin level may gradually rise
JOINT EFFECTS:
Pain and tenderness relieved
Mobility increases
Swellings diminish or disappear
Muscle strength improves
Rheumatic nodules may disappear
Even severe or advanced deformitj
may improve
Active inflammatory process usual
subsides
Joint effusion may diminish
DOSAGE:
Aralen is cumulative in action and
requires four to twelve weeks of
administration before therapeutic ef
become apparent.
Latest information indicates that an
initial dose of 250 mg. of Aralen
phosphate is preferable to the highi
doses sometimes recommended. How
If side effects appear, withdraw Ara
for several days until they subside.
Reinstate treatment with 125 mg.
daily and, if well tolerated, increase
250 mg. The usual maintenance dose
is 250 mg. daily.
Neiu Chemotherapy
INDICATIONS:
• Rheumatoid arthritis, acute or chronic
—with or without adjunctive therapy.
• Spondylitis
• Arthritis associated with lupus
erythematosus or psoriasis
HOW SUPPLIED:
THEORY OF ACTION:
Aralen appears to suppress or
induce remission of rheumatoid
inflammatory processes by inhibiting
adenosinetriphosphatase.
Aralen phosphate: 250 mg. tablets in bottles of 100 and 1000.
125 mg. tablets in bottles of 100.
Tolerance:
Aralen is usually well tolerated. Toxic effects are
usually mild and to date have been transitory in
nature, disappearing completely either on con-
tinuance or cessation of therapy or on reduction in
dosage.
Gastrointestinal disturbances (e.g. nausea,
rarely vomiting, diarrhea, abdominal cramps,
anorexia) are frequent manifestations of intoler-
ance. Temporary blurring of vision (due to inter-
ference with accommodation) is also relatively
frequent.
Pleomorphic skin eruptions (e.g. lichenoid,
maculopapular.purpuric) , although generally mild,
may preclude the use of an optimum dosage
schedule. If a skin reaction persists on a reduced
dosage schedule, or recurs after reinstitution of
treatment with gradually increasing doses, discon-
tinue Aralen till the lesion again disappears and
:onsider resuming treatment with Plaquenil®
(brand of hydroxychloroquine).
Less frequently transitory vertigo, headache,
lassitude, or neurological disturbances, such as
nervousness, irritability, emotional change, and
nightmares have been reported. Instances of unex-
plained slight gradual weight loss as the patient’s
general health and arthritic condition improved
nave been mentioned. Occasional instances of
nleaching (depigmentation) of the hair have been
described.
Although an occasional instance of leukopenia,
•vith normal differential count, has been reported
(WBC about 3000), it has not proved troublesome
because it has always been reversible on discontinu-
mce, or diminution of the dose. Even spontaneous
eversal may occur while full dosage is maintained.
Caution :
Aralen is known to concentrate in the liver and,
although hepatic damage has never been reported,
the drug should be used with caution in the pres-
ence of liver disease. In the presence of severe
gastrointestinal, neurological, or blood disorders,
the drug should be used with caution or not at all.
If such disorders occur during the course of ther-
apy, the drug should be discontinued. Concomitant
use of gold or phenylbutazone with Aralen should
be avoided because of the tendency of these agents
to produce drug dermatitis.
Clinical Comments:
Of fifty patients receiving Aralen therapy, “43
have become really well ; that is, they have no stiff-
ness, and any pain that occurs can reasonably be
attributed to use of joints affected by secondary
degenerative changes. They have no evidence of
joint inflammation, but may have a raised erythro-
cyte sedimentation rate. They have little or no need
for analgesics.” Freedman1 2 3
“One hundred and twenty-five private patients
have been carefully followed clinically and haema-
tologically while receiving well over 200 patient-
years of chloroquine [Aralen] therapy. The results
are considered good in 70%, one-half of these cases
being in remission. Improved work performance,
sedimentation rate, and hemoglobin levels para-
lleled the major objective gain in this 70%. 90% of
them remained on chloroquine [Aralen] therapy,
half for more than two years. Classical peripheral
rheumatoid arthritis, spondylitis, arthritis of
juvenile onset, and rheumatoid disease with
psoriasis, all appeared to respond about equally
well.
“It is suggested that chloroquine comes closer to
the ideal for long-term, safe, control of rheumatoid
disease than any other agent now available.”
Bagnall 4
“Out of the 36 rheumatoid arthritis cases we
treated . . . favorable results were obtained in 32
Cases. Bruckner et al .5 6
Terences
1. Haydu, G.G.: Rheumatoid arthritis therapy: a rationale and the use of
chloroquine diphosphate. Am. J. M. Sc. 225:71. Jan., 1953.
2. Rinehart, R.E.: Chloroquine therapy in rheumatoid arthritis, Northtvest Med.
54:713, July, 1955.
3. Freedman, A.: Chloroquine and rheumatoid arthritis, a short-term controlled trial,
Ann. Rheum. Din. 15:251, Sept., 1956.
4. Bagnall, A.W.: The value of chloroquine in rheumatoid disease, a four year study
of continuous therapy, read at the Ninth International Congress on Rheumatic Diseases
in Toronto. Canada, June 23-28. 1957.
5. Bruckner I., and Rosenzweig. S. : Treatment of chronic rheumatoid
arthritis with synthetic antimalarials, read at the Ninth Internationa
on Rheumatic Diseases in Toronto. Canada. June 23-28. 1957.
6. Cohen, A.S.. and Calkins, Evan: A controlled study of chloroquine as an antirheumatic
agent, read at the Ninth International Congress on Rheumatic Diseases
in Toronto. Canada. June 23-28, 1957.
Scherbel. A. L., Schuchter, S.L.. and Harrison. J.W.: Comparison of effects of two
antimalarial agents, hydroxychloroquine sulfate and chloroquine phosphate,
in patients with rheumatoid arthritis, Cleveland Clin. Quart. 24:98, April, 1957.
LABORATORIES
NfW YO#K 18. N t
414
Volume XLIV
Number 4
Achrostatin V combines AcHROMYcmt V . . .
the new rapid-acting oral form of
Achromycin! Tetracycline . . . noted for its
outstanding effectiveness against more than
50 different infections . . . and Nystatin . . . the
antifungal specific. Achrostatin V provides
particularly effective therapy for those
patients who are prone to mondial overgrowth
during a protracted course
of antibiotic treatment.
supplied:
Achrostatin V Capsules
contain 250 mg. tetracycline
HC1 equivalent (phosphate-
buffered) and 250,000
units Nystatin.
dosage:
Basic oral dosage (6-7 mg.
per lb. body weight per day)
in the average adult is
4 capsules of Achrostatin V
per day, equivalent to
1 Gm. of Achromycin V.
^Trademark
tReg. U. S. Pat. Off.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, N. Y.
For anxiety, tension
and muscle spasm
in everyday practice.
well suited for prolonged
therapy
well tolerated, relatively
nontoxic
no blood dyscrasias,
liver toxicity, Parkinson-like
syndrome or nasal
stuffiness
1ELAXES BOTH MIND AND MUSCLE
WITHOUT IMPAIRING MENTAL OR PHYSICAL EFFICIENCY
Milt own
tranquilizer ivith muscle-relaxant action
2-methyl-2-n propyl-1, 3-propanediol
dicarbamate — U. S. Patent 2,724,720
Supplied: 400 mg. scored tablets
200 mg. sugar-coated tablets
Usual dosage: One or two
400 mg. tablets t.i.d.
Literature and samples available on request
WALLACE LABORATORIES. New Brunswick. N. J.
AN IMPORTANT ADVANCE IN MENOPAUSAL THERAPT
Because it replaces half control with full control.
Because it treats the whole menopausal syndrome. I
Because one prescription manages both the
psychic and somatic symptoms.
Two-dimensional
treatment
SUPPLIED : Bottles of 60 tablets.
Each tablet contains :
MILTOWN® (meprobamate, Wallace) 400 mg.
2-methyl-2-n -propyl- 1,3-propanediol dicarbamate.
U. S. Patent No. 2,724,720.
Conjugated Estrogens (equine) 0.4 mg.
Licensed under U. S. Patent No. 2,429,398.
DOSAGE: One tablet t.i.d. in 21-day courses with one week rest periods.
Should be adjusted to individual requirements.
Samples and literature on request.
“Milprem”
MILTOWN® , CONJUGATED ESTROGENS (EQUINE)
A Proven Tranquilizer ■ A Proven Estrogen
WALLACE LABORATORIES, New Brunswick, N. J.
who discovered and introduced Milt own. the orieinal me.Drobam.ate .
J. Florida, M. A.
October, 195 7
415
now . . care of the man
rather than merely his stomach”1
Miltown® r 7 anticholinergi
controls
gastrointestinal dysfunction
at cerebral and peripheral levels
tranquilization without
barbiturate loginess
spasmolysis without
belladonna-like side effects
for duodena / ulcer • gastric ulcer • intestinal colic
spastic and irritable colon • ileitis • esophageal spasm
G. I. symptoms of anxiety states
prescribe.
1 tablet t.i.d. at
mealtime and
2 at bedtime.
Milpati
Miltown® O anticholinergic (
dicarbamate)
U. S. Patent 2,724,720
tridihexethyl iodide 25 mg.
(3-diethylamino - 1- cyclohexyl -
1 - phenyl - 1 - propanol -ethiodide)
WALLACE LABORATORIES New Brunswick, N. J.
t. Wolf <C Wolff, Human Gastric Function
Literature, samples, and
persojially imprinted peptic ulcer
diet booklets on request L
416
Volume XLiV
Number 4
.
4
why California
table wine
the low-sodium diet?
No. specimens
Sodium (mg. /100 cc.)
examined
Mean
Musts (crushed white grapes)
9
1.63
California
Red Table Wines
82
5.56
California
White Table Wines
73
5.44
California
Dessert Wines
104
7.10
v:
VJ
/dietary restriction of sodium has become a standard procedure in the control
of edema associated with cirrhosis of the liver, congestive heart failure, certain
kidney ailments, toxemias of pregnancy, during digitalization and in drug-
induced diuresis.
Unfortunately sodium-restricted diets tend to be flat, tasteless, monotonous,
leading toward failure of dietary cooperation by the patient.
In such cases California table wine may be employed safely as well as to
advantage in making the food more palatable without adding significant
0 amounts of sodium .
In a recent study1 it was shown that California table wines are remarkably
low in sodium content — less than 10 mg. per 100 cc. ( 3 Va ounce glass).
Since recent research 2,3,4 has also shown that wine stimulates a lagging
appetite and aids digestion while adding a sparkle to any meal — why not encour-
age the moderate use of wine by the patient on a restricted dietary, as well as by
the sufferer from anorexia, the post-surgical, convalescent or geriatric patient?
May we send you a copy of “Uses of Wine in Medical Practice”? A copy
is available to you, at no expense, by writing to: Wine Advisory Board, 717
Market Street, San Francisco 3, California.
/--Sl
1. Lucia, S. P. and Hunf, M. L.: Am. J. DigesU Dis. 2.26 (Jan.) 1957.
2. Goetzl, F. R.: Permanente Found. M. Bull. 8.7 2 (April) 1950.
3. Irvin, D. L. and Goetzl, F. R.: Permanente Found. M. Bull. 9 119 (Oct.) 1951.
4. Irvin, D. I ; Durra A., and Goetzl, F. R.: Am. J. Digest. Dis. 20 117 (Jan.) 1953.
J. Florida, M. A.
October, 195 7
417
( Continued from page 407 )
elected to membership on the American Board of
Anesthesiology. Locally, he was a member of the
staff at St. Vincent’s, St. Luke’s and Brewster
hospitals and the Duval Medical Center. He was
a communicant of the Episcopal Church, and a
Mason and member of the Scottish Rite Bodies.
A life member of the Duval County Medical
Society, Dr. Beckman also was a life member
of the Florida Medical Association, in which he
held membership for 45 years. Through the years
he had, in addition, been affiliated with the Amer-
ican Medical Association. He was a fellow of
the International College of Anesthesiology and
held membership in other societies of his spe-
cialty.
Surviving are the widow, Mrs. Clara Braun
Beckman, and a son, John A. Beckman, of Jack-
sonville; a brother, Dr. John C. Beckman, of
Georgetown, S. C.; and two nephews.
James A. Smith
Dr. James A. Smith of Sanford died on FH).
19, 1957, at the home of his son, Dr. James A.
Smith Jr., in New Smyrna Beach after an illi ess
of two months. He was 68 years of age.
Born May 31, 1888, in Fletcher, W. Va., Dr.
Smith attended public schools in his native state
and received his academic education at Marshall
College in Huntington, W. Va., and Valparaiso
University in Indiana. He was graduated from
the Chicago College of Medicine and Surgery in
1915 and was licensed to practice medicine in
West Virginia that same year. He practiced
there until 1943, when he came to Florida. He
located in Sanford and continued in the general
practice of medicine there until he became ill in
December 1956. Locally, he was a member of
the Masonic Lodge and the First Baptist Church.
Dr. Smith was a past president of the Semi-
nole County Medical Society. He had for 14
years held membership in the Florida Medical
Association and was also a member of the Amer-
ican Medical Association.
Survivors include the widow, Mrs.' Ethel M.
Smith, of Sanford; two sons, Dr. James A. Smith
Jr., of New Smyrna Beach, and William P. Smith,
of Sanford; two brothers, Perry G. Smith, of
Charleston, W. Va., and S. D. Smith, of Ken-
tucky, W. Va., one sister, Miss Florence Smith, of
Kentucky, W. Va., and five grandchildren.
when anxiety and tension "erupts” in the G. I. tract...
IN GASTRIC ULCER
j
PATH I BAM ATE
Meprobamate with PATHILON- Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of gastric ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON {25 tng.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
■Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for T ridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
418
Volume XLI V
Number 4
Ralph Sommerkamp Torbett
Dr. Ralph Sommerkamp Torbett of Tampa
died at St. Joseph’s Hospital in that city on April
28, 1957, following critical injuries sustained in
an automobile accident near Crystal River on
April 1, 1957. He was 63 years of age.
Born in Columbus, Ga., in 1893, Dr. Torbett
was educated in his native state. The University
of Georgia awarded him the degree of Bachelor
of Arts, and in 1919 the School of Medicine of
that institution conferred upon him the degree
of Doctor of Medicine. After serving internships
at hospitals in Macon, Ga., he continued his post-
graduate study in New York, where he served on
the staff of the Roosevelt Hospital.
In 1924, Dr. Torbett entered the private prac-
tice of medicine in Tampa, where he continued
to engage in the practice of his specialty of in-
ternal medicine for 33 years. He served on the
staff of the Tampa General Hospital and was
Chief of Medicine on the staff of St. Joseph’s
Hospital at the time of his death. He was a mem-
ber of the Tampa Yacht and Country Club and
of the Hyde Park Methodist Church.
This distinguished internist was a past presi-
dent of the Hillsborough County Medical Asso-
ciation. He had been affiliated with the Florida
Medical Association since 1925 and through the
years held membership in the American Medical
Association and the Southern Medical Associa-
tion. He was one of the founders of the Hills-
borough County Heart Association, and was ser-
ving as its vice president. He was also active in
the P'lorida Heart Association.
Dr. Torbett is survived by his widow. Mrs.
Jesse Torbett; one daughter, Mrs. Charles E.
Ford Jr.; two granddaughters, Nancy Joan and
Charlton Ford, all of Tampa; two brothers,
Charlton Torbett and Joseph L. Torbett, both
of Columbus, Ga.; and two sisters, Mrs. C. W.
Crocker, of Birmingham. Ala.; and Miss Louise
Torbett. of Columbus, Ga.
Benjamin Arthur Wilkinson
Dr. Benjamin Arthur Wilkinson of Talla-
hassee died April 12, 1957, at the Baptist Hos-
( Continued on page 427 )
Both
and
■V*
PHERAL
itrol of C OiXOjkj
m
SYNEPHRICOL0
ANTITUSSIVE • DECONGESTANT • A N T I H I ST A M I N I C
Central Antitussive Effect - mild, dependable
Topical Decongestion - prompt, prolonged
Antihistaminic and Expectorant Action
(4cc.) cjwdbm
LAB
LABORATORIES
NEW YORK 18, N. Y.
EX E MrT NARCOTIC
a NEW antidiarrheal for
\ddition of neomycin to the
fective Donnagel formula assures
in more certain control of most
}f the common forms of diarrhea.
Neomycin is an ideal antibiotic
nteric use: it is effectively
icteriostatic against neomycin-
:eptible pathogens; and it is
elatively non-absorbable.
The secret of Donnagel with Neomycin’s clinical dependability
lies in the comprehensive approach of its rational formula:
Informational
literature
available
upon request.
COMPONENT
in each 30 cc. (1 fl. oz.)
ACTION
BENEFIT
Neomycin base, 210.0 mg.
(as neomycin sulfate, 300 mg.)
antibiotic
Affords effective intestinal bacte-
riostasis.
Kaolin (6.0 Gm.)
adsorbent,
demulcent
Binds toxicand irritatingsubstan-
ces. Provides protective coating
for irritated intestinal mucosa.
Pectin (142.8 mg.)
protective,
demulcent
Supplements action of kaolin as
an intestinal detoxifying and
demulcent agent.
Dihydroxyaluminum
aminoacetate (0.25 Gm.)
antacid,
demulcent
Enhances demulcent and detoxi-
fying action of the kaolin-pectin
suspension.
Natural belladonna alkaloids:
hyoscyamine sulfate (0.1037 mg.)
atropine sulfate (0.0194 mg.)
hyoscine hydrobromide (0.0065 mg.)
anti-
spasmodic
Relieves intestinal hypermotility
and hypertonicity.
Phenobarbital (Vi gr.)
sedative
Diminishes nervousness, stress
and apprehension.
INDICATIONS: Donnagel with Neomycin
is specifically indicated in diarrheas or
dysentery caused by neomycin-suscep-
tible organisms; in diarrheas not yet
proven to be of bacterial origin, prior to de-
finitive diagnosis. Also useful in enteritis,
even though diarrhea may not be present.
SUPPLIED: Bottles of 6 fl. oz. At all pre-
scription pharmacies.
DOSAGE: Adults: 1 to 2 tablespoonfuls (15
to 30 cc.) every 4 hours. Children over 1
year: 1 to 2 teaspoonfuls every 4 hours.
Children under 1 year: y2 to 1 teaspoon-
ful every 4 hours.
ALSO AVAILABLE: Donnagel, the original
formula, for use when an antibiotic is not
indicated.
A. H, ROBINS CO., INC., RICHMOND 20, V A.
Flu Fight
Drug Firms Speed
Vaccine Output, B
Will the U.S. Nee.
Asiatic Virus Raises T
. #
Government Buys,
nd Hens Have to F
8 STUDENTS ON
FLIGHTS TO U. S.
HAVE ASIAN FLU
! New York, Aug. 15 tiP
en Attack, Rapid 5
e War on Mutant A
f Florence was in the grip of an epi-
•iic of colds, coughs and fevers, astrolo-
s . . . declared that it was caused by
influence of an unusual conjunction of
nets. This sickness
be known as “infl
-2
-Chronicles of
i 200-1470.
'o combat new r
nee.’’ a worldwide
week in respons
n the Far East. St
he World Health
a, which collects i
0 around the globe
cimens of the ene
is. In more than a
Asian Flu: the Outlook
Asian influenza will hit the U.S. this
fall before mass immunization can be
effective, and the nation faces an epi-
demic which may strike 15 million to
30 million people. The disease is relatively
mild (in no way comparable to the kill-
ing “Spanish flu" of 1918-19), and is
likely to cause only a small number of
deaths among the feeble young and. En-
feebled old. But it may compel 10% to
20% of the population in affected areas
to tal
j Laboratory tests on e
foreign exchange student
arrived Aug. 8 show they
victims of Asiatic flu, the
health department repo
today. The eight arrived
plane from Europe.
Twenty-nine other stud,
suffering from influenza
rived Tuesday from Rok._i
dam on the ship Arosa Sky
One, Nicholas Memmos, '■
Greek exchange student, tnc'<.
yesterday. Six of these stu
dents were released today — |
the others are to be r
tomorrow
THE INFLU
How Deadly Will i
What Can We Do
It has not /
termined whether.
died from Asiatic
£ ~ -J U-. T ~
IF
An«
— IS
tirourl
Pez
vac
izat
flov
the .
or it A
States
U.S. Fightin
now
ud’nv those of tfr
thus >
Wr
The War On Asiatic Flu
quie'
a cm
There's cause for concern about Asiatic
pect flu, but scientists and public health officials
ber sce n0 reason for anyone to panic.
non
First shipments of the vaccine against the
new influenza strain have arrived in Chi-
cago, setting off a flood of telephone calls
from worried patients to doctors, and from
doctors to drug suppliers. This is a nor"
pattern of mass fear and is understan
>f the r
Even though Salk vaccine priorities were
necessary, the regulation produced adminis-
trative headaches, public complaints and
probably a gray, if not a black market. When
, , . .... - . 1
regulation 1
invoke it.
would u
PUBLIC HEALTH
Influenza
THc
^ INFLUENZA, one of the m.
dictable of communicable disease
ing “on cat feet” across the na
now. It has already struck once
in mild epidemic form at an
base in Colorado. When and ho
it will strike again is a perennial
public health authorities.
..:n 1...U1..
to counteract
complications from
MIC
ising It?
fiBIFlMTA T T?T TT”
uiiiEjii i l\ i j r I ji j
JCH " ASIATIC" FLU-
e New Virus Threat From Orient
t" flu
there
effective against staph-, strep- and pneumococci
QMrett
ucturc of the vir
422
Volume XI.IV s
Number 4
On Self-Regulated
Schedules For Infants
Genetically acquired behavioral predisposi-
tions enable the normal baby to regulate its
feeding intake and periodic hunger sensa-
tions, its feeding habits. These physiological
regulatory forces may be satisfied by adapt-
ing the formula content and feeding period
to the individual needs cf the infant. It in-
volves a sensible compromise between too
rigid a schedule, geared to the clock and too
lax a schedule, based on self-demand feed-
ings. Such is the current objective: for either
extreme can lead to infant feeding difficulties.
The newborn may become a feeding prob-
lem if the prescribed formula is excessive or
the feeding schedule rigid. Every time he is
awakened abruptly from satisfying slumber
to be fed forcefully, the baby gradually loses
his enthusiasm for the food and begins to
resist the feeding. The young infant may balk
at the crude introduction of a new food or
feeding procedure without the proper prelude
of gradual adaptation cf taste, color, consist-
ency and quantity.
The older infant weaned from bottle to cup
may reject milk or go on a hunger strike.
Devoted to his bottle he resents its sudden
deprivation. It takes a certain readiness for
weaning to make that change agreeable. Later
the infant becomes somewhat independent of
his mother and arbitrary with his food. What
he enjoyed yesterday, he rejects today. If he
distorts the diet for a day and his mother
resorts to force, a feeding problem is in the
making. Sensible decorum will solve these
little difficulties before they become big be-
havior disturbances in childhood.
The problems of infant feeding are always
the same but solutions may differ with each
era. The carbohydrate requirement for all
infants is as completely fulfilled by Karo®
Syrup today as a generation ago. Whatever
the type of milk adapted to the individual
infant, Karo may be added confidently be-
cause it is a balanced mixture of low sugars,
easily mixed, well tolerated, palatable, hypo-
allergenic, resistant to fermentation, easily
digestible, readily absorbed, non-laxative.
Readily available in all food stores.
MEDICAL DIVISION
CORN PRODUCTS REFINING CO.
1 7 Battery Place, New York 4, N. Y.
Behind Every Karo Bottle ... A Generation of World Literature
J. Florida, M. A.
October, 195 7
423
V
optimal dosages for atarax,
based on thousands of case histories:
mg. ft.i.d.J
for these 2! 5 adult indications:
TENSION SENILE ANXIETY MENOPAUSAL SYNDROME ANXIETY PREMENSTRUAL TENSION
PHOBIA HYPOCHONDRIASIS TICS FUNCTIONAL G. I. DISORDERS PRE-OPERATIVE ANXIETY
HYSTERIA PRENATAL ANXIETY • AND ADJUNCTIVELY IN CEREBRAL ARTERIOSCLEROSIS
PEPTIC ULCER HYPERTENSION COLITIS NEUROSES DYSPNEA INSOMNIA
PRURITIS ASTHMA ALCOHOLISM DERMATITIS PARKINSONISM PSORIASIS
perhaps the safest ataraxic known
PEACE OF MIND AT A RJ X'
( bran o or HvoMomiNi) rp | i , c*
lablets-byrup
Consider these 3 atarax advantages:
• 9 of every 10 patients get release from tension,
without mental fogging
* extremely safe — no major toxicity is reported
• flexible medication, with tablet and syrup form
Supplied:
In tiny 10 mg. (orange) end 25 mg. (green)
tablets, bottles of 100.
atarax Syrup, 10 mg. per tsp., in pint bottles.
Prescription only.
ajji
W i '
why Dimetane is the best reason yet for you to re-exami
the antihistamine you’re now using » Milligram for miiiigr i
Diagnosis
No. of
Patients
Response
Side Effects
Excellent
Allergic
rhinitis and vaso*
motor rhinitis
Urticaria and
angioneurotic
edema
30
3
14
Allergic
dermatitis
Bronchial asthma
Pruritus
37
Negative
-
DIMETANE potency is unexcelled. DIMETANE has a therapeutic index unrivaled by i
other antihistamine— a relative safety unexceeded
by any other antihistamine, dimetane, even in very
low dosage, has been effective when other antihis-
tamines have failed. Drowsiness, other side effects
have been at the very minimum.
» unexcelled antihistaminic action
Slight Drowsi »
Dizzy (1)
Slight Drowsi ;
Drowsiness (f
Dizzy (1)
From the preliminary Dimetane Extentabs studies of three investigators. Further clinical investigations will be reported as c« 1
DIMETANE IS PARABROMDYLAMINE MALEATE - EXTENTABS 12 MO., TABLETS 4 MO.,ELtXIR 2 MG. PER 5 CC.
lanket of allergic protection, covering 10-12
irs— with just one Dimetane Extentab » dimeta ne
entabs protect patient for 10-12 hours on one tablet.
Periods of stress can be easily han-
dled with supplementary dimetane
Tablets or Elixir to obtain maxi-
mum coverage.
A. H. ROBINS CO., INC.
Dosage:
Adults— One or two i-mg. tabs,
or two to four tcaspoonfuls
Elixir, three or four times daily.
One Extentab q.S-12 h,
or twice daily.
Children over 6— One tab,
or two tcaspoonfuls Elixir t.i.d.
or q.i.d., or one Extentab q.l2h.
Children 3-6— % tab.
or one tcaspoonful Elixir t.i.d.
Richmond, Virginia | Ethical Pharmaceuticals of Merit Since 1878
426
Volume XU V
Number 4
A natural
biochemical treatment
for your problem
^ '
of PRURITUS ANI -
HYDROLAMINS*
TOPICAL AMINO ACID THERAPY
Immediate and prolonged relief . . . Inherent safety
98% Effective 1 and Why —
Recent observations on the pruritogenic
effects of proteolytic enzymes2 have focused
new interest on the value of proteins and
amino acids in pruritus ani.
Using selected amino acids — Hydrolamins
— Bodkin and Ferguson1 obtained relief in
98% of pruritus ani cases. McGivney3
states that practically all his patients have
had immediate relief.
Hydrolamins offers a protective stainless
biochemical barrier to irritating enzymes
and also neutralizes alkaline irritants
seeping from the anal canal.
100% Safe and Why —
Being biochemical in character and having
a pH of around 6, Hydrolamins harmo-
nizes with the skin, does not — unlike the
"caines” and steroids — tend to cause
treatment dermatitis or sensitization — in
a word is SAFE.
Hydrolamins is, therefore, indicated in the topical treatment of —
Pruritus Ani et V ulvae • Fissures • Diaper Rash • Anal Irritations and
Erythemas • Pinworm Pruritus • Ileostomy and Colostomy Irritations
SUPPLIED: 1 oz. and 2.5 oz. tubes.
Pharmaceutical Company
Chicago 14, Illinois
1. Bodkin, t. G., and Ferguson. E. A., Jr.: Am. J Digest. Dis. 11:59 (Feb.) 1951. 2. Arthur. R. P„ and Shelley,
W B.: J. Invest. Derm. 25:341 (Nov.) 1955. 3, McGivney, J.: Texas J. Med. 47.770 (Nov.) 1951.
J. Florida, M. A.
October, 195 7
427
(Continued from page 418)
pital in Pensacola. Dr. and Mrs. Wilkinson were
en route from New Orleans, where he had under-
gone a medical examination. He was 60 years of
age.
Born in Quitman, Ga., on July 29, 1896, Dr.
Wilkinson was educated in his native state. He
received his medical training at the University of
Georgia School of Medicine and was awarded the
degree of Doctor of Medicine in 1924. He in-
terned at the Georgia Baptist Hospital in Atlanta.
Dr. Wilkinson practiced medicine in Talla-
hassee for 32 years. He was a member of the
Leon-Gadsden-Liberty-Wakulla-Jefferson County
Medical Society, the Florida Medical Association,
the American Medical Association and the Amer-
ican Academy of General Practice. He served as
secretary-treasurer of the Leon County Medical
Society for nine years. He was on the executive
staff of the Tallahassee Memorial Hospital and
at one time was college physician for the Florida
State College for Women.
Dr. Wilkinson was a deacon of the First Bap-
tist Church. He was a member of the American
Legion and the Elks Lodge 937 and was a veteran
of World War I.
Surviving are the widow, Mrs. Kathleen Perry
Wilkinson, of Tallahassee; one daughter, Mrs.
Roderick K. Shaw Jr., one granddaughter, Floride
Elizabeth Shaw, and one grandson, Roderick K.
Shaw III, all of Tampa; one brother, Dr. James
C. Wilkinson, of Athens, Ga.; and one sister,
Mrs. A. H. Robinson, of Adel, Ga.
BOOKS RECEIVED
Medical Services for Rural Areas. The Ten-
nessee Medical Foundation. By Willman A. Massie. Pp.
68. Price, $1.25. Published for The Commonwealth
Fund by Harvard University Press, Cambridge, Massa-
chusetts, 1957.
A group of physicians in Tennessee experienced an
unpleasant twinge of conscience when presented with the
picture of Pruden Valley. They decided to do something
about it and other communities like it. This is the story
of their effort, resulting in a program to improve the
health service for a group of communities in rural Ten-
nessee, and a fascinating story it is. Realizing that or-
ganized medicine in the state had a moral obligation to
extend good medical care to all the people of Tennessee,
the Board of Trustees of the Tennessee State Medical
Association delegated to the Tennessee Medical Founda-
tion, an organization the Association had founded to ad-
vance medical knowledge and service, the task of estab-
lishing and financing adequate medical facilities in Pruden
Valley and other areas in the eastern Tennessee moun-
tains. Grants from The Commonwealth Fund furthered
the project with these results:
‘‘The Foundation’s effort has served to curb costly
mistakes, to plan wisely the material facilities to fit long-
range needs, to develop the type of service best suited to
each community’s health requirements and economic
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
*
Combmes Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate loginess, hangover or
habituation . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexefhyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
428
Volume XI
Number 4
portrait of a contented baby
Jtfrefrt
VC HYPOALLERGENIC FORMULA
Q An ideal food for milk allergies, eczema and problem feeding
An excellent formula for regidar infant feeding
Strikingly similar to mother’s milk in composition and ease of assimila-
tion, babies thrive on soyalac.
Clinical data furnish evidence of soyalac’s value in promoting growth
and development.
Protein of high biologic value is obtained from the soybean by an ex-
clusive process.
soyalac is an ideal “regular” formula. It also helps solve the feeding
problems of prematures and infants requiring milk-free diets.
No mixing problem with soyalac Concentrated Liquid. Simply dilute
with equal amount of water.
FREE BOOKLET AND SAMPLES
A request on your professional lelterhead or prescription form will bring
complete information and a supply of samples. Address Loma Linda Food
Company, Arlington, California or Mount Vernon, Ohio.
LOMA LINDA FOOD COMPANY
ARLINGTON, CALIF. MOUNT VERNON, OHIO
Medical Products Division
. Florida, M. A.
October, 1957
429
esources, to teach the people and the medical profession
o work together with dedication toward alleviation of
uffering and long-range improvement in health of all the
ieople in each community. This, then, is the direction
,f a program ‘based on the acceptance of the fundamen-
al philosophy that organized medicine can and should
ssume an active role in the medical affairs of local com-
aunities and shall stand in a position to materially assist
nd insure the provision of good medical care to the
ieople of the State of Tennessee.’ ”
Ciba Foundation Symposium on Paper Elec-
rophoresis. Editors for the Ciba Foundation, G. E. W.
Volstenholme, O.B.E., M.A., M.B., B.Ch., and Elaine
P. Millar, A.H-W.C., A.R.I.C. Pp. 224. IUus. 74.
’rice, $6.75. Boston, Little, Brown and Company, 1956.
This is the first book to appear in which the world’s
eading experts in the field of paper electrophoresis to-
other present their work. It is the end result of a
vmposium, held at the Ciba Foundation in London,
lesigned to lead to the employment of methods allow-
nz a much better basis of comparison between different
indings in laboratories.
Paper electrophoretic technic has become an increas-
ngly important diagnostic tool. Workers in many coun-
ries have proceeded along independent lines during the
>eriod of development. Now, in this convenient volume,
hose who have made important, original contributions
■xchange their views with an eye to standardizing meth-
>ds, results and apparatus. Through formal papers and
nformal discussions the applications of paper electro-
ihoresis to protein chemistry are explored. Quantitative
nethods and the criteria for those methods are discussed.
Outstanding among the many topics covered are:
reneral methods of paper electrophoresis and their use
n medical and biochemical problems; evaluation of the
dbumin-globulin ratio of blood plasma or serum by
>aper electrophoresis; analysis of human hemoglobins by
paper electrophoresis; physicochemical aspects and their
relationship to the design of apparatus; the future of the
technic in its application to clinical research and routine
analysis.
A Visit to the Hospital. By Francine Chase.
Pp. 68. Price, $1.50. New York, Grosset & Dunlap Inc.,
1957.
The purpose of this well illustrated book is to allay
the fears and anxieties of children who are about to
undergo surgical experience in a hospital. It incorporates
all the psychologic principles for the emotional prepara-
tion of children for surgery established by educators,
psychologists and surgeons everywhere. Written under
the supervision of Dr. Lester L. Coleman, an ear, nose
and throat surgeon who is particularly identified with
psychosomatic concepts in medicine, the book carries an
introduction by Dr. Flanders Dunbar, Editor-in-Chief,
Emeritus, American Psychosomatic Society. A Visit to
the Hospital is primarily directed towards the removal
of the tonsils since two to three million such operations
occur yearly in America. Because a tonsil operation
can be planned for, this book can help to convert an
emotionally traumatic experience into a productive growth
experience of childhood. Dr. Coleman believes that the
teachings of this book can apply likewise for eye sur-
gery or any other elective or even emergency operation.
Human Blood Groups and Inheritance. By
Sylvia D. Lawler, M.D., and L. J. Lawler, B.Sc. Pp.
108. Price, $1.50. Cambridge, Mass., Harvard Univer-
sity Press, 1957.
This little book offers a readable, accurate and up-to-
date account of the human blood groups, for both the
( Continued on page 432 )
when anxiety and tension "erupts” in the G. I. tract..,.
IN ILEITIS
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of ileitis — without fear of barbiturate loginess, hangover or
habituation . . . zvith PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: I tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
'Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
one dose
a day. . .
announcing...
a new practical
and effective method
for lowering blood
cholesterol levels...
Just one dose a day effectively
lowers elevated blood cholesterol
. . . while allowing the patient
to eat a balanced . . . nutritious . . .
and palatable diet
ach tablespoonful of emulsion contains:
Linoleic acid 6.8 Gm.
Vitamin B6 0.6 mg.
Mixed tocopherols (Vitamin E) 11.5 mg.
(sodium benzoate as preservative)
Arcofac is effective in small doses
and is reasonable in cost
to the patient
Whm the armour
■■M LA BOR AT O R I E S
A DIVISION OF ARMOUR AND COMPANY
KANKAKEE, ILLINOIS
Armour. ..Cholesterol Lowering . . . Factor
432
Volume XLIV
Number 4
(Continued from page 429)
biologist and the lay reader. As stated in the Foreword,
blood groups are of importance in medicine, in anthro-
pology and occasionally in the law, and all these aspects
are dealt with in this hook. “But to the reader with a
general interest in biology the most fascinating aspect
must surely be their inheritance. In no species could
clearer or simpler examples be found of the basic
mechanism of heredity discovered by Mendel in the gar-
den pea over 80 years ago.
“The exact manner of inheritance of only eleven
normal human characters is yet known with certainty.
Since nine of these characters are blood groups, it is im-
portant that all students of biology should have some
knowledge of this subject. They could have no better
guides than Mr. and Dr. Lawler, who have here provided
a complete and authoritative account in a commendable
concise form.”
Rypins’ Medical Licensure Examinations:
Topical Summaries and Questions. By Walter L. Bier-
ring, M.D., M.A.C.P., M.R.C.P., Edin. (Hon.), with the
Collaboration of a Review Panel. Ed. 8. Pp. 964.
Price, $10.00. Philadelphia, J. B. Lippincott Company,
1957.
A panel of outstanding teachers and clinicians has
collaborated with the present editor to ensure the con-
tinued usefulness of this worth while publication, origin-
ally written and revised by the late Harold Rypins, M.D.
The original plan has been retained in this eighth edition
— separate summaries of each subject and actual ques-
tions based on the essential facts contained in each sum-
mary. The Table of Contents is divided into two parts:
Part One, Basic Medical Sciences, including Anatomy,
Physiology, Biochemistry, Microbiology, Pathology and
Pharmacology; Part Two, the Clinical Sciences, includ-
ing Surgery, Medicine, Obstetrics and Gynecology, Pre-
ventive Medicine and Public Health, and Psychiatry.
It is hoped that this publication will continue to in-
terest both the examiner and the examinee and enlist the
cooperation of the medical educator in the broad field
of licensure and other types of qualifying examinations.
It also provides the undergraduate student with a com-
pact and orderly presentation of the several fields of
medicine which will permit of a dependable review of
the material covered in the medical course.
Health Services for American Indians. U. S I
Department of Health, Education, and Welfare, Public I
Health Service, Office of Surgeon General, Division of I
Public Health Methods. Pp. 344. Price, $1.75. Public I
Health Service Publication No. 531. Washington, D. C., I
Superintendent of Documents, U. S. Government Printing I
Office, 1957.
The study here reported was divided into four major I
areas: 1. Indian health status and needs; 2. Medical I
care and hospital services; 3. Public health and preven- I
tive services, and 4. Economic and social resources avail- |i
able for health purposes. In submitting this report to I
the Committee on Appropriations of the House of Rep- I
resentatives, Secretary Folsom of the Department of I
Health, Education, and Welfare, wrote: “The report I
which I am sending you, and the appended study of I
health problems among the Alaska natives which was I
made two years ago, clearly indicate the intricate inter- |
play of health and social, economic, educational and
other nonmedical problems. While health measures alone
cannot solve the whole problem, the survey findings and
data do provide an essential factual base for the planning
of positive steps which can be taken to improve the health
level of Indians. Many concrete recommendations are
made with the dual purpose of reducing preventable
illness and death and at the same time advancing the
orderly integration of Indian and non-Indian health pro-
grams and services.”
when anxiety and tension "erupts” in the G. I. tract . . .
in spastic
and irritable colon
PATHIBAMATE
Meprobamate with PATHILON® Lederle
Combmcs Meprobamate ( 4G0 mg.) the most widely prescribed tranquilizer... helps control the
“emotional overlay” of spastic and irritable colon — without fear of barbiturate loginess, hangover or
habituation... with PATHILON (25 ;//e.)the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t. i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
J. Florida, M. A.
October, 195 7
in bronchial asthma and respiratory allergies
specify the buffered “predni-steroids”
to minimize gastric distress
combined steroid-antacid therapy . . .
Tablets
‘Co-Deltra’ or ‘Co-Hydel- MultiP|e
tra’ provides all the bene- Comi»ressed
fits of “predni-steroid”
therapy and minimizes the
likelihood of gastric distress
which might otherwise im-
pede therapy. They provide
easier breathing— an d
smoother control — in bron- 2-5 mg- °r 5-° mg-
chial asthma or stubborn prednfso'iln"! plus
respiratory allergies. 300 mg. of dried
,, ... , _ , aluminum
supplied: IVtuUip’e Compressed hydroxide
Tablets Co-Deltra or Co-Hy- , d 50 me
deltra’ in bottles of 30, 100, and ®f magnesium‘
trisilicate.
500.
Co Delira
(Prednisone buffered)
Cofiydeltra
MERCK SHARP & DOHME
•CO-DELTRA* and 'CO-H YDELTRA* are
registered trademarks of MERCK & Co.. Inc\
DIVISION OF MERCK a CO.. INC.
PHILADELPHIA ». PA.
433
434
VOI.UME XLIV
Number 4
Relax the best way
. . . pause for Coke
Make your pause at work
truly refreshing. Have a frosty bottle
of pure, delicious Coca-Cola
. . . and be yourself again.
Florida, M. A.
K'TOBER, 195 7
435
If you could
D Q
visit
with a user of the Picker Anatoniatic
Century x-ray unit you'd soon know
_A why this remarkable "new way in x-ray"
machine has come so far so fast.
He'd probably tell you first how incredibly easy it is to use
(just dial the body part and set its thickness...
'then press the button). He might sigh with
4 *' relief at having no charts to consult,
calculations to make (the anatomatic
no
principle does all the tedious "figgerin"
for you) .
He'd probably show you how good
a radiograph he gets every time
He might even touch on the peace-of-mind
that comes of having a local Picker
office so near, with a trained Picker
expert always on call for help and counsel
isl-
and there'd be no mistaking
the light in his eye when it
falls on the handsome big-name
unit whose fine appearance
adds so much to the
impressiveness of his office.
P.S. Somewhere along the line the matter of price would
come up ... he'd most likely comment on how little he paid
to get so much. Or he might even be among those who rent
their x-ray machine (Picker has an attractive rental plan,
you know) .
.P.S. Next best thing is to call your local Picker man in and
et him tell you about this great new machine (find him in your
phone book) or write Picker X-Ray Corporation, 25 South Broadway,
hite Plains, N. Y.
KAMI 35, FLA., 1363 Coral Way
acksonville 7, Fla., 1023 Mary Street
t. Petersburg, Fla., 601 Rutledge Bldg.
Orlando, Fla., 1711 Oakmont Street
W. Palm Beach, Fla., 305 South Flagler Drive
436
Volume XLIV
Number 4
RADIUM
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician. Radiologist)
HAROLD SWANBERG, B.S., M.O., Director
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THE DUVALL HOME
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A home offering the finest custodial care with a
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Under New Medico
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Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
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QUALITY BOOK PRINTING
PUBLICATIONS ☆ BROCHURES
2 I s West Ciiukcii St.
] A C K S O N V I I. I. K , F I. O l< I D A
" A lien i Invalid Home I
MILLEDGEVILLE, GA. I
Established 18V0 !
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof i
Comfortable Convenient I
Site High and Healthful
K VV. Allen, M.D., Department jor Men
H. D. Allen, M.D., Department jor Women
Terms Reasonable :
mum:
?'<T' '
ii mi li
Information
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
Brochure 0 Modern Treatment Facilities
O Occupational and Hobby Therapy
Rates
Available to Doctors
and Institutions
# Psychotherapy Emphasized
• Large Trained Staff
0 Individual Attention
0 Healthful Outdoor Recreation
• Supervised Sports
0 Religious Services
0 Capacity Limited 0 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, MD ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., MD
PETER J . SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G GONZALEZ, M D
Consultants in Psychiatry
AUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
438
Volume XLIV ;
N U M UK K 4
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association of
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D.
Medical Director
P. O. Box 218
ALBERT F. BRAWNER, M.D.
Assistant Director
Phone 5-4486
ASHEVILLE
APPALACHIAN HALL
Established 1916
NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall. Asheville, N. C.
Florida, M . A.
October, 195 7
439
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St.
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9. Florida
440
Volume XL1V
Number 4
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.
Phone WOrth 1-1151
f. Florida, M. A.
October, 195 7
INDEX TO ADVERTISERS
441
1 Abbott Laboratories
■ Allen’s Invalid Home
1 Ames Co., Inc.
1 Anclote Manor
1 Anderson Surgical Supply Co.
■ Appalachian Hall
• Armour Laboratories
1 Ayerst Laboratories
■ Baker Laboratories
• Ballast Point Manor
1 Brawner’s Sanitarium
■ Brayten Pharmaceutical Co.
• Burroughs Wellcome & Co.
• Convention Press
Coca Cola Co 434
Corn Products Refining Co. 409, 422
Desitin Chemicals Co. 336
1 Drug Specialties, Inc. 342
Duvall Home 436
Emory University 386
Fort Lauderdale Beach Hospital 441
Geigy Pharmaceuticals 344
General Electric Co. 408
Highland Hospital, Inc. 439
■ Hill Crest Sanitarium 440
■ L. & B. Laboratories, Inc. 400
Lakeside Laboratories 333
Lederle Laboratories 388, 389, 397, 401, 405,
414, 417, 427, 429, 432
341, 406a, 406b, 420, 421
437
340
437
407
438
430, 431
396
410
439
438
335
334, 338
437
Lewal Pharmaceutical Co.
426
Eli Lilly & Co.
346
Loma Linda Food Co.
428
Medical Protective Co.
390
Medical Supply Co.
436
Merck Sharp & Dohmc
337,
399, 406, 433
Miami Medical Center
443
Parke-Davis & Co.
Second Cover, 331, 393
Pfizer Laboratories
143
Picker X-Rav Corn.
435
Quincv X-Ray & Radium Labs
436
Rich Company, Inc.
395
A. H. Robins & Co.
338a, 338b, 338c, 338d,
398,
419, 424, 425
Roerig & Co.
402, 403, 423
St. Albans Sanitarium
442
Schering Corp.
145
Third Cover
Schieffelin & Co.
390
G. D. Searle Company
387, 392
Smith, Kline & French Labs.
Back Cover
E. R. Squibb & Sons
339
Sun Ray Park Health Resort
436
Surgical Supplv Co
404
Tucker Hospital, Inc.
-
j ... 440
S. J. Tutag & Co.
394
Upjohn Co.
411
Wallace Laboratories
414a, 414b, 415
Westbrook Sanatorium
442
Wine Advisory Board
416
Winthrop Laboratories, Inc.
391,
412, 413, 418
FORT LAUDERDALE BEACH HOSPITAL
125 N. Birch Rd., Ft. Lauderdale, Florida
A modern hospital for general
medical care, with excellent
diagnostic, therapeutic and re-
habilitation facilities.
Patients under care of private
physicians.
For information write to the
Medical Director or Kenneth A.
Dahl, Administrator, Fort Lau-
derdale Beach Hospital, 125 N.
Birch Road, Fort Lauderdale,
Fla.
442
Volume XU V
Number 4
SAINT ALBANS
A P R I V A T I PSYCHIATRIC HOSPITA1
RADFORD, VIRGINIA
Affiliated Clinics:
STAFF
James P. King, M.D.
Director
James K. Morrow, M.D.
Thomas E. Painter, M.D.
Clara K. Dickinson, M.D.
Bluefield Mental Health Center
Bluefield, W. Va.
David M. Wayne, M.D.
Daniel D. Chiles, M.D
James L. Chitwood, M.D.
Medical Consultant
Harlan Mental Health Center
Harlan, Ky.
C. H. Crudden, M.D.
Beckley Mental Health Center
Beckley, W. Va.
W. E. Wilkinson, M.D.
■ — - ■ ■ — — — — j ■' |
Westbrook. Sanatorium
RICHMOND
t jStablished lf)U
V I R.G I N I A
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin. psychotherapy, occupational
and recreational therapy- — for nerv ous
and mental disorders and problems of
addiction.
Staff PAUL v- ANDERSON, M.D., President
REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K, HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and J/ietvs Sent On Request - P. 0 • Box 1514 - Phone 5-3245
M. A.
>5 '!
SCHEDULE OF MEETINGS
443
RGAN1ZATION
PRESIDENT
SECRETARY
ANNUAL MEETING
(edical Association
ledical Districts
nvest
least
iwest
least
lecialty Societies
of General Practice
;ociety
logists, Soc. of
s., Am. Coll., Fla. Chap.
1 Syph., Assn of
ficers’ Society
and Railway Surgeons
lynec. Society.
It Otol., Soc. of
: Society
ts, Society of
Society
Reconstructive Surgery
c Society
: Society
al Society
Am. Coll., Fla. Chapter
Society
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Joel V. McCall Jr., Daytona Beach
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Burns A. Dobbins Jr., Ft. L’d’dale
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
Miami Beach, May 10-14, ’58
Panama City, Oct. 28, ’57
Orlando, Oct. 30, ’57
Clearwater, Oct. 29, ’57
Fort Pierce, Oct. 31, ’57
St. Petersburg, Oct. 31-Nov. 2, 57
Miami Beach, May 1958
Nov. 30-Dec. 1, ’57
Jan. 58
Miami, Nov. 10, ’57
Miami Beach, May 1958
W. Palm Beach, Oct. 31-Nov. 3, ‘57
Miami Beach, May 1958
Nov. ’57
Miami Beach, May 1958
Miami Beach, May 11, ’58
Miami Beach, May 1958
ience Exam. Board
Tanks, Association
oss of Florida, Inc.
ield of Florida, Inc
Council
; Assn
Society, State
ssociation
I Association
Examining Board
Postgraduate Course
anesthetists, Fla. Assn.
Association, State
ceutical Assoc., State
Health Association
1 Society
ilosis & Health Assn.
’s Auxiliary
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax.
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
Edward R. Smith, Jacksonville
Bryant S. Cattoll, D.D.S. Jax.
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal.
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax.
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Joseph J. Lowenthal, Jacksonville
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Clarence L. Brumback, W. P. B.
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
Gainesville, Nov. 9, ’57
Ponte Vedra, May 1958
Miami Beach, May 1958
Gainesville, Oct. 24-26, ’57
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
Clearwater, Nov. 21-22, ’57
Miami, Nov. 24-26, ’57
Clearwater, Oct. 17-19, ’57
Jacksonville, May 18-21, ’58
Ft. Lauderdale, Oct. 31-Nov. 2, ’57
Miami Beach, May 10-14, ’58
Medical Association
Clinical Session
Medical Association
Medical Association
vledical Assn, of
pital Conference
■cn Allergy Assn
:rn, Am. Urological Assn,
‘in Surgical Congress ....
st Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala.
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Miami Beach, Nov. 11-14, ’57
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Charleston, S.C., Nov. 1-2, ’57
Hollywood, Jan. 12-16, ’58
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin, Electroshock, Hydrotherapy.
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on reauest
Member American Hospital Association
444
V'olume XLIV
Number 4
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
WILLIAM C. ROBERTS, M.D., President . .Panama City
JERE W. ANNIS, M.D., Pres. -Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D..
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . .Jacksonville
SHALER RICHARDSON, M.D., Editor. Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR., M.D. ..AL-58 Ocala
GEORGE S. PALMER, M.D.. .A-58 Tallahassee
CLYDE O. ANDERSON, M.D. C-59 Si. Petersburg
REUBEN B. CHRISM AN JR., M.D. D-60. Coral Gables
MEREDITH MALLORY, M.D...B-61 Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D...PP-59 Si. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D.
GEORGE M. STUBBS, M.D.
DOUGLAS D. MARTIN, M.D.
RICHARD A. MILLS, M.D
JAMES L. BRADLEY, M.D.
LOUIS M. ORR, M.D. (Advisory)
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL-58 Broohsville
First— ALPHEUS T. KENNEDY, M.D. 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D. 3-58 Jacksonville
Fourth— DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D 6-58 Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
FOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm.
Orlando
THOMAS II. BATES, M.D. “A”
FRANK L. FORT, M.D. “B”
ALVIN L. MILLS, M.D. ...“C”
St. Petersburg
JOHN 1). MILTON, M.D “D”
Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm C 61 Tampa
LEO E. REILLY, M.D. AL-58 Panama City
ROBERT B. McIVER, M.D B-58 Jacksonville
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
DONALD W. SMITH, M.D D-60 Miami
BLUE SHIELD LIAISON
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A 58 Tallahassee
JOHN J. CHELEDEN, M.D. B-58 Daytona Beach
JOHN M. BUTCHER, M.D. C-58 Sarasota
PAUL O. SHELL, M.D. I) 58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D A 59 Pensacola
HENRY L. HARRELL, M.D. I! 59 Ocala
JAMES R. BOULWARE JR., M.D. C-59 Lakeland
RAI I’ll M. OVERSTREET JR., M.D. D 59 VV. Palm lleach
MERRITT It. CLEMENTS, M.D. A 60 Tallahassee
ROBERT E. ZELLNER, M.D. B-60 Orlando
WHITMAN C. McCONNELL, M IL C 60 St. Petersburg
RALPH S. SAPPENFIELD, M.D D 60 Miami
HAROLD E. WAGER, M.D. A 61 Panama City
CHARLES F. McCRORY, M.D. B-61 Jacksonville
JOHN S. STEWART, M.D C 61 _ Fort Myers
DONALD F. MARION, M.D. D 61 Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M IL D-58 Miami
SAMUEL B IL RHEA, M.D A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D. B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm. D 58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D A-60 Tallahassee
J. K. DAVID JR., M.D. B-61 Jacksonville
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm. AL-58 Orlando
WILLIAM W. TRICE JR., M.D C-58 Tampa
JOHN V. HANDWERKER JR., M.D. D 59 Miami
WALTER C. PAYNE JR., M.D. A-60 Pensacola
W. DEAN STEWARD, M.D B-61 Orlando
CONSERVATION OE VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orlande
HUGH E. PARSONS, M.D. C-58 Tampa
CHARLES C. GRACE, M.D B 59 St. Augustine
ALAN E. BELL, M.D A-60 _ Pensacola
LAURIE R. TEASDALE, M.D. D-61 W. Palm Beach
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D. St. Petersburg
JOHN D. MILTON, M.D Miam:
DUNCAN T. McEWAN, M.D Orlande
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 T ampe
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D. B-58 Jacksonville
CECIL M. PEEK, M.D. D-60 W. Palm Bead
GEORGE H. GABMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama Cite
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
MATERNAL WELFARE
E. FRANK McCALL, M.D., Chm. B-60 Jacksonville
WILLIAM C. FONTAINE, M.I). AL-58 Panama Cit
J. LLOYD MASSEY M.D. A-58 Quine
RICHARD F. STOVER, M.D D 59 Miam
S. L. WATSON, M.D. C.61 Lakelan.
Jacksonville
Jacksonville
Tampa
Fort Lauderdale
- Fort Myers
Orlando
J. Florida, M. A.
October, 195 7
445
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm. AL.58 Orlando
DEWITT C. DAUGHTRY, M.D. D 58 Miami
S. CARNES HARVARD, M.D. C-59 ilrooksville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
MEDICAL EDUCATION AND HOSPITALS
IACK Q. CLEVELAND, M.D., Chm. D 58 Coral Cables
PAUL J. COUGHLIN, M.D. AL-58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. B 60 Gainesville
RAYMOND B. SQUIRES, M.D. A 61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D. B-58 Gainesville
IAMES N. PATTERSON, M.D. C-61 Tampa
EDWARD W. CULLIPHER, M.D D-59 Miami
HOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1061 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm. B 59 Jacksonville
1EO M. WACHTEL, M.D. AI. 58 Jacksonville
C. FRANK CHUNN, M.D. C-58 Tampa
WILLIAM D. CAWTHON, M.D. A-60 DeFuniak Springs
V. MARKLIN JOHNSON, M.D D 61 W. Palm Beach
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D. AL 58 Pensacola
I LLOYD MASSEY, M.D A-58 Quincy
W. TRACY HAVERFIELD, M.D D-59 Miami
MASON TRUPP, M.D C-60 Tampa
NECROLOGY
I. BASIL HALL, M.D., Chm AL-58
WALTER W. SACKF.TT JR., M.D. D 58
i.EO M. WACHTEL, M.D. B 59
\LVIN L. STEBBINS, M.D A-60
RAYMOND H. CENTER, M.D. ..C-61
NURSING
rHOMAS C. KENASTON, M.D., Chm. B 59 Cocoa
CARL M. HERBERT, M.D. AL-58 Gainesville
HERBERT L. BRYANS, M.D A-58 Pensacola
VORVAI. M. MARR SR., M.D. C-60 St. Petersburg
IAMES R. SORY, M.D D 61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm. B-59 Jacksonville
OHN J. BENTON, M.D AL-58 Panama City
TEORGE S. PALMER, M.D A-58 Tallahassee
EDWARD W. CULLIPHER, M.D D 60 Miami
PRANK H. LINDEMAN JR., M.D. C-61 Tampa
representatives to industrial council
PASCAL G. BATSON JR., M.D., Chm. A-60 Pensacola
WILLIAM J. HUTCHISON, M.D. AL 58 Tallahassee
HAS. L. FARRINGTON, M.D. C-58 St. Petersburg
THOMAS N. RYON, M.D. D 59 Miami
RAYMOND R. KILI.INGER, M.D B-61 lacksonville
Special Assignment
1. Industrial Health
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm. B 60 Gainesville
FRANZ H. STEWART, M.D AL 58 Miami
DONALD F. MARION, M.D D 58 Miami
RICHARD REESER JR„ M.D. C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D. A-61 Pensacola
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm. A-60 Chattahoochee
NELSON H. KRAEFT, M.D AL 58 Tallahassee
WILLIAM L. MUSSER, M.D. B 58 Winter Park
WHITMAN H. McCONNELL, M.D. C-59 St. Petersburg
DONALD W. SMITH, M.D. D 61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm B-61 Jacksonville
HENRY I. LANGSTON, M.D. AL 58 Marianna
JOHN G. CHESNEY, M.D I) 58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D. A 60 Wewahitchka
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
C. W. SHACKELFORD, M.D., Chm. A-61 Panama City
FRANK V. CHAPPELL, M.D. AL 58 Tampa
A B UI ST LITTFRF.R, M.D D 58 Miami
LINUS W. II F. WIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.D B 60 Jacksonville
WOMAN S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm. A-60 Tallahassee
JOHN H. TERRY, M.D. AL-58 Jacksonville
WILEY M. SAMS, M.D. D-58 Miami
G. DEKLE TAYLOR, M.D B-59 Jacksonville
CHARLES McC. GRAY, M.D. C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate- __ Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 - Fort Myers
JOHN S. McEWAN, M.D., 1925 Orlando
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 . Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR„ M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
JOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR„ M.D., 1951 ....Tampa
RORF.RT It. McIVER, M.D., 1952 Jacksonville
FREDERICK K. HERPEL, Ml)., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M l)., Secy., 1956 St. Petersburg
Tavares
Miami
Jacksonville
I’ensacola
Clearwater
County Medical Societies of Florida
446
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Meti-steroid benefits are potentiated in
METRETON
*
TABLETS
with stress supportive
vitamin C
METI-STEROID — ANTIHISTAMINE COMPOUND
NASAL SPRAY
prompt nasal comfort
without jitters or rebound
ESPECIALLY FOR RESISTANT AND YEAR-ROUND ALLERGIES
Because edema is unlikely with the tablets and sympathomimetic
effects are absent with the spray, Metreton Tablets and Nasal Spray
afford enhanced antiallergic protection in vasomotor rhinitis
and all hard-to-treat allergic disorders — even in the presence of
cardiorenal and hepatic insufficiency.
COMPOSITION AND PACKAGING
Each Metreton Tablet contains 2.5 mg. prednisone, 2 mg.
chlorprophenpyridamine maleate and 75 mg.
ascorbic acid. Bottles of 30 and 100.
Each cc. of Metreton Nasal Spray contains 2 mg. (0.2%)
prednisolone acetate and 3 mg. (0.3%) chlorprophenpyridamine
gluconate in a nonirritating isotonic vehicle.
Plastic squeeze bottle of 15 cc.
'cet/w?
T.M. MT.J.1 17
2
new yor* acadcwy or
weo jc ine
2 C 103RD ST
HEW YORK N Y 29 J C~E
when anxiety must be relieved,
‘Compazine’ works rapidly.
A few hours after the initiation of therapy,
most patients notice a lessening of their
anxiety and tension. Improvement
continues, reaching a maximum in from
3 to 5 days. Patients are emotionally
calm, yet mentally alert.
Compazine
Available:
■Spansulet capsules, io mg. and 15 mg.
Tablets, 5 mg. and 10 mg; and, primarily
for use in hospitalized psychiatric patients,
25 mg. tablets.
Ampuls, 10 mg. (2 cc.)
S.K.F.'s outstanding tranquilizer
Smith, Kline & French Laboratories, Philadelphia
★T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
fT.M. Reg. U.S. Pat. Off. for sustained release capsules, S.K.F.
Patent Applied For
Vol. XLIV
NOVEMBER, 1957
FOR PERSISTENT INFECTIONS
CHLOROMYCETIN
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
Acquired resistance seldom imposes restrictions on
antimicrobial therapy when CHLOROMYCETIN (chlor-
amphenicol, Parke-Davis) is selected to combat gram-
negative pathogens involving enteric and adjacent
structures of the urinary tract. The acknowledged effec-
tiveness with which CHLOROMYCETIN suppresses highly
invasive staphylococci1-9 extends to persistently patho-
genic coliforms.6’10'15 Experience with mixed groups of
Proteus species, for example, . . shows chloramphenicol
to be the drug of choice against these bacilli...’.’15
CHLOROMYCETIN is a potent therapeutic agent and, because
certain blood dyscrasias have been associated with its administra-
tion, it should not be used indiscriminately or for minor infections.
Furthermore, as with certain other drugs, adequate blood studies
should be made when the patient requires prolonged or intermit-
tent therapy.
REFERENCES:
(1) Petersdorf, R. G.; Bennett, I. L., Jr., & Rose, M. C. : Bull. Johns Hopkins
Hosp. 100:1, 1957. (2) Yow, E. M.: GP 15:102, 1957. (3) Altemeier, W. A.,
in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957, New
York, Medical Encyclopedia, Inc., 1957, p. 629. (4) Kempe, C. H.: California
Med. 84:242, 1956. (5) Spink, W. W.: Ann. New York Acad. Sc. 65:175,
1956. (6) Rantz, L. A., & Rantz, H. H.: Arch. Int. Med. 97:694, 1956.
(7) Wise, R. I.; Cranny, C., & Spink, W. W.: Am. J. Med. 20:176, 1956.
(8) Smith, R. T.; Platou, E. S., & Good, R. A.: Pediatrics 17:549, 1956.
(9) Royer, A.: Scientific Exhibit, 89th Ann. Conv. Canad. M. A., Quebec City,
Quebec, June 11-15, 1956. (10) Bennett, I. L., Jr.: West Virginia M. J. 53:55,
1957. (11) Altemeier, W. A.: Postgrad. Med. 20:319, 1956. (12) Felix, N. S.:
Pediat. Clin. North America 3:317, 1956. (13) Metzger, W. I., & Jenkins,
C. J., Jr.: Pediatrics 18:929, 1956. ( 14) Woolington, S. S.; Adler, S.J..& Bower,
A. G., in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957,
New York, Medical Encyclopedia, Inc., 1957, p. 365. (15) Waisbren, B. A.,
& Strelitzer, C. L.: Arch. Int. Med. 99:744, 1957.
PARKE, DAVIS & COMPANY - DETROIT 32, MICHIGAN
50168
COMPARATIVE SENSITIVITY OF MIXED PROTEUS SPECIES TO CHLOROMYCETIN
AND SIX OTHER WIDELY USED ANTIBIOTIC AGENTS*
90
80
CHLOROMYCETIN 78%
70
50
ANTIBIOTIC F 5%
‘This graph is adapted from Waisbren and Strelitzer.15 It represents in vitro data obtained with clinical material isolated between the years
1951 and 1956. Inhibitory concentrations, ranging from 3 to 25 meg. per ml., were selected on the basis of usual clinical sensitivity.
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
volume xliv, No. 5 ♦ November. 1957
CONTENT S
Scientific Articles
Complications of Acquired Diseases of the Aorta,
Samuel M. Day, M.D., and John H. Terry, M.D 471
Reconstructive Arterial Surgery, James D. Moody, M.D.,
and James A. McLeod, M.D 480
Blood Vessel Banks, John H. Terry, M.D., and John B. Ross, M.D. 484
Clinical Report of an Unusual Contagious Exanthem,
Ethel H. Trygstad, M.D 489
Encephalitis in Cat Scratch Disease, David R. Gair, M.D., and
William L. Walls, M.D. 491
Abstracts
Drs. C. Frank Chunn, Clarence Bernstein, Solomon D. Klotz, Louis M. Orr,
B. E. Lowenstein, Sidney J. Peck, James M. Davis, Gerard Raap,
Henry T. Bahnson, Arthur R. Nelson, and Alvan G. Foraker 493
Editorials and Commentaries
Psychiatric Analysis 497
Artery Bank Problems 498
Annual Meeting — Scientific Program 499
“Fill Our Hearts With Thankfulness” 500
Physicians’ Role in Social Security Cash Disability Benefit Program 501
Second Medico-Legal Institute, Jacksonville, Nov. 22-23 501
A. M. A. Clinical Meeting, Philadelphia, Dec. 3-6 502
General Features
President’s Page 496
Others Are Saying 502
State News Items 503
Classified 505
Component Society Notes 505
Births, Marriages and Deaths 506
New Members 510
Medical Licenses Granted 510
Obituaries 521
Woman’s Auxiliary 542
Books Received 547
Schedule of Meetings 563
Florida Medical Association Officers and Committees 564
County Medical Societies of Florida 566
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price $5.00 a vear: single numbers, 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411, 735 Riverside Ave., Jacksonville 3, Fla. Telephone EL 6-1571. Accepted for mail-
ing at special rate of postage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16,
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at JacksonviUe,
Florida. October 23, 1924
453
l\ Florida, M. A.
November, 1957
your patients with generalized gastrointestinal
complaints need the comprehensive benefits of
Tridal
(DACTIL® + PIPTAL® — in one tablet)
rapid, prolonged relief throughout the G.I. tract
with unusual freedom from antispasmodic
and anticholinergic side effects
One tablet two or three times a day and one at bedtime. Each TRIDAL tablet
contains 50 mg. of Dactil, the only brand of N-ethyl-3-piperidyl
diphenylacetate hydrochloride, and 5 mg of Piptal. the only brand
of N-ethyl-3-pipendyl-benzilate methobromide
LAKESIDE
14357
454
Volume XLIV
Number 5
• six years of experience with Pentids in mil-
lions of patients confirm clinical effectiveness
and safety
• excellent results with 1 or 2 tablets t.i.d. for
many common bacterial infections
• may be given u'ithout regard to meals
• economical . . . Pentids cost less than other
penicillin salts
Just 1 Or 2 tablets t.i.d. Bottles of 12, 100 and 500
NEW! PENTIDS FOR SYRUP. Orange flavored powder
which, when prepared with water, provides 60 cc. of
syrup with a potency of 200,000 units of penicillin G
potassium per 5 cc. teaspoonful.
Also available: Pentids Capsules, Pentids Soluble Tab-
lets. Pentid-Sulfas.
Squibb Quality— the Priceless Ingredient
Squibb
SQUIBB TBADCMAaK
J. Florida, M. A.
November, 1957
455
(dihydroxy aluminum aminoacetate with belladonna alkaloids and phenobarbital)
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs!
BELLADONNA ALKALOIDS
ALONE
LD 90%*
*15 mg. dose
of spasmolytic
proved lethal
in 90% of
test animals
IS MG. ALKALOIDS
BELLADONNA ALKALOIDS
WITH
ALUMINUM HYDROXIDE
BSE
Al(OH),
w/spasmolytic
substantially
duces spasmolyt
drug effect
BELLADONNA ALKALOIDS WITH
DIHYDROXY ALUMINUM AMINOACETATE
(alolyn®, brayten)
mm
|
B
LO 83%
Malglyn Compound
provides maximal
spasmolytic effect
Alglyn
adsorbed only
7%
IS MG. ALKALOIDS
200 MG. AL (OH),
IS MO. ALKALOIDS
300 MG. ALGLYN
COMPARISON OP ADSORPTIVE PROPERTIES OF AL(OH), AND ALGLYN
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked adsorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
each tablet contains
dihydroxy
aluminum
aminoacetate, o.a omi
N.N.R.
belladonna
alkaloids o.iea mo.
(as sulfates)
phenobarbital lo.a mo.
For both rapid and prolonged antacid effect, with consistently
effective spasmolytic and sedative action, rely upon Malglyn
for treatment of peptic ulcer and epigastric distress.
Also supplied: Alglyn* (dihydroiy alumi-
num aminoacetata, N.N.R. 0.5 Cm par tablet).
BELGLYN* (dlhydroxy aluminum amlnoacatata.
N.N.R., 0.5 Cm. and balladonna alkaloids. 0. 162 fn|.
pat tablet).
Specialities for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA 9, TENNESSEE
456
Volume XLIV
Number 5
If you could
D Q
visit
with a user of the Picker Anatomatic
Century x-ray unit you'd soon know
why this remarkable "new way in x-ray'
machine has come so far so fast.
He'd probably tell you first how incredibly easy it is to use
(just dial the body part and set its thickness...
then press the button). He might sigh with
relief at having no charts to consult, no
calculations to make (the anatomatic
principle does all the tedious "figgerin"
for you).
He'd probably show you how good
a radiograph he gets every time
He might even touch on the peace-of-mind
that comes of having a local Picker
office so near, with a trained Picker
expert always on call for help and counsel
and there 'd be no mistaking
the light in his eye when it
falls on the handsome big-name
unit whose fine appearance
adds so much to the
impressiveness of his office.
P.S. Somewhere along the line the matter of price would
come up ... he'd most likely comment on how little he paid
to get so much. Or he might even be among those who rent
their x-ray machine (Picker has an attractive rental plan,
you know) .
P.P.S. Next best thing is to call your local Picker man in and
let him tell you about this great new machine (find him in your
'phone book) or write Picker X-Ray Corporation, 25 South Broadway,
White Plains, N. Y.
MIAMI 35, FLA., 1363 Coral Way
Jacksonville 7, Fla., 1023 Mary Street
St. Petersburg, Fla., 601 Rutledge Bldg.
Orlando, Fla., 1711 Oakmont Street
W. Palm Beach, Fla., 305 South Flagler Drive
J. Florida, M. A.
November, 1957
457
(Prednisolone ferfrorybvtylocefotc, Merck)
for relief that lasts -longer
in SPRAINS -
Osteoarthritis
Acute gouty arthritis
Bursitis
Tendinitis
Trigger finger
Peritendinitis
Trigger points
Tennis elbow
Lumbosacral strain
Capsulitis
Rheumatoid arthritis
Frozen shoulder
Coccydynia
Rheumatoid nodules
Fibrositis
Tensor fascia lata syndrome
Collateral ligament strains
Sprains
Radiculitis
Osteochondritis
Ganglia
reduces tenderness,
swelling and
limitation of motion
Anti-inflammatory
effect lasts longer
than that provided
by any other
steroid ester
E5B&E&39 (6 dayt— 37.5 mg.)
(8 day>— 20 mg.)
HYDELTRA-T.B.A.
(13.2 days— 20 mg.)
' * •< $«!*•••• • •
I 1 I I # • « I » I 10 H 12 13
Dosage: the usual intra-articular,
intra-bursal or soft tissue dose
ranges from 20 to 30 mg. depend-
ing on location and extent of
pathology.
5-cc. vials.
MERCK SHARP ft DOM MS?
DIVISION OF MERCK • CO.. IRC.
PHILADELPHIA I. PA.
458
Volume XLIV
Number 5
FOR OVER
YEARS
HASKELL'S
has provided Safe, Effective Spasmolysis and Sedation
NOW IN 5 CONVENIENT DOSAGE FORMS
Phenobarbital
Belladonna
Alkaloids
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1
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hyoscyamine,
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2
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Vl gr.
and
scopolamine
Bottles of 100, 500
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3 BELBARB-B
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1 Trisule is equivalent to
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Bottles of 30 and 10
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“Thiamine Hydrochloride — 5 mg., Riboflavin — 2 mg.. Calcium Pantothenate — 2.5 mg., Pyridoxine
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Send for free samples and literature.
CHARLES C. HASKELL & CO., INC., Richmond, Virginia
J. Florida, M. A.
November, 1957
459
1. TRAPPED — This highly mo-
tile, viable sperm becomes non-repro-
ductive the instant it contacts
IMMOLIN Cream-Jel.
2. WEAKENED - Devitalized,
and no longer motile, the sperm
swerves from line of travel and is
pulled aside by spreading matrix.
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“freezes,” weakens and kills
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The unique sperm-trapping matrix formed with explo-
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DEPENDABLE WITHOUT D I APH R AG M— With this
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per 100 woman-years of exposure is reported.* “This
extremely low pregnancy rate indicates that IMMOLIN
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♦Goldstein, L. Z.: Obst. & Gynec. 70:133 (Aug.) 1957.
JULIUS SCHMID, INC.
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IMMOLIN is a registered trade-mark of Julius Schmid, Inc.
4. BURIED — The dead sperm is trapped
deep in the impenetrable IMMOI.IN matrix.
460
Volume XLIV
Number S
for “This Wormy World”
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J. Florida, M. A.
November, 1957
461
FOR THE ENTIRE RANGE OF RHEUMATIC-ARTHRITIC
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462
Volume XLIV
Number 5
in acne
“results were uniformly encouraging ”l
Sudsing,
nonalkaline
antibacterial
detergent —
nonirritating,
hypoallergenic.
The acne skin that is “surgically
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patients. The addition of pHisoHex ®
washings to standard treatment pro-
duced results that far excel any ob-
tained previously.
pHisoHex, a powerful antibacterial
skin cleanser containing hexachloro-
phene, removes oil and virtually all
the bacteria from the skin surface.
For best results prescribe from four
to six pHisoHex washings of the
acne area daily.
1. Hodges, F. T.: GP, 14:86. Nov., 1956.
pHisoHex, trademark reg. U. S. Pat. Off.
LABORATORIES
New York 18, N.Y.
J. Florida, M. A.
November, 1957
463
unique
derivative of
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with a new degree of freedom from side effects
Harmonyl makes rauwolfia more useful in
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Most significant: Harmonyl causes less
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Patients became more lucid and alert, for
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as well as the severe form of hypertension.”
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sense of detached existence or disturbed sleep
are seen with Harmonyl.
Professional literature on this unique rau-
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Harmonyl is supplied in 0.1-mg., /I 0 0 i_l
0.25-mg. and 1-mg. tablets. vAuvtMI
References: 1. Communication to Abbott
Laboratories, 1956. 2. Moyer, J. H. et al:
Deserpidine for the Treatment of Hyperten-
sion. Southern Medical J., 50:499, April,
1957.
_>
• Trademark for Deserpidine, Abbott
464
Volume XI. IV
Number 5
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
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NICOZOL is supplied in cap-
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capsule or V2 teaspoonful
contains:
Pentylenetetrazol . .100 ms.
Nicotinic Acid 50 ms.
1. Levy, s., JAMA., 153:1260, 1953
2. Thompson, L., Procter R..
North Carolina M. J., 15:596. 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
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Coricidin forte provides comprehensive therapy not only
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J. Florida, M. A.
November, 1957
467
Newest Pablum Cereal
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DIVISION OF MEAD JOHNSON & CO.. EVANSVILLE, IND. • Manufacturers of Nutritional and Pharmaceutical Product*
Mom “wears
the pants”
once too
often
frozen
shoulder
Bursitis and tenosynovitis are new terms to home-
makers, but they are not uncommon sequels to over-
exertion. Early antirheumatic therapy is to be
encouraged in the treatment of these conditions, as
it is in more serious rheumatic conditions, to allevi-
ate pain and prevent progression of the disorder.
With adequate therapy the prognosis of bursitis in
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in extension of the inflammation and gross anatom-
ical changes that tend to incapacitate the patient.
Sigmagen provides doubly protective corticoid-sali-
cylate therapy— a combination of Meticorten® (pred-
nisone) and acetylsalicylic acid providing additive
antirheumatic benefits as well as rapid analgesic
effect. These benefits are supported by aluminum
hydroxide to counteract excess gastric acidity and by
ascorbic acid, the vitamin closely linked to adreno-
cortical function, to help meet the increased need for
this vitamin during stress situations.
protective corticoid-salicylate therapy
SIGMAG6N
corticold-analgeslc compound TclblstS
for patients
who go beyond
their physical
capacity
470
Volume XI. IV
Number 5
when infection
strikes the respiratory tract . . .
ILOTYCIN
(Erythromycin, Lilly)
provides singularly effective antibiotic
therapy because
Dosage: The usual adult
dose is 250 mg. every six
hours.
Available in specially
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• Virtually all gram-positive organisms are sensitive
• Allergic reactions following systemic therapy are rare
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• Normal intestinal flora is not appreciably disturbed
. INDIANAPOLIS 6, INDIANA, U.S.A.
732150
ELI LI LLY AND COMPANY
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, November, 1957 No. 5
Complications of Acquired Diseases
Of the Aorta
Samuel M. Day, M.D.
AND
John H. Terry, M.D.
JACKSONVILLE
Many years ago, the great French surgeon,
Rene Leriche,1 wrote that the ideal treatment of
occlusive arterial disease would be to resect the
obliterated zone and bridge the vascular defect
by graft. Various surgeons attempted ligation,2
wiring3 and other methods4 of dealing with
arterial aneurysms without consistent success.
Since no therapy warranting optimism existed,
little attention was paid to these conditions by
the average doctor. Carrel5 pointed the way for
a brighter future with his exceptional experiments
in vascular surgery in 1907, but surgeons were
long in following his lead.
A new era of surgery was opened by Gross5
and Crafoord and Nylin7 in 1945, when they
independently and successfully resected a segment
of the thoracic aorta for coarctation and restored
continuity by end to end suture. The successful
resection of diseased segments of arteries by
Oudot8 in 1951 for aortic occlusion, and by Du-
bost, Allary and Oeconomos9 and Schafer and
Hardin10 in 1952 for aneurysms, offered untold
opportunities in new fields. Mortality and mor-
bidity rates have been reduced to reasonable
limits. Excellent men, De Bakey, Cooley, Huf-
nagel, Shumacker, Creech, Bahnson, Julian, Ed-
wards and others were quick to popularize these
procedures. New evaluations in peripheral vas-
cular disease have resulted.
Formerly, the arterial diseases were treated
through their myoneural components. Sympathet-
ic blocks and ganglionectomies, and vasodilator
drugs and devices were in vogue as the best avail-
able therapy. Beyond those, most surgeons dared
not go. More tangible methods of treatment have
changed our thinking so that emphasis has shifted
from the small to the large arteries since the
From the Departments of Surgery, St. Luke’s Hospital, St.
\ incent’s Hospital and the Duval Medical Center, Jacksonville.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957.
latter are more receptive to successful grafting.
Intelligent use of aortography, which was intro-
duced by Dos Santos11 in 1931, has led to ac-
curate localization of occlusions in major vessels
which were formerly thought to be in peripheral
arterioles and capillaries. Drugs and surgery of
the sympathetic nerves still may have a place
in the therapy of vascular diseases, but they no
longer play the dominant role. Arteriosclerosis
and its complications now share the center of
attention.
The addition of “hope” to our armamentarium
has alerted us to the complications of these vas-
cular diseases, which too recently were thought
to be inevitable sequelae. More of us, however,
need to be conscious of the seriousness of the dis-
eases and their complications so that they can
be recognized and treated early. Cases in which
Buerger’s disease, peripheral “neuritis” or “poly-
neuritis,” or “generalized arteriosclerosis” pre-
viously was diagnosed or other “inclusive” diag-
noses were made, should be re-evaluated. If a
specific point of occlusion exists, it should be
correctly localized and treated definitively before
serious complications develop. Many patients
with suspected back, abdominal or urologic prob-
lems should be given the benefit of further study.
Arteriosclerotic aneurysms most frequently
occur in the terminal portion of the aorta below'
the origin of the renal arteries.12 This site is a
fortunate feature from a surgical point of view.
Our experience is limited in this new field,
but already we have seen some of the tragedies
that result from delay. We hope that bringing
these cases to the attention of others may enable
them to avoid these pitfalls.
The first case, previously reported by us,13
illustrates the fallacy of thinking that surgery
should not be advised because the patient was
able to live with his disease. He did not live
472
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
Volume XLI V
Number 5
long. He might have lived longer had foresight
had the wisdom of hindsight.
Report of Cases
Case 1. — A SS year old white man first complained
of easy fatigability and claudication in both legs in 1942,
at the age of 41 years. Pain in the hip followed. All
symptoms gradually progressed in severity. The diag-
nosis of Buerger’s disease was made by physicians in
more than one reputable clinic. Nonsurgical measures
were prescribed without benefit. Absence of femoral and
pedal pulses was noted years ago. Hypertension had
been present for an unknown period. He survived a
coronary thrombosis and a cerebral vascular accident dur-
ing 1953 without residual physical defects, except cardiac
enlargement. Pallor increased, and swelling of the legs
occurred during the six months prior to his final illness.
A huge toxic goiter was treated with radioactive
iodine by Dr. Samuel W. Root in July 1955, with tem-
porary improvement. The residual thyroid gland enlarged
rapidly in 1956, and a total thyroidectomy was performed
by one of us (S.M.D.) on July 2. Adenomatous changes
were diffuse throughout the entire gland, but no evi-
dence of cancer was found. The patient withstood the
procedure surprisingly well. Thyroid extract, 1 grain
daily, was prescribed, with steady improvement in his
general condition until he was considering returning to
limited work for the first time in years. He denied im-
potence. The hypertension was reduced from 200 sys-
tolic and 90 diastolic to 150 systolic and 80 diastolic.
He had been a heavy smoker until May 1956, when he
stopped smoking. The leg symptoms did not improve,
but they did not seem to progress. Since he could walk
two or three blocks before pain stopped him. it was
agreed that he was able to live with his symptoms and
should be left alone in s<? far as the Leriche syndrome
was concerned. Subsequent events indicated that our
reasoning was in error. He continued to take digitalis
under Dr. Root’s direction.
The patient was seized with a sudden severe epigastric
pain after eating a “cold pork chop” on the night of
August 30, 1956. The pain was intermittent during the in-
itial 24 hours, but was constant thereafter. He was ad-
mitted to St. Luke’s Hospital for Dr. Root approximately
12 hours after the onset, at which time he was in moder-
ately severe shock. The impression was that he was suffer-
ing from coronary thrombosis, but it soon developed that
this was in error. Attention was turned to the abdomen,
which was not tender on admission, but moderate tender-
ness and distention gradually developed. Diagnoses of
acute pancreatitis, dissecting aortic aneurysm, and mesen-
teric thrombosis were entertained when we saw the
patient approximately 26 hours after admission. The
serum amylase rose to 500 mg. per hundred cubic centi-
meters, the leukocyte count to 27,500, and the hemoglobin
estimation to 17.2 Gm. Bowel sounds disappeared.
Abdominal roentgenograms suggested paralytic ileus.
Flank paracentesis revealed dark bloody fluid with a foul
odor in insufficient amount for amylase determination.
The Levin tube drained blood-tinged fluid. Urinary
output was negligible.
The patient was not thought to be a fit candidate
for surgery. Oxygen and norepinephrine were continued,
and a blood transfusion was started. His condition stead-
ily deteriorated, and he died a few hours later, approxi-
mately 34 hours after admission.
At autopsy, the thymus was enlarged. The heart
showed diffuse moderate hypertrophy, most prominent in
the left ventricle.
The abdomen was moderately distended. The ab-
dominal cavity contained 100 cc. of brown hemorrhagic
fluid. The stomach and small intestine contained thin
hemorrhagic fluid. There was hemorrhagic infarction of
the entire jejunum and ileum, with inflammatory changes
in the serosa of the right colon.
The aorta showed severe irregular diffuse arterio-
sclerosis. There were three shallow pouchlike aneurysmal
protrusions of the thoracic aorta measuring up to 3.5
cm. in greatest diameter and 1.3 cm. in depth. That of
the aortic arch was fusiform, of the descending aorta,
saccular, and of the lower portion of the thoracic aorta,
fusiform. The walls were thin and fibrous.
The distal abdominal aorta was dilated, measuring 6
cm. in length and 3 cm. in greatest diameter. The lumen
of this portion of the aorta was completely replaced by
dense, yellowish fibrous tissue. A fresh thrombus oc-
cupied the aortic lumen superior to this fibrous area prop-
agating upward within the lumen to overlay and ob-
struct the superior mesenteric and the left renal arteries I
(fig. 1). This fresh thrombus obviously caused the in-
farction of the small intestine. Both iliac arteries were I
occluded proximally by the dense fibrous process of the I
lower segment of the aorta secondary to slow thrombosis I
over many years. Small lumens were present more dis-
tally in the external iliac arteries.
This case represents a typical pathologic pic- I
ture of the Leriche syndrome,14 or gradual oc-
elusive disease of the aortic bifurcation due to I
arteriosclerosis. The condition usually originates I
in adult males in the fourth and fifth decades of I
life. It is characterized by symptoms of (1) easy I
fatigability of the legs, (2) pain in the lower part I
of the back and in the hips, (3) intermittent
claudication on walking, and (4) inability to main- I
tain an erection, and later there is total impotence I
in approximately 30 per cent of the cases.15 Phy- 1
sical signs include (1) minimal color and trophic
changes in both lower extremities, (2) global
atrophy of both lower extremities, (3) absence of
pulsations in the large and small arteries of the
lower extremities, (4) the presence of a midab-
dominal bruit, and (5) hypertension.
Fig. 1. Case 1. — Descending and abdominal aort
(opened) demonstrating two of the aneurysms of th
thoracic aorta; the dilated lower abdominal aorta cor
tains fresh thrombus above the fibrotic occluded bifut
cation. The probe lies in the left renal artery.
J. Florida, M. A.
November, 1957
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
473
There was present in this case a complication
of the disease about which we have been warned
since Leriche’s original description, namely, that
of ascending thrombosis of the aorta above the
older occluded area. The renal arteries are oc-
cluded more frequently than the superior mesen-
teric arteries, although in this case the kidney did
not reveal the severe infarction seen in the intes-
tine. It is possible that the fresh propagating
thrombus occluded the left renal artery later than
the superior mesenteric artery. It is noteworthy
that the right colon was not infarcted, particular-
ly since the inferior mesenteric artery was long
since occluded by the old occlusion process.
This case is unusual in that it represents the
two major types of aortic disease, aneurysmal
and occlusive, and death ensued as a result of a
complication of the latter. Not only were the two
types of disease present, but the two types of
aneurysm, saccular and fusiform, were demon-
strated, and the thoracic aorta contained two of
the latter. Fortunately, such extensive disease is
not seen too often in a single patient. In 1948,
Leriche and Morel14 stated: “Aortic thrombosis,
although apparently very well-borne for years (5
and even 10) always ends in gangrene.” Although
mesenteric thrombosis was not specifically men-
tioned by them, this case illustrates the accuracy
of their prediction.
The second case illustrates one of the dangers
inherent in aneurysms, particularly if their treat-
ment is delayed, as in this instance by refusal of
the patient to submit to operation. De Bakey,
Cooley and Creech16 stated that the average sur-
vival time of patients with aneurysms is from one
to two years, with rupture being the most common
cause of death. The studies of Estes,17 Kamp-
meier18 and Nixon19 were considered in making
this prediction. Certainly, a look at the sac of a
few of these aneurysms will make one respect
their tendency to burst.
Case 2. — A 64 year old white man was first seen by
one of us (S.M.D.) in January 1954 because of a severe
abdominal pain associated with partial intestinal obstruc-
tion, probably due to further expansion of an aneurysm.
There was a history of gradual loss in weight, chronic
cough, irregular heart beat, dyspnea and recurrent con-
stipation. Physical examination revealed pronounced club-
bing of the fingers, bilateral basilar rales, hypertension,
and a large pulsating mass occupying the pelvis and lower
part of the abdomen. The symptoms subsided with con-
servative therapy in St. Vincent’s Hospital. An abdominal
aortogram confirmed the diagnosis of abdominal aortic
aneurysm. The usual pulses were palpable in the lower
extremities. Other studies confirmed the diagnosis of
severe pulmonary emphysema and cardiac hypertrophy
with pulsus alternans. In spite of his poor condition the
patient was advised to be treated for the cardiac and
Fig. 2. Case 2. — Opened aneurysmal sac after re-
moval.
pulmonary disease and to consider surgical treatment of
the aneurysm. He refused all recommendations, but he
did report for periodic examinations because of insurance
requirements.
He was able to retire to his brother’s farm and main-
tain a small garden, enough work to lose his insurance
payments after a year. He had several less severe epi-
sodes of abdominal pain, which were probably due to
further sudden expansion of the aneurysm. These be-
came more frequent in the fall of 1956. When last seen
in the office on October 9, he was urged to consider sur-
gical treatment of his huge aneurysm. In an attempt
to prepare him further, we succeeded in getting him to
consult an internist, Dr. David R. Moomaw, who pre-
scribed potassium iodide and succeeded in stopping his
smoking for three weeks. It is noteworthy that his vital
capacity increased from 1 liter to 2.5 liters on this regi-
men.
On the morning of November 10, the patient experi-
enced a severe agonizing pain in the suprapubic area
while attempting to lift a television set. He became
weak, had a desire to defecate, and lost consciousness
while sitting on the toilet. He was admitted to St. Luke’s
Hospital by ambulance in moderately severe shock.
Blood was ordered immediately by telephone because of
our familiarity with the case and its impending catas-
trophe. During a five hour period of observation he
failed to respond adequately to transfusion therapy.
Furthermore, an enlarging tender mass in the right flank
indicated the site of retroperitoneal hemorrhage. He
continued to complain of severe pain in the suprapubic
region and in the right leg. The urine output measured
25 cc.
After careful consideration of the immediate problem,
surgery was advised as the only hope of survival. The
family and patient were informed of the problem and of
the high expectant mortality. They consented in view
of the hopeless outlook otherwise.
Exploration was carried out through a long midline
incision. The aneurysm was firmly wedged into the
pelvis and lower part of the abdomen, and was of tre-
mendous size with rupture of the right posterior wall and
severe retroperitoneal hemorrhage. The aneurysm origi-
nated just below the renal arteries and extended in a bag-
like manner into the pelvis, terminating abruptly at the
bifurcation. There were secondary dilatations of both
common iliac arteries. The entire aneurysm was removed
(fig. 2) except for a small section of the right posterior
lateral wall which was densely adherent to the vena cava
(fig. 3) and was not disturbed. The aneurysm measured
30 cm. in its greatest circumference and contained large
amounts of old and fresh clotted blood (fig. 4).
Since only two thoracic aortic homografts and no
plastic bifurcation prostheses were available, it was neces-
sary that we construct a bifurcation from the two homo-
grafts. This was satisfactorily inserted, and linear flow
was established after two hours and forty minutes of
occlusion. During this time the iliac clamps were released
at intervals to back flush the vessels. The vena cava was
474
DAY AND TERRY: ACQUIRED DISEASES OE THE AORTA
Volume XLIV
Number 5
Fig. 3. Case 2. — Segment of aneurysm left attached
to interior vena cava.
slightly injured at two points near its bifurcation. It was
repaired with arterial silk. A segment of ileum was so
densely adherent to the wall of the aneurysm that it was
necessary to resect that segment with the sac and perform
an end to end ileoileostomy.
The patient did surprisingly well during surgery al-
though the urinary output was nil. He was awake and
talking for approximately four hours after surgery; then
he slowly lost consciousness. Neo-Synephrine and blood
were administered with little rise in pressure. We did
not think reoperation indicated or justified. The patient
remained anuric and died 11 hours following the comple-
tion of surgery.
The autopsy revealed a moderate amount of old and
fresh blood in the retroperitoneal space. There was a
small tear in the wall of the inferior vena cava adjacent
to the area repaired at operation, which could have
been caused by the postmortem dissection. The graft
was patent and did not leak when water was inserted
under pressure of 30 pounds (fig. 5). There was severe
parenchymatous degeneration of the kidneys, and arterial
and arteriolar nephrosclerosis. An old anterior myocar-
dial infarct, myocardial hypertrophy, and bilateral severe
pulmonary emphysema also were present.
There was generalized arteriosclerosis which, interest-
ingly enough, had given rise to two additional complica-
tions. One of these was a saccular aneurysm of the
proximal aortic arch with a dissecting aneurysm extend-
ing into the innominate artery (fig. 6). The other com-
plication was an old thrombosis with complete occlusion
of the left subclavian artery at its origin from the aortic
arch (fig. 6). This explained the absent pulse and blood
pressure in the left arm.
Apparently, the thrombosis of the left sub-
clavian artery at the aorta in this case represents
an example of an incomplete “Martorell’s syn-
drome,” which was redescribed by Martorell and
Fabre20 in 1944. Successful treatment of such a
case by curettement and suction was reported by
Fig. 4. Case 2. — Contents of aneurysm, illustrating
clots in various stages of organization.
Fig. 5. Case 2. — Bifurcation graft constructed from
two thoracic homografts showing no leakage at four
sites of anastomosis even when under 30 pounds of
water pressure.
Davis, Grove and Julian21 in 1956. Successful
treatment of ruptured aneurysms has been re-
ported by Cooley and De Bakey22 and Farrar and
his associates.23 Certainly, our patient with all
these troubles did not truly represent his home
address, which was, ironically, “Lucky Drive.”
Patients in other cases in our presentation could
more appropriately have claimed that address.
Still another unusual problem encountered in
our practice was that of unilateral nephrectomy
having been performed in three patients who pre-
sented themselves for abdominal aortic surgery,
one with the Leriche syndrome and two with
aneurysms. Ordinarily, cardiac disease and renal
disease constitute the chief contraindications to
surgery.24 It is not unusual for many of the pa-
tients to present these difficulties, as in cases 1
and 2, because of the nature of the disease and
the age of some of the patients. Such extensive
surgery in patients with only one kidney presents
a problem that may be particularly acute if the
remaining kidney is diseased.
Case 3. — The first of these patients was a 42 year old
white woman with occlusion of the aortic bifurcation.
At the time of hospitalization in December 1956, she had
the classical complaints of pain in the back and hips and
claudication in the legs for three years, of such severity
that she could hardly walk across a room. There was
a history of recurrent kidney infection and stones since
the age of 16 years. Calycectomy on the right side had
been performed at Orlando in 1950 because of “pyelone-
phritis.” She had been admitted to St. Vincent’s Hospital
in Jacksonville eight times since July 1953, the last admis-
sions being as a service patient. Five of these admissions
were for urologic treatments, the first and major one of
which was left nephrectomy in July 1953 for pyone-
phrosis and nephrolithiasis. Subsequent treatment usually
included cystoscopy and dilatation of a stricture at the
right ureteropelvic junction.
In September 1956, she emphasized the weakness of
her legs, the easy fatigability and claudication so much
that surgical consultation was obtained. An alert resi-
dent, Dr. James Bond, discovered the absence of femoral
and pedal pulsations and performed an aortogram, which
J. Florida, M. A.
November, 1957
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
475
demonstrated blockage of the distal aorta and proximal
common iliac arteries with prominent collateral circula-
tion. The blood urea nitrogen level was elevated to 36
mg. per hundred cubic centimeters, and there was much
albumin and pus in the urine. She was treated con-
servatively and observed for three months with slight im-
provement of renal function, but with increasing severity
of the vascular symptoms.
Conferences with internists, urologists and surgeons
resulted in a decision to advise surgery. It was believed
that the renal disease was of long duration and relatively
static, but that the aortic occlusion was progressing so
much that the patient desired and needed relief. A con-
centrated effort was made to improve kidney function
with a degree of success. The preoperative blood urea
nitrogen level was 17 mg. per hundred cubic centimeters.
The right ureter was catheterized preoperatively by the
urology resident, Dr. William Hutchinson. On December
20, an aortic bifurcation homograft was used to bypass
the occluded segment (fig. 7), extending from the aorta
proximal to the complete blockage to each common iliac
artery distal to it. There was severe atherosclerosis of
the vessels so that more endarterectomy was performed
on each than is desirable. This amounted to several
centimeters in the right common and external iliac ar-
teries, in which the condition was the most severe.
The bypass procedure was decided upon in order to
reduce the operating time for such a poor risk patient.
The circulation in the right leg was not as good as desired,
and an additional ileofemoral bypass would have been
inserted had the patient been in better condition. Fem-
oral pulses were palpable bilaterally, but the pedal
pulses were not palpable on the right. The preoperative
blood pressure was 90 systolic and 60 diastolic, unusually
low for this disease, and most likely accounted in part
for the weak peripheral pulsations postoperatively.
The postoperative course was surprisingly uneventful.
The catheter was left in for several days, and adequate
urinary output and hydration were maintained with in-
Fig. 6. Case 2. — Saccular aneurysm of proximal
aortic arch with dissecting aneurysm of innominate ar-
tery (at tip of left index finger). Thrombosis of the
left subclavian artery is visible just opposite the right
index finger.
travenous fluids. The right leg now has the better cir-
culation with better femoral and pedal pulsations than
the left leg. The patient can walk two or three blocks
before noting claudication in the left leg. Her condition
is gradually improving, and she is quite happy.
Cooley23 has performed bypasses of bifurca-
tion occlusions with satisfactory results and with-
out additional pain, vasospasm and thrombosis,
Fig. 7. Case 3. — Aortic bifurcation homograft bypass in situ.
476
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
Volume XLIV
Number 5
Fig. 8. Case 4. — Excised aneurysm with contents.
which were formerly thought to be important rea-
sons for excising the involved segments. Appar-
ently, a major shunt in such a large vessel serves
as a deterrent to further stagnation and throm-
bosis. Interestingly enough, the patient in this
case brought her brother in a few days ago for
examination because of symptoms somewhat simi-
lar but milder than hers. Fortunately, he has two
kidneys.
Case 4. — A 58 year old white man had complained of
epigastric pain almost constantly since its onset following
use of a pneumatic drill while at work at the Naval Air
Station in 1954. The pain was aggravated by exercise
and was associated with exertional dyspnea without
orthopnea or other evidence of cardiac decompensation.
An aneurysm was discovered by Dr. James Sinnett, a
resident at St. Vincent’s Hospital, when he was on duty
at the Naval Air Station in 1954. Cholecystectomy was
performed for cholelithiasis by others at St. Vincent’s
Hospital in 1954, at which time the aneurysm was noted,
but no therapy was undertaken. The pain had become
steadily worse in recent months, with severe exacerba-
tions occurring at times. Nephrectomy on the left side
had been performed in 1951 by the Mclver Clinic for
massive nephrolithiasis. Recent renal studies by Dr. Rob-
ert J. Brown revealed satisfactory function of the re-
maining right kidney. The urine showed good concen-
tration, 4 plus albumin, and 3 to 4 red blood cells, 0 to
2 white blood cells and several coarse granular casts,
when first examined in our office. The hematocrit read-
ing was 53 per cent, the hemoglobin estimation 11 Gm.,
and the blood urea nitrogen level 11 mg. per hundred
cubic centimeters.
The patient was studied thoroughly by an internist,
Dr. Lawrence E. Geeslin, who collaborated with the
urologists, Dr. Brown and Dr. William A. Van Nortwick,
and us to decide that in view of persistent pain and
progressive enlargement of the aneurysm, as demon-
strated on roentgenograms of the abdomen and by pal-
pation of the 10 by 8 cm. pulsatile mass, surgical therapy
was advisable. One week of preoperative preparation was
recommended to allow preparation for surgery, with par-
ticular emphasis on the kidney. The albumin disappeared
from the urine. Opiates were necessary to control back
and epigastric pain. The blood pressure in the upper
extremities varied from 150 systolic and 90 diastolic to
170 systolic and 120 diastolic. The pulsations were de-
creased in both lower extremities, with absent dorsal
pedal pulses on the left and posterior tibial pulses on
the right.
At exploration on Jan. 22, 1957, a large arteriosclerot-
ic aneurysm of the abdominal aorta was found (fig. 8).
Fig. 9. Case 5. — Small aneurysm in situ before
complete excision.
It originated sharply from just below the origin of the
right renal artery and terminated abruptly just above
the aortic bifurcation. There was erosion of vertebral
bodies posterior to the aneurysm. Both common iliac ar-
teries were diffusely dilated down to and including the
external iliac arteries. The left kidney was absent; the
right kidney was of normal size and consistency.
The aneurysm was resected with difficulty because of
adhesions to the vena cava and the right renal artery.
One small branch to the right kidney was sacrificed, as
was the inferior mesenteric artery, the usual procedure.
An Edwards-Tapp nylon prosthesis20 was inserted from
2 cm. below the renal artery to 1 cm. proximal to the
bifurcation. The peripheral arteries showed advanced
atherosclerosis, but the lumen was patent. The blood
flow into the lower extremities was fairly good. The
postoperative course was uneventful. Adequate hydra-
tion and urinary output were maintained by intravenous
fluids and electrolytes for five or six days. The peripheral
pulsations remained as good or better than before the
operation. The maximum blood urea nitrogen level was
46 mg. during the postoperative period.
The patient was permitted to return to “light work”
on March 7. After one month, it was learned that there
was no light work associated with his job at the Naval
Air Station ; so he had performed full work without
difficulty other than occasional aches and pains. He is
relieved of his severe pain and takes no more narcotics.
Fig. 10. Case 5. — Interior of excised aneurysm illus-
trating ulcerations with softening and thinning of wall.
J. Florida, M. A.
November, 1957
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
477
Fig. 11. Case 5. — Edwards-Tapp nylon prosthesis
anastomosed to lower abdominal aorta.
This case represents the rehabilitation of a
completely disabled patient who suffered from
progressive disease which likely would have caused
his death, but who might easily have been re-
fused surgery on the basis of disease of the re-
maining kidney.
Case S. — A 60 year old white woman was first seen
by us on April 19, 19S7, with a medium-sized abdominal
aneurysm known to have been present for two years. Re-
cently, she had experienced episodes of abdominal pain
to the left of the umbilicus, and this region was more
tender to palpation.
There was also a history of long-standing genitouri-
nary disease. In 1928, a urethral furuncle was removed.
Since then she had required periodic urethral dilatations.
In October 1942, she was under the care of Dr. Robert
B. Mclver because of low back pain and frequency of
urination of two years’ duration. Calculous pyonephrosis
of the right kidney necessitated a right nephrectomy. Since
this procedure, the patient has had no further serious
urinary difficulties, but she has required urethral dilata-
tions. She has had moderate hypertension for several
years, which has responded satisfactorily to hypotensive
agents prescribed by Dr. Simon D. Doff.
Physical examination revealed a well developed and
well nourished woman appearing younger than her
stated age of 60. A tender, lemon-sized pulsating mass
was present in the periumbilical region, slightly to the
left of the midline. Peripheral pulses were satisfactory.
Soft tissue roentgenograms of the abdomen clearly out-
lined an aneurysm in this location. Repeated urinalyses
showed concentration to 1 .01 5 and no albuminuria or
pyuria.
Surgery was performed on April 21. The urethra re-
quired dilatation before insertion of an indwelling catheter
on the operating table. The patient had been prepared
with urinary antibiotics and a high fluid intake, so that
the preoperative blood urea nitrogen level was 15 mg. per
hundred cubic centimeters. The section and the excision
of this aneurysm were not particularly difficult be-
cause of its relatively small size (fig. 9). It contained
several areas of softening and thinning of the wall (fig.
10). It ended abruptly just above the bifurcation and
required only a linear Edwards-Tapp nylon graft for
replacement (fig. 11). The occlusion time was one hour
and 35 minutes. The postoperative course was unevent-
ful. The blood urea nitrogen level rose to a height of 33
mg. per hundred cubic centimeters during this period.
It has long been known that aneurysms act
as a persistent hammer when adjacent to bone,
frequently eroding through it and causing a con-
siderable degree of pain as in case 4. Another
case is briefly presented to illustrate dramatically
this characteristic (fig. 12). The patient was not
ours; she was presented at a conference at the
Duval Medical Center where she was a patient.
Case 6. — A 65 year old Negro woman had a history
of syphilis and a mass on the anterior wall of the chest
for two years. Because “it bled a little for two days,”
she presented herself with this large aneurysm protrud-
ing through the anterior wall of the chest. It had the
appearance of a “mid-breast” (fig. 12). It had eroded
completely through the sternum. There had been necrosis
of the skin over the most distal part of it with clotting,
the dislodgement of which might cause “considerable
excitement.” Surgery was performed on this patient at
the Duval Medical Center by the surgeon on service.
Unfortunately, hemorrhage ensued, and she expired on
the operating table.
Aneurysms of this type are comparatively
rare, are usually of syphilitic origin, and as a rule
do not require transection of the aorta or graft-
ing. Since they are saccular in type, the sac can
be excised and aortorrhaphv performed. As would
be expected, the dissection is treacherous.
Discussion
Acquired arterial diseases present a problem
as old as medicine itself. Their complications em-
phasize the seriousness of the “do-nothing” treat-
ment. It is not surprising that medicine and sur-
gery have progressed so rapidly in the past few
years in treating such diseases, but it is appalling
that we men of science have come so slowly in
dealing with this particular field. According to
Shumacker,27-28 as long ago as 1761 Lambert of
Fig. 12. Case 6. — Saccular aneurysm of ascending
aorta with erosion through sternum and anterior chest
wall, revealing fresh clots on surface secondary to re-
cent "little bleeding.”
478
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
Volume XLIV
Number 5
England reflected in a letter to Hunter the hope
“that a suture of the wound in an artery might
be successful.” At his suggestion Hallowed ac-
complished closure of a small rent in an artery
by twisting a thread about a pin placed through
the lips of the wound. Approximately 200 years
passed before we were able to fulfil his hopes
with reasonable safety.
It is to be hoped that we can reduce the inci-
dence of acquired arterial diseases and their com-
plications by preventive medicine, but first we
must determine the basic causes for their exist-
ence. In the meantime, let us become more con-
scious of the existence of these diseases so that
we may recognize them and treat them before
disabling and fatal consequences develop.
Too often we surgeons are more afraid of our
statistics than of our patients’ disease. Sometimes
we may be afraid of the procedure itself, and on
occasion rightly so. We have refused surgical
aid to patients with the excuse that the vessels
were too poor to withstand surgical anastomosis.
De Bakey and others have succeeded in explod-
ing this fallacy, having turned down no cases in
recent years for this reason. Certainly severe
cardiac, renal and other diseases sometimes forbid
surgical procedures of any kind, but let us not
withhold treatment without thorough study and
evaluation. Many of the patients with these dis-
eases not only can tolerate the surgery, but can
benefit enough from it to lead useful and happy
lives. The expectant benefits must be weighed
carefully against the involved risks, and the pa-
tient must be informed of the results. Each pa-
tient should be permitted to make a decision
knowing all angles.
The fatal outcome in cases 1 and 2 of this
series suggests more respect for the dangerous
complications of the disease and more thorough
consideration of the situation from all angles be-
fore withholding surgical aid. Despite hyperten-
sion, coronary disease and a cerebral accident,
the patient in case 1 withstood total thyroidecto-
my without difficulty two months prior to death.
On the basis of life expectancy of less than two
years after diagnosis of an aneurysm, some experts
might have recommended initial surgical attack
on the three aneurysms present in this case. In
case 2, the patient was likewise an extremely poor
operative risk having multiple complications of
arteriosclerosis. Nevertheless, had he consented
to the removal of the aneurysm when it was first
diagnosed and surgery had been undertaken then
instead of as a last resort after its rupture, the
fatal outcome might have been averted.
Cases 3, 4 and 5, in which the patients had
previously been subjected to nephrectomy because
of nephrolithiasis and associated infection, sug-
gest that nephrectomy need not be a contraindica-
tion to definitive surgery of arterial occlusions and
aneurysms in selected cases, even when the re-
maining kidney may show disease. The careful
preparation of such patients for surgery usually
calls for teamwork between the urologist, the
internist and the surgeon.
Erosion of bone by an aneurysm is illustrated
by cases 4 and 6. In case 4, the patient with one
kidney suffered severe pain in the back due to
erosion of vertebral bodies. A large aneurysm, in
case 6, protruded through the sternum with
necrosis and crusting of the distal skin. This type
of aneurysm usually can be treated by excision
and primary suture.
Patients with persistent problems relative to
abdominal, pelvic, back or leg pain, fatigue, or
weakness should be given the benefit of thorough
investigation from a vascular standpoint. If pe-
ripheral pulsations are unequal or missing, further
studies for localization of the disease should be
insisted upon. Roentgenograms will usually reveal
aneurysms, but aortography will be necessary to
reveal thrombosed areas. Definitive surgery
should be advised early if such a localized process
is demonstrated.
Few drugs are of value in the treatment of
such cases. Sympathetic surgery would simply
delay more beneficial treatment in most cases.
If an appreciable vasospastic element is present
in patients with complications of arteriosclerosis,
sympathectomy can be performed at the time of
aortic surgery.
Synthetic prostheses offer great promise as
substitute grafts for the large arteries, but they
do not yet completely replace arterial homografts.
Both should be available when such surgery is
electively undertaken.
Legal complications and family misgivings
must be overcome if we are to maintain an ade-
quate supply of homografts. This calls for doctor
cooperation. Physicians who lose patients under
45 years of age from accident or disease can do
a great service by obtaining an autopsy with
permission for use of the large arteries. It can
be considered a fitting memorial to a lost loved
one to permit the use of the large arteries to be
a life-saving measure for another.
J. Florida, M. A.
November, 1957
DAY AND TERRY: ACQUIRED DISEASES OF THE AORTA
479
Summary
A series of cases is presented which illustrates
advanced arterial diseases and their complications.
In two cases there were multiple complications,
with both thrombotic and aneurysmal compo-
nents. One terminated fatally from mesenteric
thrombosis due to ascending fresh thrombus above
a bifurcation occlusion and the other from rupture
of a huge aneurysm of the abdominal aorta.
Three cases illustrate successful aortic graft-
ing in patients with only one kidney. In two of
these cases there was evidence of disease in the
remaining kidney. Careful preparation for sur-
gery in such cases is stressed.
Two cases present a common characteristic
of aneurysms, bony erosion. One illustrates the
relatively rare picture of erosion of the aneurysm
through the anterior wall of the chest with pres-
entation on the chest.
A plea is made that physicians become more
“vascular conscious” so that these diseases will be
diagnosed and treated before serious complications
develop.
References
1. Leriche, R.: Des obliterations arterielles hautes (oblitera-
tion de la terminaison de l’aorta) comme cause des in-
suffisances circulatoires des membres inferieurs, Bull, et
mem. Soc. Chir. 49:1404, 1923.
2. Matas, R. : Aneurysm of Abdominal Aorta at Its Bifurca-
tion Into Common Iliac Arteries; Pictorial Supplement il-
lustrating History of Corrine D., Previously Reported as
First Recorded Instance of Cure of Aneurysm of Abdom-
inal Aorta by Ligation, Ann. Surg. 112:909-922 (Nov.)
1940.
3. Finney, J. M. T. : Wiring of Otherwise Inoperable An-
eurysms, With Report of Cases, Tr. South. S. A. 24:246-
279, 1912.
4. Blakemore, A. H.: Progressive Constrictive Occlusion of
Abdominal Aorta With Wiring and Electrothermic Coagu-
lation; One-Stage Operation for Arteriosclerotic Aneurysms
of Abdominal Aorta, Ann. Surg. 133:447-462 (April) 1951.
5. Carrel, A.: On Experimental Surgery of Thoracic Aorta,
Ann. Surg. 52:83, 1910.
6. Gross, R. E. : Surgical Treatment for Coarctation of Aorta,
Surgery 18:673-678 (Dec.) 1945.
7. Crafoord, C., and Nylin, G. : Congenital Coarctation of
Aorta and Its Surgical Treatment, J. Thoracic Surg. 14:347-
361 (Oct.) 1945.
8. Oudot, J. : La greffe vasculaire dans thromboses du carre-
four aortique, Presse med. 59:234-236 (Feb. 21) 1951.
9. Dubost, C.; Allary, M., and Oeconomos, N.: Resection of
Aneurysm of Abdominal Aorta; Reestablishment of Con-
tinuity by Preserved Human Arterial Graft, With Results
After 5 Months, A. M. A. Arch. Surg. 64:405-408
(March) 1952.
10. Schafer, P. W., and Hardin, C. A.: Use of Temporary
Polythene Shunts to Permit Occlusion, Resection and
Frozen Homologous Graft Replacement of Vital Vessel
Segments; Laboratory and Clinical Study, Surgery 31:186-
199 (Feb.) 1952.
11. Dos Santos, R., Lamas and Caldas: Arteriographic des
membres et de l’aorte abdominale, Paris, Masson & Cie,
editeurs, 1931.
12. Bahnson, H. T. : Treatment of Abdominal Aortic Aneurysm
by Excision and Replacement by Homograft, Circulation
9:494-503 (April) 1954.
13. Day, S. M., and Terry, J. H. : Mesenteric Thrombosis
Complicating Occlusive Disease of Abdominal Aorta, Am.
Surgeon. To be published.
14. Leriche, R., and Morel, A.: Syndrome of Thrombotic Ob-
literation of Aortic Bifurcation, Ann. Surg. 127:193-206
(Feb.) 1948.
15. De Bakey, M. E., and Cooley, D. A.; Surgical Consider-
ations of Acquired Diseases of Aorta, Ann. Surg. 139:763-
777 (June) 1954.
16. De Bakey, M. E. ; Cooley, D. A., and Creech, O. Jr.:
Surgery of Aorta, Ciba Clin. Sympos. 8:45-75 (Mar. -Apr.)
1956.
17. Estes, J. E.: Abdominal Aortic Aneurysm: Study of 102
Cases, Circulation 2:258-264 (Aug.) 1950.
18. Kampmeier, R. H.: Saccular Aneurysm of Thoracic Aorta;
Clinical Study of 633 Cases, Ann. Int. Med. 12:624-651
(Nov.) 1938.
19. Nixon, J. A.: Abdominal Aneurysm in Girl Aged 20 Due
to Congenital Syphilis, With Tables of Collected Cases of
Abdominal Aneurysms, St. Barth. Hosp. Rep. 47:43-66,
1911.
20. Martorell-Otzet, F., and Fabre Tersol, J.: El Sfndrome
de Obliteration de los Troncos Superaaorticos, Med. Clin.
2:26-30 (Jan.) 1944.
21. Davis, J. B.; Grove, W. J., and Julian, O. C.: Thrombic
Occlusion of Branches of Aortic Arch, Martorell’s Syn-
drome: Report of Case Treated Surgically, Ann. Surg.
144:124-126 (July) 1956.
22. Cooley, D. A., and De Bakey, M. E. : Ruptured Aneurysms
of Abdominal Aorta; Excision and Homograft Replace-
ment, Postgrad. Med. 16:334-342 (Oct.) 1954.
23. Farrar, T., and others: Surgical Treatment of Acute
Rupture of Abdominal Aortic Aneurysms; Report of Two
Cases, Proc. Mavo Clin. 31:299-304 (May 16) 1956.
24. De Bakey, M. E.; Cooley, D. A., and Creech, O. Jr.:
Treatment of Aneurysms and Occlusive Diseases of Aorta
by Resection; Analysis of Eighty-Seven Cases, J A. M. A.
157:203-208 (Jan. 15) 1955.
25. Personal communication from Dr. Denton A. Cooley,
Assistant Professor of Surgery, Baylor University College
of Medicine. Houston, Texas.
26. Edwards, W. S., and Tapp, J. S.: Peripheral Artery
Replacement with Chemically Treated Nylon Tubes, Surg.,
Gynec. & Obst. 102:443-449 (April) 1956.
27. Shumacker, H. B. Jr.: Problem of Maintaining Continuity
of Artery in Surgery of Aneurysms and Arteriovenous
Fistiilae; Notes on Development and Clinical Application
of Methods of Arterial Suture, Ann. Surg. 127:207-230
(Feb.) 1948.
28. Shumacker, H. B. Jr.: Coarctation and Aneurysm of
Aorta; Report of Case Treated by Excision and End-to-End
Suture of Aorta, Ann. Surg. 127:655-665 (April) 1948.
415 Medical Arts Building.
Erratum
On page 252 of the September issue of The Journal of the Florida Medical Association, the state-
ment is made to the effect that the virus diagnostic laboratory of the University of Miami School of
Medicine Department of Bacteriology and the Variety Children’s Hospital is the only comprehensive
facility for service and research in the virus diseases in Florida.
The University of Miami School of Medicine has advised The Journal that Dr. Albert V. Hardy,
Director of the Bureau of Laboratories, Florida State Board of Health, has called attention that the
Florida State Board of Health at Jacksonville also has a virus diagnostic and research laboratory.
The laboratory is supported by research grants from various federal agencies and some state funds.
480
Volume XL1V
Number 5
Reconstructive Arterial Surgery
James D. Moody, M.D.
AND
James A. McLeod, M.D.
ORLANDO
The entire field of vascular surgery has mush-
roomed during the past 15 years. Reconstruc-
tive arterial surgery, although perhaps one of the
older and more established facets of vascular
surgery, has shared in this tremendous develop-
ment. In large measure, the basic principles of
arterial surgery were meticulously formulated
during the early portion of the twentieth century,
but it was not until late in the forties and early
fifties that the lessons learned by the surgical
pioneers in this field could be put into everyday
use. The vast amount of experimental work in the
field of arterial transplants and preservation of
homografts has completely revitalized arterial
surgery. The most important and far reaching
result of this work is the fact that this surgery
can now be performed, and should be performed,
in any major hospital in the United States. It
therefore behooves every individual physician to
understand thoroughly and recognize the various
arterial lesions amenable to surgery, the essential
diagnostic steps and the anticipated results. This
is a rapidly changing field, and unless he keeps
abreast of these changes, his patients will not re-
ceive the best of treatment.
Some of the more common situations needing
to be discussed will be illustrated in the cases to
follow. In general, they are the result of trauma,
degenerative diseases, or mechanical obstructions.
As mentioned, corrective surgery of all these le-
sions has been tremendously dependent upon the
development of arterial substitutes and methods
in the preservation of homografts. During the
past five years, numerous experiments have shown
that living arterial tissue is not essential in recon-
structing an arterial pathway; furthermore, homo-
grafts may be used successfully after being ob-
tained as long as 12 to 24 hours postmortem.
Such grafts are now commonly sterilized by ir-
radiation or by chemical means. Our community
is well serviced by an Artery Bank, which ob-
tains all its vessels from the pathology service
of a 400 bed hospital. These grafts are sterilized
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957.
by a chemical, beta-propiolactone, and then tem-
porarily preserved for one month in a balanced
salt solution. Equipment is also available com-
mercially by which these vessels may be freeze-
dried and preserved indefinitely. Thus the avail-
ability of a substitute artery is no longer a prob-
lem in moderate-sized communities as long as
the products of Detroit continue to decimate the
population, the only problem lies in the actual
physical removal and preservation of the arteries.
Its solution requires a small amount of initiative
and a minimum of work and equipment.
Inasmuch as one is dealing with an unknown
factor in the ultimate fate of this dead tissue
acting simply as a strut for an arterial pathway,
attention has also been directed towards per-
fection of a fabric prosthesis which might sup-
plant the homograft. Of the fabrics in general
use, nylon, particularly in the crimped form, has
been most popular, although dacron has been
shown recently to have many more advantages.
Since there has been extensive duplication of ef-
fort throughout the country in this work, a com-
mittee has been established by the American Col-
lege of Surgeons and the Society of Vascular Sur-
geons to organize and simplify further experi-
ments. For the present, it is generally conceded
that the homograft gives distinctly better results
in small artery replacement, although both the
fabric graft and the homograft have equal ad-
vantages in replacing portions of the aorta and
iliac arteries.
Trauma
To return now to the clinical application of
these grafts, military and civilian experience of
the past few years has shown that all acute arte-
rial injuries should be treated immediately by cor-
rective arterial surgery, either by direct reanas-
tomosis, or insertion of a graft where loss of arte-
rial substance is extensive. The tremendous in-
crease in salvage of extremities and prevention of
amputation in the Korean conflict are directly
attributable to the adoption of such surgical
J. Florida, M, A.
November, 1957
MOODY AND McLEOD: RECONSTRUCTIVE ARTERIAL SURGERY
481
principles. It is no longer permissible to stand
by, placating one’s feeling of helplessness with
sympathetic blocks and vasodilators; a pulseless
extremity in the presence of recent trauma de-
mands immediate surgical exploration.
The same principles apply in the treatment
of post-traumatic arterial aneurysms and arterio-
venous fistula. Such lesions are frequently missed
initially, or immediate surgical attention is lack-
ing. An example of the latter situation concerns
a machine operator who was injured in the right
thigh by a deflected piece of steel from a chisel.
First aid with control of superficial bleeding was
rendered, and when referred for surgery three
weeks later, the patient had ample evidence of a
false aneurysm and a fistulous communication
between the superficial femoral artery and vein.
Immediate surgery with excision of less than a
centimeter of artery, reanastomosis, and closure
of the laceration in the vein returned this patient’s
vascular system to a normal status, as evidenced
by postoperative arteriograms, and return to full
work in three weeks. Following the old practice
of delaying surgery for six weeks to three months
awaiting the development of collateral circula-
tion would have made this case unnecessarily com-
plicated. The increase in size of the aneurysm
probably would have made grafting a necessity,
and the continuing presence of the fistula would
certainly have had a decided effect on the patient’s
cardiac status.
In my opinion, the old premise of delayed
surgery in the treatment of such lesions is no
longer tenable; too much can be gained with less
risk by immediate or early surgery. Furthermore,
the success of grafting procedures in major ar-
teries of the extremities has made obsolete the
practice of quadruple ligation of an arteriovenous
fistula. There is no need in salvaging an extremity
only to have incapaciting claudication when one
can reconstruct the arterial pathway and end
with a normally functioning limb.
A second example of arterial injury concerns
an eldery man who struck the inner aspect of
his thigh on a swimming pool. A persistent and
enlarging hematoma was finally diagnosed cor-
rectly, and a femoral arteriogram corroborated the
palpatory diagnosis of a massive false aneurysm.
Since the lesion was at least three months old, it
was thought that surgery could be performed on
an elective basis. Sudden extension of the aneu-
rysm and occlusion of the distal superficial fem-
oral artery, however, completely overruled this
decision and made emergency exploration im-
perative. Removal of the aneurysm, and recon-
struction of the superficial femoral artery with a
3 inch crimped nylon graft produced a viable,
normally functioning leg. Procrastination with
sympathetic blocks, intra-arterial injections, or
vasodilators might well have cost this patient his
life, let alone his leg.
Degenerative Diseases
A much more serious condition confronts one
in the surgical correction of the abdominal aortic
aneurysm. Although there is not complete una-
nimity of opinion concerning the prognosis of
cases of this type, most physicians agree that
about 50 per cent of the patients will expire with-
in two years and 80 per cent within five years of
diagnosis. The majority of these deaths are due
to rupture of the aneurysm. It is our belief that
once a diagnosis of an abdominal aneurysm has
been elicited, a most careful evaluation should be
made concerning the patient’s probable future. If
he is not likely to die within a three to five year
period of other causes, then the aneurysm should
be considered as grave as a malignant disease
and dealt with promptly.
At this point I should like to emphasize the
word promptly. If a patient with an aneurysm is
allowed to become symptomatic from the stand-
point of back and abdominal pain, the risk of
surgical correction is significantly increased. An
example is found in the case of a 56 year old man
referred to a urologist for investigation of a kid-
ney tumor. The patient was shunted from one
doctor to another over a six month period in an
effort to get relief from severe back pain. By the
time he was seen by the urologist, abdominal
pain had likewise become a major factor. Ex-
ploration following completion of the correct
diagnosis revealed a medium-sized aneurysm with
almost complete overlapping of the vena cava
and extensive erosion of the vertebral column.
The latter was so severe that the proximal aorta
had to be occluded twice as long as ordinarily
preferred and the aneurysm actually cut away
from the vena cava and vertebral column. Post-
operative discomfort in the leg due to prolonged
loss of blood supply was severe, although tem-
porary; this, plus the danger of severe hemorrhage
during the dissection, could have been obviated
by diagnosis and treatment at a much earlier
stage. Fortunately, diagnosis can be, and fre-
quently is, made before the onset of symptoms;
482
MOODY AND McLEOD: RECONSTRUCTIVE ARTERIAL SURGERY
Volume XUV
Number 5
it is at this point or at the beginning of symptoms
that maximum attention should be paid to arriv-
ing at a decision for surgical treatment.
Abdominal palpation and lateral roentgeno-
grams of the abdomen are the two most important
diagnostic means. Mobility of the aneurysm as
shown by palpation offers an excellent clue as to
the ease of removal. Operability, however, can-
not be determined by palpation alone; many re-
sectable aneurysms appear to extend up under
the xiphoid cartilage. Fortunately, less than 10
per cent of the abdominal aortic aneurysms in-
volve the aorta above the renal arteries. The
lateral roentgenogram frequently reveals the con-
figuration of the aneurysm because of calcifica-
tion in its wall and is thereby helpful in deter-
mining the proximal extent of the lesion. It is
now generally agreed that aortograms do not add
sufficient information concerning the extent or
operability of an aneurysm to warrant their defi-
nite risk.
Although our experience in this field is not
large enough to be significant from the stand-
point of figures, it is ample enough to warrant
forming certain conclusions. As mentioned, we
believe that it is a mistake to clamp off the aorta
at the beginning of dissection; to do so may aid
in the removal of the aneurysm, but prolonga-
tion of lack of blood supply to the lower extremi-
ties will be much more detrimental to the patient.
I have found little difference, except for two
factors, between homografts and the crimped ny-
lon bifurcation graft. The former are easier to
work with and certainly far more adaptable to
unusual situations. Also, the lack of elasticity in
the proximal end of the nylon graft may have
an ultimate detrimental effect on its continued
patency. I strongly favor the use of dilute heparin
solution in large quantities injected both proxi-
mally and distally in the aorta and iliac arteries;
our zero incidence of postoperative graft occlu-
sion at this level is certainly due in some measure
to this technic. We believe that the current mor-
tality statistics of 10 to 14 per cent as reported in
the large clinics are favorable when one considers
the malignancy of the primary lesion and the
general age group in which this condition pre-
vails. The sharp rise in immediate mortality to
40 or 50 per cent for those patients surviving
perforation of an aneurysm long enough to reach
the operating room only emphasizes the need for
an early decision as to surgical therapy for ab-
dominal aortic aneurysms.
There is another complication of atherosclero-
sis involving the abdominal aorta similar to aor-
tic aneurysm only in etiology. This consists of
luminal obstruction of the aorta plus one or both
iliac arteries; the symptoms produced are fre-
quently referred to as the Leriche syndrome.
Patients with this complication have unilateral or
bilateral paresthesia and claudication involving
the hips, thighs and ultimately the entire legs, de-
pending on the site of the obstruction. Diminished
to absent aortic pulsation and absent femoral
pulsations make the diagnosis fairly simple. An
aortogram is helpful in delineating the proximal
level of obstruction; it is of more importance,
however, to visualize the distal circulation to be
sure of its patency. Visualization may be accom-
plished with delayed films at the time of the
aortogram or by femoral arteriography.
Interestingly enough, a sufficient number of the
patients with this condition may be in their fourth
decade of life, and surgical correction is thus of
much greater importance than in an elderly pa-
tient who does not need to do extensive walking
in order to make a livelihood. Resection and
grafting of the obstructed aorta and common iliac
arteries will frequently return these patients to a
normal exercise tolerance. Two of our patients
had such intense claudication that they were
practically unable to walk from their bed to the
bathroom. Reconstruction of their obstructed cir-
culation has resulted in complete relief of clau-
dication even under conditions of severe exercise.
In some clinics the opinion is held that better
results are obtained by reaming out the ather-
osclerotic deposit within the aorta and iliac ar-
teries, and then reclosing the incision in these ves-
sels. We have not used this maneuver and are un-
able to comment on its usefulness. Certainly, re-
section with grafting has been successful in a high
percentage of cases. Unfortunately, a certain
number of the patients have involvement up above
the renal arteries making grafting or endarterec-
tomy hazardous. What the ultimate proper pro-
cedure for these cases will be remains to be seen.
One of the problems in reconstructive arterial
surgery still not completely answered concerns the
patient with atherosclerotic obstruction in the ar-
teries of the lower extremities. In general, we see
two essentially different types of patient in this
group. The first type is usually in the sixth or
seventh decade of life, and will have a history of
claudication involving one or both calves of a
significantly long duration. The onset of pain
J. Florida, M. A.
November, 1957
MOODY AND McLEOD. RECONSTRUCTIVE ARTERIAL SURGERY
483
is gradual and progression slow. Femoral artery
pulsations are usually present, but diminished in
amplitude, and the popliteal pulsation is char-
acteristically absent. Oscillometric measurement
in the upper part of the thigh will be reduced to
one and a half or two units, and in the lower por-
tion will show no fluctuation. Roentgenograms
of the extremities will probably show extensive
spotty calcification from the iliac arteries down
to the popliteal bifurcation. These patients have
generalized atherosclerotic deposits, and in our
opinion are not candidates for any present day
form of arterial surgery. Involvement of the
branches of the popliteal artery by their primary
disease will automatically result in obstruction
of any arterial graft placed above this level. Their
only benefit from a surgical standpoint will come
from a lumbar sympathectomy.
The second type of patient differs in that there
is a history of claudication which is relatively
acute, and progression of symptoms is rapid. The
femoral artery pulsation and oscillometric meas-
urements of the upper part of the thigh are usually
normal. A block can easily be demonstrated,
usually in the mid or lower third of the super-
ficial femoral artery by palpation or oscillometric
measurement. Roentgenograms usually will show
no calcification in the femoral vessels. The most
important diagnostic method consists of a femoral
arteriogram to delineate the level of obstruction,
and, of far more importance, to show the patency
of the outflow system below the obstruction. Gen-
erally, the popliteal artery and its branches an
normal. In essence then, this type of patient hr.;
a localized segmental block, which can usually b ;
overcome by reconstructive surgery. At the pres-
ent time, it is generally agreed that a bypass
graft which leaves the obstructed artery in place
and simply detours blood down to the outflow
artery is the best method. The collateral circula-
tion already developed is not distributed by this
plan. Judging from reports from the larger cen-
ters, about 70 per cent of grafts of this type
will remain patent over a two year period; some
clinics are reporting a SO per cent salvage of
extremities in the early stages of gangrene by this
method. Another technic reported in the litera-
ture giving considerable success is that of en-
darterectomy of the obstructed femoral artery;
success here is again dependent, however, on a
patent outflow tract.
Emboli
When arterial continuity is interrupted, a
different situation exists. Aortic or peripheral
arterial emboli, whether derived from auricular
thrombi or calcific aortic plaques, carry a mor-
tality of over 20 per cent and a loss of limbs of
over 50 per cent. In general, most emboli will
lodge in the lower portion of the aorta or in the
common iliac arteries. Sudden occlusion of the
superficial femoral artery is usually associated
with a pre-existing area of atherosclerotic narrow-
ing. The surgical attack upon aortic or arterial
emboli is directed towards direct removal of the
embolus and the thrombus associated with it.
This is accomplished through an arteriotomy at
the proximal level of obstruction. The recently re-
vived method of flushing out thrombi from the
peripheral arterial bed by means of retrograde in-
jections of heparin solution has resulted in an
even higher rate of successful salvage of extrem-
ities. With proper technics this now approaches
70 per cent.
It has been amply shown that the success of
embolectomy is enhanced the shorter the duration
of the process and the less distal the thrombus
present. There are, however, many cases recorded
in which successful removal occurred after as
much as 24 to 48 hours had elapsed.
One example of delayed removal concerned
a 50 year old postal employee who suffered from
recurrent auricular fibrillation. While working
one day, he suddenly found that his right arm
became useless while pitching letters into con-
tainers. After a few minutes’ rest his arm strength
returned only to be lost on resumption of activity.
He was found to have an embolus in the axillary
artery just beyond the anterior humeral circum-
flex branch. The latter was sufficient in providing
enough blood at rest, but exercise produced al-
most immediate arterial insufficiency. Removal
of the embolus by simple arteriotomy returned
this man to his work with no residual claudication.
Certainly the situation of sudden arterial obstruc-
tion by emboli demands immediate attention. It
is of maximum importance not to procrastinate
just to see whether or not gangrene will super-
vene. A curative surgical procedure will offer far
more than watchful waiting.
320 North Main Street.
(A discussion of this paper by Dr. Francis
N. Cooke may be found on the following page.)
484
TERRY AND ROSS: BLOOD VESSEL BANKS
Volume XLIV
Number 5
Discussion
Francis N. Cooke, Miami: Dr. Moody has presented
an extremely important subject and one that I have been
actively interested in for many years. I wish to con-
gratulate Dr. Moody on his most informative presentation.
Blood vessel replacement therapy is today no longer
in its experimental or developmental phase. On the con-
trary, the methods and technics now utilized have stood
the test of time and are currently accepted as being on
a firm footing. This modality, therefore, I believe is a
most valuable addition to our medical armamentarium.
This slide represents our experience to date. The total
number of cases in which blood vessel transplants have
been used is 48. These cases are divided into the signif-
icant anatomic regions because of the problems peculiar
to those particular areas.
Nine of these transplants have been autogenous vein
grafts, and these of course have been used only in the
peripheral vessels where short segments of the artery are
involved, such as traumatic aneurysm or arteriovenous
fistula. Bullet and knife wounds usually account for most
of these, as in the case Dr. Moody illustrated.
The great majority of our transplants have been ho-
mologous arterial grafts. Only two are plastic material —
one of Vinfon N and one of Dacron taffeta which I
bought at Sears Roebuck.
Results. — In cases involving the thoracic aorta, we
have had three deaths, a SO per cent mortality, which is
too high. The average life of a person with intrathoracic-
aneurysm, however, is six to eight months, and in uncom-
plicated cases I believe we can improve on this consider-
ably. We have had four cases of ruptured aneurysms of
the aorta, and we have saved two of these with emer-
gency surgery. These are difficult cases to manage.
In the cases of elective resection of the abdominal
aorta, there have been two deaths, an operative mortality
of 11.7 per cent, which compares favorably with most
of the published series throughout the country.
I believe, however, the important thing to consider
is the long term results of this type of therapy. What
does the future hold for these patients?
For those patients who survive the operation for
aneurysm, the results have been excellent. In all of these
cases blood flow to the extremities has been re-established,
and the grafts have functioned well.
In obliterative arterial disease with skip areas of ar-
terial occlusion, long term results have not been good, as
with aneurysm. Nevertheless, they are considered good.
We must realize that the arteriosclerotic process is diffuse
and progressive and that blood vessel replacement therapy
does not alter the course of the systemic disease. For
this reason, patients must be carefully selected. Carefully
performed angiograms are an absolute necessity for prop-
er assessment of the problem.
In my experience endarterectomy — removal of the
organized thrombus along with the blood vessel intima —
is of value in only a few cases and can be extremely
dangerous if the clot reforms and propagates.
Lumbar sympathectomy for claudication has little
value in obliterative arterial disease. For this reason I
rarely recommend such a procedure.
Blood Vessel Banks
John H. Terry, M.D.
AND
John B. Ross, M.D.
JACKSONVILLE
Since major vascular surgery is now being per-
formed in several cities in Florida, The Journal
of the Florida Medical Association has requested
that current information about blood vessel or
artery banks in the state be published so as to
acquaint all physicians with the facilities avail-
able to them. The scientific papers on complica-
tions of aortic disease and reconstructive arterial
surgery which are published in this issue of The
Journal cover well the diagnostic and therapeutic
aspects of major vascular disease. Thus, each pa-
tient who undergoes a resection of a major vessel
for congenital or acquired disease receives either
a preserved homograft or one of the approved
synthetic substitutes as a new vessel if primary
suture cannot be accomplished. More than six
years have elapsed since the first homograft ves-
sel was implanted for acquired disease of the
aorta. As early as 1948, homografts were used
to bridge defects in such congenital diseases of
the aorta as coarctation. A brief look at the ac-
cepted methods by which these vessels are obtain-
ed and processed is in order.
Blood Vessel Banks in Florida
At the present time, laboratories are equipped
to prepare and preserve arteries obtained for
therapeutic purposes in the Jacksonville, Orlando
and Miami Blood Banks. While the present facil-
ities in the state are in these three banks, it is
anticipated that other hospitals, laboratories,
blood banks and medical centers will be interested
in forming artery banks. For this reason, some
of the difficulties encountered in this endeavor
will be enumerated as part of this discussion.
Preliminary Steps
Information received from a number of labora-
tories throughout the country indicates that cer-
tain general procedures have been widely adopted
while others have been discarded. Most artery
banks are sponsored by local chapters of such
organizations as the American Heart Association
and the American Cancer Society. Funds to pur-
chase the necessary equipment for lyophilization
may be forthcoming from such sources.
J. Florida, M. A.
November, 1957
TERRY AND ROSS: BLOOD VESSEL BANKS
485
It is most important to consider in detail cer-
tain problems which are better solved before the
first homograft is obtained. Approval of such a
program by the county medical society and the
formation of an artery bank committee with equal
representation from all local hospitals constitute
a portion of the major groundwork. This com-
mittee, then, should establish good rapport with
the local Funeral Directors Association and the
pathologists. Such cooperation can usually be
obtained if the committee resolves to facilitate the
embalming process by requiring insertion of small
catheters into the ends of divided major vessels.
The legal technicalities vary to some extent
in different localities. Since, however, the primary
source of supply is potentially from the office
of the medical examiner, it behooves interested
physicians to achieve a high degree of cooperation
with this office. Written permits to obtain vessels
are likewise handled in different ways, depending
upon the degree to which legal consultation is
sought and the conformity of the individual hos-
pital autopsy permits. In general, it is satisfactory
to use the latter if an addition is made to cover
the use of blood vessels for therapeutic purposes.
It may be preferable, however, to employ special
permits protected by proper legal advice.
In addition, trained personnel is needed to
obtain the vessels as well as process them. A
physician-delegate, a house officer, a pathologist,
or a cooperative medical examiner is best able to
remove vessels with minimal injury to them.
Technicians may then clean the vessels and pro-
ceed with the sterilization process.
Procuring the Vessels
It is generally agreed that aortas should be
removed from unrefrigerated bodies within six
hours of death. The safe interval is 24 hours in
bodies which are refrigerated within three to six
hours of death. Persons 45 years of age or young-
er are likely to have acceptable aortas without
disqualifying degrees of arteriosclerosis. There
are some inconsistencies in available reports con-
cerning other disqualifying conditions. Most au-
thorities would reject bodies with certain general-
ized infections such as active syphilis, serum hep-
atitis, malaria, and generalized sepsis. Patients
with proved collagen disease, generalized lym-
phoma, and malignant disease adjacent to the
aorta should also be excluded.
The entire aorta from the proximal ascending
arch downward is removed, including both com-
mon iliac arteries just beyond their bifurcation.
The vessels can be removed during necropsy with
little additional expenditure of time and no addi-
tional disfigurement. The specimen should be re-
moved chiefly by sharp dissection from the an-
terolateral surfaces of the vertebral bodies so as
to leave the branches at least 2 cm. long. If prior
agreement with the Funeral Directors Association
has been reached to obtain femoral vessels, these
can then be procured through two incisions in the
thigh. A single lengthy incision, however, will
hasten this procedure. Small catheters may then
be inserted into the iliac vessels, the profunda
femoris, and the distal superficial femoral, or
popliteal, arteries, and secured by a ligature for
use by the mortician.
Processing
Once removed, the vessels should be placed
in a bottle containing saline or Ringer’s solution,
and stored in a refrigerator. Vessels should not
be stored at this stage in a freezer. Preferably
the same day, although longer intervals may
elapse, the vessels should be meticulously cleaned
by blunt and sharp dissection by a physician or
trained personnel. Tributary vessels should be
left as long as possible and great care taken not
to avulse these vessels at theP base or to damage
the intima.
The procedure most wiuely used at this time
to preserve soft tissues such as blood vessels con-
sists of three basic steps: first, sterilization; sec-
ond, rapid freezing; and third, drying.
Sterilization
A number of methods have been used to steril-
ize vessels. Earlier, Formalin and Tyrode's solu-
tion were popular. More recently, high voltage
cathode ray irradiation, beta propiolactone, and
ethylene oxide have been used. Ethylene oxide is
preferable if precautions against explosion are
taken. The vessel is placed in a special sterile
pyrex tube. Sufficient liquid ethylene oxide to
fill the entire container is added and maintained
for 30 minutes. This method must be used under
a hood or in a fireproof cubicle because of the ex-
plosive properties of this agent. The excess ethy-
lene oxide is then decanted off. A small segment
may be taken for culture and microscopic study
if desired.
Quick Freezing
Once sterilized, vessels may thereafter be pre-
served by one of two currently popular methods.
486
TERRY AND ROSS: BLOOD VESSEL BANKS
Volume XLIV
Number 5
Fig. 1. — Sterilized and frozen graft, not dried.
In medical centers where the majority of vessels
will be used in one institution, it is convenient to
preserve the vessels in a frozen state. Thus, the
sterilized vessel within the pyrex container is
rapidly immersed in a mixture of equal parts of
dry ice and alcohol (-75 C.) or acetone (-78 C.)
for 15 minutes, and then placed for storage in a
deep freeze until the moment of utilization (fig.
1). This quick freezing is said to produce much
less cell damage by crystallization than occurs in
slowly cooled material. It is believed that such
grafts can be preserved for a period of at least
one year.
Freeze Drying
The method best adapted to preservation in
all situations and localities is that of freeze dry-
ing, or lyophilization. It consists of removing the
protein-bound w’ater within the vessel by the
process of sublimation, or passage from the frozen
state to gas. The proteins are not denatured in
sublimation, provided it occurs below a critical
temperature. A freeze drying unit consists of four
basic elements:
(1) A vacuum system generally accomplished
by the use of a mechanical oil-sealed
rotary pump with or without the attach-
Fig. 2. — Hufnagel Iyophilizing apparatus, with grafts immersed in dry ice and alcohol.
J. Florida, M. A.
November, 1957
TERRY AND ROSS: BLOOD VESSEL BANKS
487
ment of an oil diffusion pump to augment
the vacuum.
(2) A manifold connection to attach the
flasks containing the frozen material to
be processed.
(3) A condenser or cold trap, kept cold by an
external refrigerant, connected between
(1) and (2) to prevent water vapors from
reaching the vacuum system, thereby re-
ducing greatly its efficiency.
(4) A vacuum gage to measure the pressures
in the system.
Thus, after the specimens are frozen in the
dry ice-acetone mixture as described in step two,
the container is connected to the system and the
mechanical vacuum pump started. If the vessels
have been sterilized with ethylene oxide which
freezes at -111.3 C., liquid nitrogen must be used
ta cool the condenser and to solidify the sub-
limated ethylene oxide. It is convenient to keep
the specimen frozen with the dry ice-acetone mix-
ture during the early period of processing (fig. 2).
This process usually requires six to 10 hours
if a satisfactory pump is available to obtain a
pressure of 1 to 0.5 microns (fig. 3). Leaks in the
system must be carefully avoided.
The last step consists of sealing the pyrex con-
tainer and varies to some extent, depending upon
the type of freeze-drying apparatus used. Usual-
ly, the tubes are sealed with an oxygen-methane
torch. The graft is then ready for indefinite stor-
age or early use (fig. 4).
Reconstitution
At the time of their use, the preserved grafts
require a period of reconstitution in a sterile
saline solution, preferably containing penicillin
and streptomycin. If they are preserved by freez-
ing alone, this period need only be for 10 to 15
minutes. At least 30 minutes of immersion, how-
ever, should be allowed for the lyophilized graft.
Availability of Grafts
Several of the larger artery banks in the Unit-
ed States, such as the Central Artery Bank of
Fig. 3. — Hufnagel Iyophilizing apparatus, with grafts nearing the final state of lyophilization.
488
TERRY AND ROSS: BLOOD VESSEL BANKS
Volume XLIV
Number 5
Fig. 4. — Lyophilized artery ready for storage or shipment.
Chicago and the Northern California Artery Bank
in San Francisco, have established ambitious pro-
grams to supply vessels to rather large areas.
Such a program can be carried out in Florida if
the need exists. It would require distribution to
“membership hospitals” of explicit details as to
how the artery bank functions; how the vessels
are obtained, shipped, and stored; the legal re-
quirements; and the prerequisite that a vessel be
donated for every one used in the local hospital.
At the present time any appreciable demand
for vessels could not be met by the artery banks
in the state. It is true that more and more syn-
thetic prostheses are being used in preference to
the homograft. Recent reports, however, of a
variety of complications in the use of these sub-
stances in the smaller vessels should encourage
Florida physicians to maintain and increase their
interest in artery banks. Anyone desiring further
information is asked to write to one of the banks
in the state, or the Editor of The Journal.
Photographs supplied through the courtesy of the Tissue
Bank, Jacksonville Blood Bank, Incorporated.
415 Medical Arts Building (Dr. Terry).
536 West Tenth Street (Dr. Ross).
Eleventh Clinical Meeting, American Medical Association
December 3-6, Philadelphia
Convention Hall
Headquarters, House of Delegates, Bellevue-Stratford Hotel
Fifty-First Annual Meeting, Southern Medical Association
November 11-14, Miami Beach
Auditorium
J. Florida, M. A.
November, 1957
489
Clinical Report of an Unusual
Contagious Exanthem
Ethel H. Trygstad, M.D.
NAPLES
During February and March of this year, in
a group of children and one adult in Naples an
exanthem developed which did not conform to
any of the recognized entities. It was character-
ized by fever, headache, moderately sore throat,
and a fine red rash beginning on the inner sur-
face of the upper portion of the thighs and ex-
tending, in a few hours, over the abdomen, chest
and back. A series of cases of a similar syn-
drome was reported from a children’s orthopedic
hospital in Pennsylvania.1 The purpose of this
report is to add certain details not noted there,
and to direct the attention of Florida physicians
to a disease which may be confused with scarlet
fever.
In the 1 1 cases of the present series, all but
one of the patients were pupils in one school, or
familial contacts. The seven primary cases occur-
red in seven and eight year old boys; the younger
brothers, aged five and two, and the mother of
the boys and a 10 year old girl whose contact
with any known case was not discovered, made
up the total.
Headache was the usual initial symptom,
quickly followed by fever, ranging from 100 to
103.4 F. On questioning, all admitted that their
throats either were or had been sore. The 28 year
old mother, who had the highest temperature,
found the sore throat the most distressing part of
the illness. About 12 to 24 hours after the onset,
a fine, bright red papular rash was noted on the
inner surface of the thighs, just below the crotch,
and this rapidly extended up over the abdomen,
chest and back; in some cases the extensor sur-
faces of the extremities were involved. No erup-
tion was seen on the face, the palms or soles.
One boy had some fine exanthem on the palate
and buccal mucosa. The rash was moderately
itchy.
The first two boys were seen after the throat
symptoms had subsided and the rash was full-
blown, suggesting an allergic dermatitis. Both
had a history of allergic skin reactions in the
past; so they were given an antihistamine, and
a regimen of high calcium, vitamin C, low sodium
and abundant fluids was recommended. The
rash lasted three or four days. Eight patients seen
early were treated with chlortetracycline or tetra-
cycline. In these patients the rash did not ex-
tend as far, and both rash and sore throat cleared
up in 48 hours. One boy received no treatment
except local applications of an antipruritic lotion.
The rash disappeared in about the same length
of time as in those treated with antihistamines,
et cetera.
The second and third cases in the one fam-
ily began 10 and 11 days after the first, and the
onset of the mother’s symptoms occurred 10 days
after these secondary cases, thus establishing a
presumptive incubation period of about 10 days.
Slight desquamation was noted in the children
with extensive rash. All patients made an un-
eventful recovery in two to five days, and no un-
toward sequelae have been noted up to the pre-
sent.
Only one blood count was made, and this
showed a hemoglobin estimation of 14.4 Gm. and
slight leukocytosis (9,000) with normal distri-
bution.
Nose and throat cultures showed a variety of
organisms, including alpha and gamma type strep-
tococci, hemolytic Staphylococcus aureus and
yeastlike organisms. No beta hemolytic strep-
tococci were isolated. No virus studies were
made.
Differential Diagnosis
This outbreak appears to be one of a conta-
gious exanthem resembling the one described in
Pennsylvania,1 and differing in certain respects
from previously named diseases. It can be dis-
tinguished from measles, rubella, roseola infan-
tum, erythema infectiosum, the “Boston disease”
and scarlet fever.
Absence of cough, conjunctivitis and Koplik’s.
spots, and the character of the eruption make it
seem unlikely that this is atypical measles.
Although the appearance of the fully devel-
oped rash is similar to that seen in German mea-
sles, its course and distribution, as well as the
490
TRYGSTAD: AN UNUSUAL CONTAGIOUS EXANTHEM
Volume XLIV
Number 5
shorter incubation period and the absence of oc-
cipital and posterior cervical adenopathy are dis-
tinguishing points.
Roseola infantum- has a longer pre-eruptive
febrile period, affects primarily a younger age
group, and the eruption is composed of larger
and more scattered maculopapules.
In ‘‘Boston disease”3 and erythema infectio-
sum,4 the character, onset and distribution of
the rash are different.
The most important disease, from a practical
point of view, with which this entity may be con-
fused is scarlet fever. In scarlet fever, however,
the rash begins on the neck, next is noted on the
face, and later involves the trunk, axillae and
groin. The systemic reaction is usually more
severe, the throat is more painful, itching is not
a common complaint, the incubation period is
much shorter, and complete desquamation occurs.
Scarlet fever is, by definition, “an acute infection,
primarily of the throat, caused by a member of
the Group ‘A’ beta hemolytic streptococcus.”5 In
the Pennsylvania outbreak and this one, no beta
hemolytic streptococci were found in throat cul-
tures on broth or blood agar. The disease there-
fore presumably is not scarlet fever.
While restrictions on patients with scarlet
fever and their contacts have been much relaxed
over those of preantibiotic days, the Florida State
Board of Health still requires isolation of patients
for one week or until 24 hours after initiation
of effective antibiotic therapy if afebrile, terminal
disinfection of premises, medical observation of
contacts for one week after exposure, and more
stringent precautions should the contacts chance
to work on a dairy farm.6 It therefore seems
most desirable to distinguish between scarlet fever
and an exanthem with a similar rash which causes
a relatively mild, short illness with no known com-
plications or sequelae.
Summary
An outbreak of a mild febrile exanthem, char-
acterized by a bright red scarlatiniform rash be-
ginning in the groin and affecting mostly children,
especially males, occurred in Naples recently. It
responded well to tetracycline treatment, which
appeared to shorten the course. The socioeconom-
ic importance of correct diagnosis is due to its
resemblance to mild scarlet fever.
References
1. Ames, M. D. : Previously Unreported Acute Exanthem
Resembling Scarlet Fever, Am. J. Dis. Child. 93:110-112
(Feb.) 1957.
2. Berenberg, W.; Wright, S., and Janeway, C. A.: Roseola
Infantum (Exanthem Subitum), New England J. Med.
241:253-259 (Aug. 18) 1949.
3. Neva, F. A.; Feemster, R. F., and Gorbach, I. J. : Clinical
and Epidemiological Features of Unusual Epidemic Exan-
them, J. A. M. A. 155:544-548 (June 5) 1954.
4. Herrick, T. P. : Erythema Infectiosum, Am. J. Dis. Child.
31:486-495 (April) 1926.
5. Nelson, Waldo, E., editor: Textbook of Pediatrics, Philadel-
phia, W. B. Saunders Company, 1954.
6. Rules and Regulations for the Control of Communicable
Diseases, Florida State Board of Health, 1956.
Called Meeting of House of Delegates
Florida Medical Association
December 8
Dr. William C. Roberts, of Panama City, President of the Florida Medical Association, has
called a meeting of the House of Delegates for 9 a.m., Sunday, Dec. 8, 1957, at the George Wash-
ington Hotel in Jacksonville to specifically consider Medicare. Delegates seated at the 1957 Annual
Meeting of the House at Hollywood are eligible to be registered and to vote at this special session.
All Association members are welcome to attend.
On Saturday preceding the meeting of the House of Delegates, there will be a meeting of Blue
Shield.
J. Florida, M. A.
November, 1957
491
Encephalitis in Cat Scratch Disease
Report of Two Cases
David R. Gair, M.D.
AND
William L. Walls, M.D.
MIAMI
Cat scratch disease is a relatively new clinical
entity; approximately 200 cases have been re-
ported in world literature since 1951. In only 12
of these cases, however, were there associated
neurologic manifestations.1'12 It is the purpose
of this paper to present two additional cases of
cat scratch disease with major central nervous
system manifestations.
Classically, cat scratch disease consists of
regional lymphadenitis with or without formation
of sterile pus and an initial skin lesion usually
following a cat scratch. In the majority of cases
the disease runs a short, mild course. Fever and
systemic symptoms are common, but rarely is the
central nervous system involved. Although an
etiologic agent has not been demonstrated, the
presumptive diagnosis is based on obtaining a
positive reaction to a skin test with an antigen
prepared from an affected lymph node.
Report of Cases
Case 1. — A 10 year old Negro boy apparently had
been in perfect health until Oct. 10, 1954, the day of
admission to the hospital, when he suddenly cried aloud
and was found on the floor with his body rigid and his
arms and head in clonic motion. This state lasted ap-
proximately 15 minutes, after which the patient became
relaxed, but was stuporous and extremely irritable. He
was taken to Temple University Medical Center for
emergency treatment, where the only specific physical
findings besides the stuporous state were enlarged epi-
trochlear and axillary nodes on the right side. The child
was then admitted to St. Christopher’s Hospital for
Children.
Physical examination at the time of admission re-
vealed a boy out of contact with reality, in a stuporous
condition, and most irritable when touched. Enlarged
right epitrochlear and axillary nodes were noted. There
was a large perforation of the right tympanic membrane.
He was afebrile, but shortly thereafter his temperature
rose to 100.6 F. Respirations were 24 per minute and
regular. The remainder of the physical examination was
within normal limits.
The history revealed that there were many cats
around the patient’s home, and he distinctly remem-
bered being scratched by a cat on the right hand a short
time before the onset of his illness. Seven weeks prior
to admission, the patient had a bullet wound of the
terminal portion of the right index finger, for which he
received penicillin and tetanus antitoxin, and the wound
was sutured.
From the Department of Pediatrics of the University of
Miami School of Medicine and the Pediatric Service of the
Jackson Memorial Hospital, Miami, and the Department of
Pediatrics of Temple University School of Medicine and the
Department of Pediatrics of St. Christopher’s Hospital for
Children, Philadelphia.
The initial laboratory studies revealed a hemoglobin
of 12.4 Gm. per hundred cubic centimeters and a white
blood cell count of 20,150 cells per cubic millimeter. The
spinal fluid pressure was 85 mm. of water. The fluid was
clear and contained 3 cells per cubic millimeter. The
protein content was 40 mg. and the sugar 50 mg. per
hundred cubic centimeters. The Pandy test gave nega-
tive results. A culture of the fluid grew no organisms.
Examination of the urine revealed no abnormalities. The
urine was negative for coproporphyrins.
On the second hospital day, the temperature returned
to normal. The patient suddenly sat up and was men-
tally alert. He could not remember anything that had
taken place since the onset of his illness. He remained
afebrile for the remainder of his hospital stay. Aqueous
penicillin, 500,000 units every six hours intramuscularly,
was given during the first day. The next day the patient
was given Terramycin, 200 mg. every four hours, and
remained on this therapy for seven days.
Studies of the cerebrospinal fluid, repeated nine days
after admission, showed no significant change. A white
blood cell count on the day after admission was 16,750
cells per cubic millimeter with a normal differential
count. There was no basophilic stippling of the red
cells, and repeated sickle cell preparations gave negative
results. A VDRL was nonreactive. The results of hetero-
phil and febrile agglutination studies were negative. The
reaction to tuberculin tests was negative, and also to the
Frei test. A nasopharyngeal culture grew Staphylococcus
aureus, sensitive to Terramycin.
Roentgenograms of the skull showed evidence of
apparently inactive right mastoidal involvement without
bony breakdown. Roentgenograms of the chest and
right hand revealed no abnormalities. An electroencephalo-
gram was compatible with encephalitis. Pus aspirated
from the right epitrochlear lymph node was sterile. The
right epitrochlear node was excised, examined *-nd re-
ported pathologically as reactive hyperplasia. Endermal
injection of cat scratch antigen produced at the end of
48 hours an area of induration (6 x 10 mm.) surrounded
by erythema (8 x 12 mm.). Blood studies on the thir-
teenth hospital day revealed the hemoglobin to be 13.1
Gm. per hundred cubic centimeters, and the white blood
cell count was 13,200 per hundred cubic centimeters.
The patient remained in the hospital 16 days and was
apparently well at the time of discharge. He was seen
slightly more than a week later in the outpatient clinic,
at which time the biopsy site was healing.
Case 2. — A six year old Negro boy was admitted to
the emergency room of the Jackson Memorial Hospital
on Sept. 4, 1955 in an active generalized convulsion. There
was no previous history of convulsions. The child had
had a swelling in the right axilla for the preceding week,
and this mass had become increasingly larger and more
tender. There was no history of fever. On awakening the
morning of admission, the boy complained of being un-
able to move the right arm because of the exquisite
tenderness of the right axillary mass. His mother noted
a short tremor of both upper extremities at that time.
Approximately two hours later, the patient had a gen-
eralized convulsion and was brought to the hospital.
Significant past history was that he had been in this
hospital for infectious hepatitis in January 1954.
Physical examination revealed a well developed, well
nourished Negro boy in a generalized convulsion. Respira-
tions were 24, the pulse rate 124, and the temperature
492
GAIR AND WALLS: ENCEPHALITIS
Volume XLIV
Number 5
99.8 F. rectally. The eyes were rolled upward, fixed and
staring. The seizure ceased after he received 128 mg. of
Nembutal by suppository and 64 mg. of Sodium Amytal
intravenously.
The pupils were dilated, but reacted slowly to light.
There was no nystagmus. The fundi were clear with no
papilledema. There were small shotty cervical nodes
bilaterally. In the right axilla there was a 2 by 3V2 by 4
cm. moderately firm mass. Neurologically, the deep
tendon reflexes were absent. The Babinski sign was pres-
ent bilaterally. The Kernig and Brudzinski signs were
absent. The patient was incontinent of urine.
The laboratory work on admission was as follows:
red blood cells 3,740,000, hemoglobin 10.0 Gm., white
blood cells 23,600; differential count 27 stab forms, 60
neutrophils, 11 lymphocytes, 1 monocyte and 1 eosinophil;
platelet count normal; spinal fluid, 6 mononuclear cells
per cubic millimeter, protein 46 mg. per hundred cubic
centimeters, sugar 109 mg. per hundred cubic centimeters;
blood sugar 141 mg. per hundred cubic centimeters; urine
negative; sickle cell preparation negative.
The patient was somewhat improved eight hours after
admission to the hospital and was able to take soup
and milk. Shortly thereafter, however, he had another
generalized convulsion and remained semicomatose and
unresponsive for the next three days. During this period
of coma, he had frequent localized convulsive movements
of the right and left sides independently, involving the
arms, legs and face. Barbiturates and Avertin were used
intermittently to control the seizures; no further seizures
were noted after the third hospital day. A stomach
tube was passed on the fourth hospital day, and fluids
and medications were given thereby. Dilantin and later
phenobarbital were given prophylactically over the pa-
tient’s remaining hospital stay.
Antibiotic therapy was started on admission to the
hospital because of the possibility of a brain abscess, and
included penicillin, tetracycline and erythromycin both
parenterally and by mouth.
The patient began to arouse on the fourth hospital
day and by the sixth day was alert enough to take food
and medications by mouth. Over the next several days
he began to show gradual improvement, but exhibited
frequent episodes of wild behavior, with long periods of
loud screaming and crying interspersed with periods of
silly laughter and striking his head against the bed rails.
He also had incontinence of urine and feces. His speech
remained garbled for approximately ten days after
awakening. On the sixteenth hospital day, the patient was
speaking clearly, following commands and laughing ap-
propriately. He was able to stand, but was unsteady on
his feet, and he walked on a wide base. He had an in-
tention tremor of the right arm, the Babinski sign was
present on the right, and the finger to nose test on the
right was grossly abnormal. Proprioception was intact.
The intention tremor became much less pronounced over
the next few days, and the gait became normal.
Aspiration of the right axillary mass, which had grad-
ually become fluctuant and larger, was performed on
the thirteenth hospital day. A thick yellow material was
removed, which showed no organisms on smear or cul-
ture.
In reviewing the course in the hospital, it became ap-
parent that cat scratch encephalitis could explain the en-
tire picture, despite no history of the patient being
scratched or bitten by a cat. Cat scratch antigen, ob-
tained from Dr. Worth B. Daniels, was given intra-
dermally. Within 48 hours, there was an area of indura-
tion 0.5 cm. in diameter, which increased in size to 1 cm.
in the next 24 hours.
A second aspiration of the axillary node gave negative
results on smear and culture. The patient was discharged
37 days after admission. The axillary mass was about
gone at that time, and had completely disappeared when
he was seen in the clinic one week later.
Other studies made while the patient was in the
hospital were as follows: Blood culture on admission gave
negative results. Lumbar punctures, repeated one and
11 days after admission, were essentially the same as on
admission. White blood cell counts, four, nine and 26
days after admission, revealed a gradual return to a
normal and differential count. Stools were negative for
ova or parasites. The P.P.D. No 1 test for tuberculosis
gave negative results. Electroencephalograms made nine
and 25 days after admission were both grossly abnormal,
and consistent with acute inflammation of the brain.
Comments
We were particularly impressed by the sud-
denness and violence of the onset of central ner-
vous system symptoms in the cases reported, by
the severity and duration of the neurologic mani-
festations, especially in case 2, and by the ap-
parent full recovery from the disease in both in-
stances. Both of the patients were apparently
well until the day of admission. In each instance,
the diagnosis was suspected during the acute or
subacute phase of the illness, and appropriate
skin tests were performed.
It is our opinion that in any case of regional
lymphadenitis associated with a sudden onset of
convulsions in previously well children with nor-
mal or equivocal spinal fluid findings, the diag-
nosis of cat scratch disease should be entertained.
Although these clinical findings and the pres-
ence of a positive reaction to skin tests with the
available antigens are not proof of any etiologic
agent, the association is probably significant.
Summary
Two cases of cat scratch disease with nervous
system involvement are reported. In both in-
stances, the patients were children; one was the
youngest patient whose case has been reported in
this country. In both cases, the diagnosis was
made on the basis of clinical and laboratory find-
ings and a skin test with specific antigen. Each
patient apparently made a full recovery.
References
1. Daniels, W. B., and MacMurray. F. G.: Cat Scratch Dis-
ease; Report of 160 Cases, J. A. M. A. 154:1247-1251
(April 10) 1954.
2. Debre, R. : Cited by Daniels, W. B., and MacMurray,
F. G.1
3. Debre, R.; van Bogaert, L. ; Thieffry, S., and Arthuis,
M.: Accidents nerveux de la maladie des griffes du chat,
Bull. Acad. nat. med. 136:454-459 (July 8-29) 1952.
4. Depaillat, A., and Condat, A.: Cited by Weinstein, L., and
Meade, R. H.12
5. Frick, P. G.: Cat-Scratch Disease Associated with Encepha-
litis and Herpes Zoster, Minnesota Med. 37:815-817 (Nov.)
1954.
6. Grossjord, A.; Wimphen, A., and Seligman, M.: Cited by
Weinstein, L. and Meade, R. H.12
7. Hradzdira, C. L. : Cat Scratch Disease with Encephalitic
Complication, Vnitr. lek. 1:81-86 (Feb.) 1955.
8. Roget, J.; Fau, R., ana Beaudoin: Cited by Weinstein, L.,
and Meade, R. H.12
9. Stevens, H.: Cat-Scratcli Fever Encephalitis, A. M. A.
Am. J. Dis. Child. 84:218-222 (Aug.) 1952.
10. Thompson, T. E., Jr., and Miller, K. F. : Cat Scratch
Encephalitis, Ann. lnt. Med. 39:146-151 (July) 1953.
11. Usteri, C. ; Wegmann, T., and Hedinger, C. : Cited by
Weinstein, L., and Meade, R. H.12
12. Weinstein, L., and Meade, R. H. Ill: Neurological Mani-
festations of Cat Scratch Disease, Am. J. M. Sc. 229:500-
505 (May) 1955.
6880 Coral Way (Dr. Gair).
1000 N. W. Seventeenth Street (Dr. Walls).
J. Florida, M. A.
November, 1957
493
ABSTRACTS
Wounds of the Colon and Rectum (1,222
Casualties). By C. Frank Chunn, M. D., and
Richard V. Hauver, M. D. In Surgery in World
War II. Volume II. General Surgery. Editor in
Chief, Colonel John Boyd Coates, Jr., MC; Editor
for General Surgery, Michael E. DeBakey, M. D.
Washington, D. C., Office of the Surgeon General,
Department of the Army, 1955, pp. 255-274.
This detailed analysis of a series of 1,222
casualties with wounds of the colon or rectum, or
both, treated by surgical teams of the Second
Auxiliary Surgical Group between Jan. 1, 1944,
and May 8, 1945, is Chapter XX of General
Surgery, Volume II, one of the recently issued
volumes of the history of the Medical Department
of the United States Army in World War II. It is
a part of the brilliant record of extremely urgent
surgery performed in forward Army medical units
during that war.
In this series, the age range was 25 to 40
years. The injuries consisted entirely of perfora-
tions, transections, and other severe injuries to
the large bowel, including injuries which resulted
in interruption of the blood supply. The average
lapsed time from wounding to operation was 10.9
hours, the interval being essentially the same for
both fatal and nonfatal cases. While the case fatal-
ity rate rose progressively from 19.5 per cent in
univisceral injuries to 100 per cent when five ad-
ditional organs were injured, there was no con-
sistent increase in the rate for the various time
intervals after injury. The case fatality rate in-
creased proportionately with the increase in the
degree of shock; the degree of shock was also
related to the number of organs injured. In the
immediate resuscitation and preparation for oper-
ation of patients with wounds of the colon, the
greatest reliance was placed upon blood, which
was used immediately, liberally, and always in
larger amounts than plasma. As experience in-
creased, operation was performed earlier in the
period of resuscitation and active shock therapy
was continued throughout the operative procedure.
In general, all surgical procedures involved
three basic technics: exteriorization of the wound-
ed segment of bowel, diversion of the fecal stream
away from wounds of the distal or lower colon and
rectum, and incomplete diversion of the fecal
stream. The special procedures carried out are
described, as are the particular problems presented
by the various regional injuries. The 433 deaths
in forward hospitals among the 1,222 patients
represented a case fatality rate of 35.4 per cent.
Shock, which occurred in 185 cases, 46.6 per cent
of the fatalities in which the cause of death could
be determined, was the largest single primary
cause of death.
Allergenicity of Tranquilizing Drugs.
By Clarence Bernstein, M.D., and Solomon D.
Klotz, M.D. J. A. M. A. 163:930-933 (March
16) 1957.
The large number of so-called tranquilizing or
ataraxic drugs now at the physician’s disposal
have produced reactions that are thought to be
due to allergic sensitization. Meprobamate, an
effective tranquilizer with low toxicity and a
wide range of usefulness, has given rise to al-
lergic reactions in eight patients observed by the
authors and in seven other patients reported to
the authors by personal communication. The
reactions included urticaria, elevation of tempera-
ture to 40 C, arthralgia, purpura, and, in a woman
being treated for lupus erythematosus, a fluny
of new skin lesions. Several of the patients with
these reactions had previously used mephenesin;
physicians might ponder the possibility that me-
phenesin may presensitize patients to meprobam-
ate, though this has not been established beyond
speculation. Reserpine and chlorpromazine have
also caused side effects essentially different and
more variable in type. Percentage-wise, the in-
cidence of allergic reactions to the tranquilizing
drugs has been extremely low, but the hazard
must be kept in mind because some of the symp-
toms, especially the fever, may confuse the pic-
ture during the course of a usual, well understood
clinical entity or syndrome. Contact dermatitis
in physicians and nurses who prepare and use
ampule solutions must be suspected.
To Socialized Medicine and Socialism by
Way of the Veterans Administration. By
Louis M. Orr, M.D. J. A. M. A. 162:860-865
(Oct. 27) 1956.
“We, and I mean all of the American people,”
says Dr. Orr, “must decide soon, before it is too
late, what is to be the future course of the YA
hospital and medical care program. That deci-
sion will determine whether we protect and im-
prove our private system of health care for all
494
ABSTRACTS
Volume XLIV
Number 5
people or whether we eventually reach socialized
medicine by default.” In this strong appeal, he
points out that the medical program of the Vet-
erans Administration shows a steady development
from 1917, when the first purely medical benefits
for veterans were authorized and limited to vet-
erans with service-connected disabilities, to 1956,
when the 170 VA hospitals have more than
123.000 constructed beds and more than 114,000
operating beds as compared with 37,570 patients
with service-connected conditions and almost
66.000 with non-service-connected conditions. The
course of this wasteful development must lead
either to an inequitable situation in which one
third of the adult citizens are, while two thirds
are not, entitled to free hospitalization, or else to
government hospital and medical care for the en-
tire population. The unfair discrimination that
now operates could be obviated by developing the
present plan consistently to its abhorrent conclu-
sion, namely, complete government control over
all personnel and services, with tax-paid, politi-
cally controlled medicine for everybody. The
reasonable alternative is to reverse this trend as
regards the VA program and to protect and im-
prove the private system of health care for all
people.
The Value of Entozyme® in the Clinical
Management of Diabetes Mellitus. By B. E.
Lowenstein, M.D. Am. Bract. & Digest Treat.
7:1465-1468 (Sept.) 1956.
Clinically, the author has noted that some
diabetic patients, particularly those who seem to
need protein most, fail to derive the anticipated
benefits from a high protein diet. It seemed to
him likely that the failure of such patients to im-
prove might be ascribable to a partial failure of
their digestive apparatus. For this reason he
decided to study the effect of adding to the high
protein diet tablets containing the pancreatic di-
gestive enzymes, in order to insure that the food
eaten was properly digested. The results thus far
obtained have been sufficiently encouraging to
warrant the publication of a preliminary report.
Significant symptomatic improvement was
shown by a group of 25 diabetic patients treated
with a high protein diet, oral pancreatic enzymes
(Entozyme) and careful control of their insulin
dosage so that neither excessive hyperglycemia
nor hypoglycemia occurred. There was also in
most cases not only a decline in the serum choles-
terol levels but a reduction of insulin require-
ments. It is suggested that this improvement was
due to redressing the nitrogen balance and making
available the lipotropic activity of protein, as well
as other intrinsic factors which are essential to
normal tissue metabolism.
Effects of Prolonged Stilbestrol Therapy
on Hematopoiesis in the Pregnant Human.
By Sidney J. Peck, M.D. Obst. & Gynec. 5:796-
800 (June) 1955.
In this study, the hematopoietic response of 10
normal pregnant women to large, prolonged doses
of stilbestrol (Smith regimen) is reported. This
regimen, begun in the early weeks of gestation,
called for an increasing dosage schedule up to the
thirty-sixth week of gestation. There were 2
primigravidas and 8 multigravidas in the study.
Their average age was 25.2 years, with the range
from 19 to 32 years. The results showed no sig-
nificant alteration in the mean erythrocyte count,
hematocrit, or hemoglobin values. The mean iron-
binding capacity was elevated above normal levels
at the height of stilbestrol therapy and after the
withdrawal of the hormone (antepartum, 38
weeks). The mean serum-iron values showed a
decrease at the height of stilbestrol therapy. The
mean erythrocyte protoporphyrin values were ele-
vated to anemia levels ante partum, both at the
height of therapy and after the withdrawal of
stilbestrol (38 weeks). The alterations in serum
iron, iron-binding capacity and erythrocyte pro-
toporphyrin were noted earlier in pregnancy than
in untreated pregnant women. In five stilbestrol-
treated patients anemia developed. No significant
changes were noted in the mean hemoglobin mass,
cell volume, or reticulocyte or leukocyte numbers.
It is concluded that stilbestrol administered
during pregnancy may be an additional factor in
the production of pregnancy anemia.
Pulmonary Resection for Tuberculosis.
By James D. Murphy, M.D., and James M.
Davis, M.D. J. Thoracic Surg. 32:772-777
(Dec.) 1956.
The high morbidity and mortality rates as-
sociated with excisional therapy for pulmonary
tuberculosis resulted in virtual abandonment of
that means of treatment prior to 1943, followed
by its revival at the beginning of the chemothera-
peutic era. The authors, along with others, were
impressed by the favorable early results obtained
when the lesions of pulmonary tuberculosis were
resected under the protection of streptomycin. It
was the consensus, however, that proper evalua-
tion of this means of therapy could not be made
J. Florida. M. A.
November, 1957
ABSTRACTS
495
until the patients had been followed for five to
10 years. The authors here present a study on
148 patients who underwent 150 pulmonary re-
sections during the years from 1946 to 1950. In
the series, 83 pneumonectomies were performed
and 67 lobectomies or resections of smaller units
than a lobe.
The operative mortality was 2.7 per cent and
the total mortality was 17.3 per cent. In the study
there was 100 per cent follow-up. Seventy-two
per cent of the entire group and 82 per cent of the
patients who left the hospital alive obtained satis-
factory results. Negroes often required a more ex-
tensive resection than white patients, but did as
well or better in so far as mortality, morbidity,
and long term follow-up were concerned.
Radiographic Findings in Certain Dis-
eases Peculiar to a Subtropical Climate. By
Gerard Raap, M.D. South. M. J. 50:189-194
(Feb.) 1957.
Dr. Raap reviews a few uncommon diseases
which may occasionally be encountered in the
South, either as importations or as examples of
indigenous disease. In this interesting account he
presents observations and experiences with ma-
laria, amebiasis, ainhum, leprosy, echinococcus
cyst, mango bezoar, ascariasis, screwworm infes-
tation, and schistosomiasis.
Cystic Medial Necrosis as a Cause of
Localized Aortic Aneurysms Amenable to
Surgical Treatment. By Henry T. Bahnson,
M.D., and Arthur R. Nelson, M.D. Ann. Surg.
144:519-528 (Oct.) 1956.
The authors recount recent experiences with
five cases of cystic medionecrosis of the aorta
treated surgically. In summary, they observe:
Cystic medionecrosis may be the cause of a local-
ized aortic aneurysm. Such aneurysms have been
seen principally in middle-aged patients in the
ascending aorta but also at the distal end of the
aortic arch. In the latter location the lesion may
be treated by excision and aortic anastomosis, pos-
sibly with an interposed graft. When the ascend-
ing aorta is involved, the aortic valve may become
incompetent as a result of dilatation of the valve
ring. The aneurysm as well as the valvular in-
competence has been relieved by excision of part
of the circumference of the aorta and restoration
of an essentially normal diameter. The structural-
ly weakened aortic wall was reinforced with a
nylon binder. The condition can be recognized
clinically and should be treated before great dila-
tation of the aorta, aortic dissection, or chronic
heart failure occurs.
Cystic medionecrosis is a poorly understood
cause of aortic disease. Results of surgical treat-
ment as well as the underlying disease require
further investigation.
Senile and Seborrheic Keratoses: Local-
ization of Succinic Dehydrogenase, Protein-
Bound Sulfhydryl and Disulfide Groups.
By Alvan G. Foraker, M.D., and William J.
Wingo, Ph.D. Am. J. Path. 32:521-533 (May-
June) 1956.
The effects of aging in the skin are obvious,
psychologically important, and accessible to study,
but comparatively little is known of their patho-
genesis, prevention, or retardation. As a contribu-
tion to knowledge of the aging process in the skin,
a study was made of the occurrence and distribu-
tion of dehydrogenase activity and of protein-
bound sulfhydryl and disulfide groups in senile
keratoses and seborrheic keratoses. The results
were as follows: (1) Dehydrogenase activity and
sulfhydryl groups, both related to vital phases of
cell function and growth, were found in non-
keratinized cells of both lesions, as well as in
basal and malpighian layers of adjacent epidermis.
(2) Evidence of dehydrogenase activity dimin-
ished in cells undergoing keratinization and was
absent in regions of complete keratinization.
(3) Disulfide groups, related to cell keratiniza-
tion, and sulfhydryl groups were found in kerat-
inizing cells and in regions of keratinization in
senile keratoses, seborrheic keratoses, and in epi-
dermis.
Despite the more ominous precancerous poten-
tial of senile keratoses, with these technics their
histochemical reaction pattern was essentially
similar to that found in seborrheic keratoses.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
496
Volume XL1V
Number S
President’ A Page
The Old Army Game
No! It isn’t stud poker. It’s the application of the old military lingo: “Hurry
up and wait,” or, as was the slogan in battle: “Use it up. Wear it out. Temporize.
Make it work.” That is the attitude and that is the challenge we are confronted
with today.
The “hurry up and wait” attitude was brought to mind this night after the
obstetric supervisor called me to the hospital because my patient was about to deliver,
in her opinion, and I should hurry. You who practice obstetrics know what I mean.
It’s no reflection on the ability of a well trained nurse, but here I am after two hours
and no delivery imminent. There is nothing wrong, but the attitude of “hurry up
and wait” is very real, yet, very proper and scientific.
This also brings to mind that we are in the act of attempting to carry out “Opera-
tions Medicare,” which from the beginning up to now is a “hurry up and wait”
affair. The government actually forced us to hurry up with the negotiations of the
contract in the beginning, and then promised to renegotiate seven months later. Be-
fore this time approached, the government announced its intention to delay renego-
tiation for an extended period. Now we hope this will take place in January 1958.
In the meantime, our Association, by resolution, has altered the original agree-
ment with the government. This resolution also carried with it a mandate that the
Board of Governors devise ways and means of taking care of the dependents involved
until another contract is negotiated. This resolution stated that the cost to the tax-
payer would be less than with the original fixed fee schedule. This portion of the
resolution further brought to mind the battle slogan: “Use it up. Wear it out. Tem-
porize. Make it work.” In carrying out the mandate of the resolution the members
of your Board of Governors have done the best they could under the circumstances.
They are using the old contract as much as possible. They hope to wear it out. They
have temporized as much as they could. They hope to make Medicare work.
We have up to now enough experience, opinions, problems, good and bad, to
know we have a real challenge before us if we continue to carry on Operations Medi-
care in Florida to the satisfaction of all concerned. Right now ours is a divided camp
in many respects. The problem is going to demand a lot of thinking, reasoning, con-
sideration, effort, concessions oftentimes, and, if we are not careful, expense to our
Association in order to reconcile this situation and come up with the best package
for all. It seems inescapable that we have a special meeting of the House of Dele-
gates to resolve this problem. This meeting is scheduled for December 8 in Jack-
sonville, well before the scheduled renegotiations in January. Let us come together
thoughtfully. Instruct your delegates, and better yet, accompany them to the meet-
ing. Let’s deliberate with the determination to settle this problem once and for all
in a manner fair and factual.
Doctors, the decision is yours. Make sure your decision is wise, workable and
satisfying to the majority of the membership of our Association. Let’s get away from
the old army game.
J. Florida, M. A.
November, 1957
497
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
SHALER RICHARDSON, M.D., Editor
Managing Editor
Editorial Consultant Ernest R‘ Gibson
Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman. .. .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D...., Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman .. .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
Psychiatric Analysis
As physicians continue to probe the tough
tegument which separates the minutiae of knowl-
edge called facts from the great core of the un-
known, they should derive satisfaction and
courage for further investigation from the ingen-
iousness of their methods. The human brain, be-
cause of its inaccessibility, has long resisted scien-
tific study of its functions. The search for a cure
of its ills, perforce, was of a philosophic rather
than a scientific nature.
Whether the recent increase in mental ill-
nesses is apparent because of better diagnoses,
or real because the exigencies of modern day
living have placed an undue burden on the
psyche, does not vitiate the fact that the last
decade has produced a greater interest in mental
disease than at any time since Freud. Classifi-
cation of mental disorders is improving. The
tautology of psychiatric terminology, if not de-
creasing, certainly has not increased. The
schizoid behavior of Freudian versus non-Freud-
ian disciples has improved to socially acceptable
levels. In fact, psychiatry recently has acquired
the same affect as dermatology or opthalmology.
True, the overworked psychiatrist, in trying to
mete out the most good to the most patients,
may have pressed the contact switch on his ECT
machine too readily, or may have deprived future
diabetics of some of their insulin supplies. Some
psychiatrists in their zeal have perhaps carried
conflicts back to the blastocyst stage of embry-
onic development, but these men, as they dis-
pensed their therapies, were also accumulating
knowledge and trying to discern what was true
and useful knowledge, so that the excessive swings
in their enthusiasm for one type of treatment
over another must not be too hastily condemned.
In any phase of medicine the impact of a new
therapeutic agent often has a greater effect on
the physician than on the patient receiving the
drug. The introduction of chlorpromazine to psy-
chiatric therapy was more stimulating to mental
disease researchers than a self-administered elec-
troshock. Unfortunately, psychiatrists have yet
to face the hangover which the sobering glare of
retrospect will have on the present day debauch
of tranquilizers, stimulants, calmatives and ener-
gizers which chlorpromazine introduced in its
498
EDITORIALS AND COMMENTARIES
Volume XUV
Number 5
wake. In this therapeutic morass, a clear path
has become visible leading to a further study of
physicochemical dysfunctions and imbalances as
a cause of mental illnesses. The demonstration
that a schizophrenic-like state may be produced
by a chemical agent assures further progress in
this direction.
Medicine, like the lives it tries to protect
and prolong, is dynamic. It is only by constant
striving along empiric lines that the physician
is able to glean some knowledge of man and his
ills. What is accepted as law and fact today may
be disproved tomorrow. Were the basis of modern
day psychiatry proved entirely false tomorrow
and all mental illnesses shown to be due to
physicochemical causes, no psychiatrist need bow
his head before his peer in apology for present
day treatment. The very fact that psychiatrists
have been able to diagnose, classify and develop
satisfactory methods of treatment for many
mental illnesses is indeed a gigantic feat consider-
ing that by the very nature of the brain, methods
of a scientific study used by other disciplines
of medicine were precluded. If the teachings of
Freud, Adler, Jung and others were totally dis-
carded as false, the magnificent intellects of these
investigators would assure that some day the
ills of man’s psyche will yet be cured by the
minds of men similar to theirs. Though their
theories may be proved wrong in part or in toto,
their energy, their methods, their analyses, and
the integration of the nebulous functions of the
mind and its ills will endure forever as a tribute
to their minds and the mind of man.
Artery Bank Problems
The cooperation of the medical profession and
the lay public of Florida is urgently needed in
an endeavor vital to the saving of lives in selected
cases, namely, that of the procuring of arteries for
artery banks. Such cooperation has not been forth-
coming in certain areas so that efforts toward
forming a bank in one city have been abandoned.
At least two cities that have banks have encoun-
tered difficulties in obtaining grafts because of
lack of wholehearted cooperation by members of
the medical profession, particularly some of those
in key positions, and lack of knowledge on the
part of the public as to the importance of these
vessels.
Articles in the current issue of The Journal
of the Florida Medical Association as well as
numerous articles in current medical literature
should indicate to the profession that cardiovas-
cular surgery represents one of the most signifi-
cant advances in the medical as well as the sur-
gical treatment of many diseases heretofore
thought hopeless in so far as rehabilitation is
concerned.
The fact that Florida surgeons are attempting
to keep abreast of the times should be appreciated
by the profession as well as the public. Efforts
should be made to stimulate interest in the secur-
ing of materials with which this work can be
done. A handful of surgeons and a few patholo-
gists cannot be expected to do it alone.
The cooperation of the public as well as pub-
lic officials can be obtained if we properly advise
and educate them. Properly worded autopsy
permits will permit cooperative pathologists and
others to secure these vessels. The placing of a
few catheters in the remaining ends of certain
vessels will overcome the objections of the mor-
ticians. Once they understand the importance of
our need, they are cooperative as long as they are
not impeded in performing their tasks.
The medical profession in some localities out-
side our state have utilized the press and other
public mediums in bringing the facts to the peo-
ple. They pointed out that sudden death may
not mean the end of earthly contributions by
loved ones. Living memorials can be established
by permitting the use of their arteries for some-
one who otherwise may not survive. Obtaining
the arteries causes no more disfigurement to a
body than a sutured operative wound or an ordi-
nary postmortem examination.
Three artery banks are operating in Florida,
in Jacksonville, Miami and Orlando. Their activi-
ties need not be limited to their immediate lo-
cality. The full capacity of these banks is not
realized because of lack of blood vessels. Cer-
tainly our highways and other danger spots pro-
duce enough deaths in young, healthy people to
more than supply our demands. Let us utilize
J Florida, M. A.
November, 1957
EDITORIALS AND COMMENTARIES
499
our facilities for the advantage of that unfortunate
patient who may need replacement of a vessel.
If laws and public servants are all that stand in
our way, let us bring our laws up to date and
let us educate our public servants, or see that
educated ones replace them. Other progressive
areas are not hamstrung by the opposition of a
few and the apathy of many.
Annual Meeting — Scientific Program
The scientific program of the annual meeting
of the Florida Medical Association presents an
unequaled opportunity for Florida doctors to pre-
sent their work to the profession. The practicing
physicians in the state have opportunities to re-
cord observations on health problems which could
not be made in other parts of the country. Be-
cause of its rapid growth, Florida is becoming
more and more a “melting pot” with its people
moving here from various parts of the land.
The effects of the change in climate, of different
types of work and of dislocation from a familiar
setting produce problems. Our geographic situa-
tion with the large number of fresh water lakes,
as well as two bodies of open salt water, and the
direct angle of the sun’s rays, as well as the
geologic formations which govern our natural re-
sources of minerals and water, offer interesting
fields for study. Certain of the more exotic dis-
eases may be recognized more frequently here
than elsewhere in the nation, and common dis-
eases often present a somewhat different natural
history than that seen in metropolitan areas.
Reports of observations of this type have been
given to the Association in the past.
The program for the next scientific session, to
be held May 10-14, 1958, at Bal Harbour, Mi-
ami Beach, will be selected by the Committee on
Scientific Work on November 16. The heart of a
scientific meeting is the caliber of the original
papers presented. A place can still be found on
the program for presentation of good work.
The development of new industries in the
state with health problems not previously faced
by our physicians offers a fertile field for ob-
servations. A growing problem is the increase in
accidents of all types and the need for develop-
ment of preventive measures. Treatment centers
for cases of poisoning have been established in
many hospitals as the result of presentations on
this subject to the Association. Automobile acci-
dents are increasing, and the fearful toll on our
roads should be critically examined for means to
reduce it. The great distances in Florida, the
straight roads, and the pressure to meet vacation
schedules lead to conditions which invite tragedy.
The alteration in the character of agriculture in
the state is changing the type of farm accidents.
The great opportunities for recreation with our
intense sun, the phenomenal increase in outboard
motor boating and water skiing must be changing
the types of injuries seen by our physicians. The
increase in problems associated with aging has
long been recognized because of the steady migra-
tion of senior citizens into the state over many
years. The effects of the change of food, water
and economic status on their nutrition could well
be studied.
The scientific exhibits present an opportunity
not only for presentation of original research and
new technics, but for review in perspective of
knowledge that has been accumulating over a
period of years. The exhibits also serve for un-
usual presentations of historical, broad general
scientific, or cultural nature related to medicine.
An excellent example of this type of exhibit re-
ceived much attention at the 1957 meeting.
The caliber of scientific motion pictures pre-
pared by Florida physicians has been unusually
high and the reception by the profession exceed-
ingly gratifying. The physical facilities for the
showing of motion pictures will be improved at
the next meeting.
The Committee on Scientific Work will review
abstracts of papers, exhibits, and motion pictures
proposed by members of the Association, select
those which seem of greatest interest, and arrange
them into a cohesive program. The innovation
last year of a day predominately devoted to scien-
tific papers permits busy practitioners to con-
dense the maximum up-to-the-minute postgrad-
uate education into a single day.
It is not too early for members to begin now
to plan presentations for the program in 1959. If
500
EDITORIALS AND COMMENTARIES
Volume XI.IV
Number 5
data are carefully collected and observations made
during the present busy fall and winter season,
they can be organized and analyzed in the spring
and summer. A review of the literature will per-
mit conclusions to be reached in ample time for
submission of abstracts in the fall of 1958. The
preparation of scientific material for presentation
to professional colleagues is a stimulating intel-
lectual experience, a rewarding type of self educa-
tion, and a duty to the profession.
“Fill Our Hearts With Thankfulness”
Traditionally, November is the month in
which the American people count their blessings
nationally. Thanksgiving Day is set aside for the
formal observance of a day of thanks for all the
benefits and privileges, the innumerable fruits
of achievement through the years, which have
accrued to the citizenry of this great democracy
since its founding. Pulpit and press and patriotic
organizations extol the founding fathers and the
glories of the democratic way of life. Such a
celebration is an altogether fitting tribute to a
great heritage. Should it not be even more?
Thanksgiving is an appropriate time for
every citizen to take stock of his individual
worthiness to share in this heritage and to eval-
uate his personal contribution toward keeping his
country strong and great and destined for an
ever greater future. A free country thrives only
at a price. The recipients of its bounty must in
turn make their contributions toward keeping
their country free and great.
The spirit that will insure the glory of Amer-
ica in the full strength of its greatness is exempli-
fied by the epitaph on a simple shaft that marks
the burial place of one of the immortals among
the founding fathers. Two days before his death,
Thomas Jefferson wrote this epitaph with his
own hand:
“ HERE WAS BURIED
THOMAS JEFFERSON ,
AUTHOR OF THE
DECLARATION OF
AMERICAN INDEPENDENCE ,
OF THE STATUTE OF
VIRGINIA FOR
RELIGIOUS FREEDOM
AND FATHER OF
THE UNIVERSITY OF VIRGINIA."
True enough, Jefferson was Governor of the
State of Virginia. He was elected to the Congress.
He was appointed Minister to France. He was
chosen to be Secretary of State. He was elected
Vice President. He was twice elected President
of the United States by a grateful Republic.
Why, then, his insistence on this extraordinary
record of his life and his place in history?
Jefferson himself gave the answer. To his
daughter he explained the reason why this in-
scription, and not one word more, was to mark
his resting place. “The things that are not on
my inscription,” he said, “are things the people
did for me. The things that are on it are things
that I did for the people.”
In his prayer book, Jefferson recorded this
prayer for his country:
“Almighty God, who has given us this good
land for our heritage; we humbly beseech
Thee that we may always prove ourselves a
people mindful of Thy favor and glad to do
Thy will. Bless our land with honorable in-
dustry, sound learning, and pure manners.
“Save us from violence, discord and con-
fusion; from pride and arrogance, and from
every evil way. Defend our liberties, and
fashion into one united people the multitudes
brought hither out of many kindreds and
tongues.
“Endowe with the spirit of wisdom those
to whom in Thy Name we entrust the
authority of government , that there may be
justice and peace at home, and that through
obedience to Thy law, we may show forth
Thy praise among the nations of the earth.
“In time of prosperity, fill our hearts with
thankfulness, and in the day of trouble, suf-
fer not our trust in Thee to fail; all of which
we ask through Jesus Christ our Lord.
Amen.”
At this Thanksgiving season, the citizens of
this entire nation would do well to lift this prayer
of Thomas Jefferson on high as their own.
J. Florida, M. A.
November, 1957
EDITORIALS AND COMMENTARIES
501
Physicians’ Role in Social Security
Cash Disability Benefit Program
As the Federal Social Security Administra-
tion’s cash disability benefit program moves into
the actual payment stage, the important role of
doctors in the program becomes increasingly
evident.
More than 100,000 disabled persons received
benefit checks during the month of August. Each
had been able to qualify under this strict federal
disability program only because of the voluntary
cooperation of his doctor.
The individual physician enters into the pic-
ture when the claimant is requested by the Social
Security Administration to submit to that agency
medical evidence of his disability. (Under the
law, the disability must be such as can be proved
by medical evidence.) There are two major
points in connection with each disability that
must be considered in the adjudication of each
claim:
1. What was the onset date of the disability?
When did it begin?
2. What is the present condition of the
claimant?
Each applicant is given medical report forms.
He is required to obtain his own medical evi-
dence by submitting the forms to one or more
doctors who have examined him and who would
be in a position to furnish the needed information.
(The responsibility rests entirely on the appli-
cant; the Social Security Administration is not
permitted to pay for the preparation of the re-
port forms. Whether there shall be such payment
and the extent of any such fees is a persona!
matter between the claimant and the physicu n 1
The physician is not asked to determ 'ne
whether his patient meets the disability require-
ments of the law. This is a matter decided upon
by teams of professional medical and lay exam-
iners who consider work history, education and
other factors as well as the condition of the ap-
plicant.
The medical report form, prepared under the
guidance of a Medical Committee, is designed to
enable the physician to give sufficient informa-
tion from his records for a determination to be
made without repeat calls or, in the vast majority
of cases, new examinations. Inherent, therefore, in
the rapid, yet thorough, development of a claim
for benefits is the necessity for complete infor-
mation on the medical form.
In submitting this information, R. B. Donald-
son, Jacksonville District Manager of the Social
Security Administration, stated that, in summary,
it might be said: No claim for Social Security
disability benefits can be paid without adequate
medical evidence of the beginning date and cur-
rent status of the disability. Procurement of this
evidence is a responsibility of the claimant, a re-
sponsibility which may be fulfilled only with the
cooperation of his physician. Clearly, the fate of
a claimant for disability benefits rests, in large
part, in the hands of his doctor.
Second Medico-Legal Institute
Jacksonville, November 22-23
The second Medico-Legal Institute sponsored
by the Florida Medical Association and The Flor-
ida Bar is being held at the George Washington
Hotel in Jacksonville, November 22-23. The
first Institute was held in Miami.
The program for the Institute should be of
interest to physicians from all Florida. It was
made up by a committee composed of Ben J.
Sheppard, M.D., LL.B., Coral Gables, Chairman,
Medico-Legal Law and Procedures Committee,
The Florida Bar, and W. Tracy Haverfield,
M.D., Miami, a member of the Public Relations
Advisory Committee of the Florida Medical
Association with the special assignment of liaison
with The Florida Bar, in consultation with John
S. Duss, LL.B., President of the Jacksonville
Bar Association; Leo M. Wachtel, M.D., Presi-
dent of the Duval County Medical Society, and
the respective committees of the medical society
and the Jacksonville Bar Association.
Registration begins at 9 a.m. Friday, No-
vember 22. Those physicians who cannot attend
the first sessions may register until 5 p.m. that
day.
There will be three social events: a luncheon,
reception and dinner on Friday. Arrangements
for attendance at these events may be made at the
registration desk.
The program follows:
FRIDAY, NOVEMBER 22
9:00 a.m. — “Relationship of Cancer and Trau-
ma”
Lucien Y. Dyrenforth, M.D., Jacksonville
Ashbel C. Williams, M.D., Jacksonville
C. C. Howell Jr., LL.B., Jacksonville
502
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 5
10:00 a.m. — “Relationship of Trauma and Strain
on the Cardiovascular System”
Karl B. Hanson, M.D., Jacksonville
James E. Cousar III, M.D., Jacksonville
Jack F. Wayman, LL.B., Jacksonville
11:00 a.m. — “Electromyograph as an Aid in Eval-
uating Nerve and Muscle Injury”
Simon Markovich, M.D., Miami
Ben J. Sheppard, M.D., LL.B., Coral Gables
12:00 Luncheon
1:30 p.m. — “Crash Syndrome”
Cornell University Team
3:00 p.m. — “Whiplash”
Richard A. Worsham, M.D., Jacksonville
Walter Beckman Jr., LL.B., Miami
4:30 p.m. — “Post Concussion Syndrome”
Edward J. Sullivan Jr., M.D., Jacksonville
William H. McCullagh, M.D., Jacksonville
Roger J. Waybright, LL.B., Jacksonville
6:00 p.m. — Reception
7:00 p.m. — Dinner
SATURDAY, NOVEMBER 23
9:00 a.m. — “Back Injury, Its Cause and
Sequelae”
Charles B. Mabry, M.D., Jacksonville
T. Paine Kelly Jr., LL.B., Tampa
10:00 a.m. — “Disability Evaluation”
Vernon T. Grizzard Jr., M.D., Jacksonville
George I. Raybin, M.D., Jacksonville
John E. Matthews Jr., LL.B., Jacksonville
Harry T. Gray, LL.B., Jacksonville
Southern Medical Association Meets
In Miami Beach, November 11-14
The Fifty-First Annual Meeting of the South-
ern Medical Association opens in the auditorium
on Miami Beach, November 11 and continues
through November 14. Dr. Donald F. Marion, of
Miami, is chairman of the Greater Miami Com-
mittees on Arrangements.
The scientific assembly will be composed of
20 sections representing the major medical and
surgical specialties. In addition to the programs
of the sections, many conjoint societies will offer
outstanding programs.
There will be 20 guest speakers from over the
nation and from foreign countries. In addition to
the national television feature, “Grand Rounds,”
a variety of color television will be presented.
A. M. A. Clinical Meeting
Philadelphia, December 3-6
The birthplace of American independence —
Philadelphia — will be the scene of the American
Medical Association’s Eleventh Clinical Meeting,
December 3-6, 1957. The center of activities will
be Convention Hall where scientific exhibits,
color television, motion pictures, technical ex-
hibits and scientific lectures will be presented
“under one roof.” Headquarters for the House
of Delegates will be the Bellevue-Stratford Hotel.
Highlights of the three and a half day con-
vention geared especially for the nation’s family
doctors include: (1) A special transatlantic
conference between distinguished physicians in
London and Philadelphia on “Advances in Chemo-
therapy of Cancer” via two way telephone at 3
p.m. EST on Wednesday; (2) A complete color
television schedule of surgical demonstrations
emanating from Lankenau Hospital; (3) A mo-
tion picture program daily plus a special session
Tuesday evening; (4) Exhibits featuring a well
rounded program and special displays on the
history of medicine in the Philadelphia area,
fractures and manikin demonstrations on prob-
lems of delivery; (5) Panel discussions on cardio-
vascular disease, cancer, emotional problems of
the menopause, hypertension, diabetes, arthritis,
and traumatic injuries; and (6) The General
Practitioner of the Year Award to be presented
by the American Medical Association to an out-
standing family doctor.
OTHERS ARE SAYING
This I Believe
As a doctor one sees life from its inception
to its termination. In this period in my own life
I have found it possible to correlate science with
spiritual beliefs and the atomic age has strength-
ened this spiritual outlook.
Wm. Howells, a leading American anthropol-
ogist, says, “Man unlike other animals is a
creature who comprehends things he cannot see
and believes in things he cannot comprehend.”
“Communism denies all religions and repudi-
ates the ancient religions as ‘The Opium of the
People.’ It is a faith proclaiming the coming
triumph of man over adversity and evil, and
man’s eventual entrance into earthly paradise.”
This I cannot believe.
J. Florida, M. A.
November, 1957
STATE NEWS ITEMS
503
“Whether your religion is Hinduism, Bud-
dhism, Islam, Judaism or Christianity your reli-
gious aspirations are similar. You seek assurance
of the favor of a God, protection against the dan-
gers of life, community with your fellows, cour-
age in your hour of conflict, comfort in your
hour of grief, guidance in your daily concerns,
release from the pains of conscience and hope
for some sort of immortality.”
Whatever my faith or my future in this
world or beyond, there is one creed I can recom-
mend to all my fellowmen. It is: whomever I
meet — whether for one minute or for a long
period — I leave some good or bad and he leaves
with me one or the other. When the end of life
comes here on earth my physical body departs
but the good and the bad remains. This I be-
lieve and I hope the good will be great and the
bad so small as to be forgotten.
(Read Life’s “The World’s Great Religions” from which por-
tions of the above were borrowed.)
“From Your President”
Frank J. Pyle, M.D.
Quarterly Bulletin, Orange County
Medical Society, July 1957
STATE NEWS ITEMS
The Public Health Service has announced
a new program of financial support for advanced
training of research scientists in neurological and
sensory disorders. The program will be conducted
by the National Institute of Neurological Dis-
eases and Blindness of the National Institutes of
Health, Bethesda, Md.
Individual awards are subject to renewal and
may be continued for a period of three years.
Stipends, which may range from $5,500 to $14,-
800 a year, are determined individually in ac-
cordance with each applicant’s qualifications and
training needs.
Application forms and instructions may be ob-
tained by writing to the Chief, Extramural Pro-
grams Branch, National Institute of Neurological
Diseases and Blindness, National Institutes of
Health, Bethesda 14, Md.
Drs. Clarence Bernstein and Solomon D.
Klotz of Orlando and Dr. Paul J. Coughlin of
Tallahassee took part on the program of the
Twelfth Annual Meeting of the Southeastern Al-
lergy Association held November 1-2 in the Fort
Sumter Hotel at Charleston, S. C.
Dr. Bernstein, who is President of the As-
sociation, presided over the first scientific session.
Dr. Klotz opened the discussion of the paper
“Allergic Vasculitis” presented by Dr. William A.
Thornhill Jr. of Charleston, W. Va. Dr. Cough-
lin presented a paper entitled “Vitamin and Min-
eral Balance.”
Dr. William C. Roberts of Panama City,
President of the Florida Medical Association, was
among the group of physicians from Florida who
attended the recent meeting of the American Col-
lege of Surgeons held at Atlantic City.
Dr. Walter C. Payne Sr. of Pensacola, a
former president of the Florida Medical Associa-
tion, presented greetings to the Gulf Coast Clini-
cal Society on behalf of the Association at its
meeting in Biloxi, Miss., the latter part of Octo-
ber.
Dr. John J. Farrell of Miami will present a
paper entitled “Diagnosis of Massive Gastrointes-
tinal Bleeding” on the program of the three day
Sectional Meeting of the American College of
Surgeons being held in the Hotel Heidelberg at
Jackson, Miss., January 16-18. Dr. Farrell will
also serve as one of the collaborators on the panel
for the discussion of “Complications of Abdomi-
nal Surgery.”
Dr. Edward R. Woodward, formerly associate
professor of surgery at the University of Cali-
fornia at Los Angeles, has been appointed Profes-
sor of Surgery and head of the Department of
Surgery at the University of Florida College of
Medicine at Gainesville.
The American Psychiatric Association through
support of The Smith, Kline & French Founda-
tion is offering a number of fellowships to psy-
chiatrists, mental hospitals, schools for the retard-
ed and teaching institutions dedicated to public
service. There are seven main types: staff psy-
chiatrist training fellowships; awards to hospitals
for teaching; extension training fellowships; stu-
dent fellowships; medical fellowships; foreign
scholar lectureships, and residency training fel-
lowships. Applications should be in the hands of
The Smith, Kline & French Foundation Fellow-
ship Committee on April 15. Information is avail-
able from Dr. Kenneth E. Appel, Chairman of
504
STATE NEWS ITEMS
Volume XLIV
Number 5
the Committee, American Psychiatric Association,
P. O. Box 7929, Philadelphia, Pa.
A^
Dr. Alvin E. Murphy of Palm Beach was
principal speaker at a recent meeting of the Ro-
tary Club of Boca Raton.
A*1
Dr. Taylor W. Griffin of Quincy was among
the group of Florida physicians who attended the
Sectional Meeting of the International College of
Surgeons held at Chicago.
A^
Dr. Williard H. H. Bennett of Titusville was
principal speaker at a recent meeting of the Ki-
wanis Club of that city.
Dr. William A. D. Anderson of Miami de-
livered the Presidential Address at the Confer-
ence of the College of American Pathologists held
at New Orleans late in September. The American
Society of Clinical Pathologists met jointly with
the College. Following the meeting in New Or-
leans, Dr. Anderson went to Mexico City for a
joint meeting with the Mexican Association of
Pathologists.
A*
Dr. Lauren M. Sompayrac of Jacksonville
presented a film on creeping eruption at the meet-
ing of the International Congress of Dermatology
held in August at Stockholm, Sweden. He also
visited clinics and hospitals while abroad.
A^
Dr. Julian A. Rickies of Miami has returned
from Washington where he attended an advanced
course in atomic warfare mass casualty manage-
ment at Walter Reed Hospital.
A*
Dr. Thomas M. Palmer of Jacksonville at-
tended the annual meeting of the Pan-American
Pediatric Conference held during August in Lima,
Peru. He also visited clinics and hospitals in
several South American countries.
A^
Dr. John T. Benbow of Chattahoochee has
been selected as chairman of the Florida Council
on Training and Research in Mental Health.
A^
Dr. Wilson T. Sowder of Jacksonville has
been reappointed State Health Officer by Gover-
nor LeRoy Collins.
Dr. Lee Sharp of Pensacola served as presid-
ing officer of the first scientific session of the
meeting of the Gulf Coast Clinical Society held
October 17 in Biloxi, Miss.
A*
Dr. Lawrence E. Geeslin of Jacksonville and
Dr. Charles K. Donegan of St. Petesrburg have
been appointed by Governor LeRoy Collins to
the State Tuberculosis Board.
A^
Dr. Nathan Arenson of Pensacola has been
appointed chairman of the medical division for
the United Fund Drive in the Pensacola area.
A^
Dr. Joseph L. Selden of Fort Myers was one
of the principal speakers on the program of the
Women's Clubs held recently at Clewiston.
A*
Dr. Rodman Shippen of Orlando discussed
“Psychiatry and Religion” recently in an address
before the Unitarian Fellowship of Jacksonville.
A*
Dr. Jess V. Cohn of Hollywood presented a
paper entitled “The Morbidophilic Diathesis” at
the Southeastern Regional Meeting of the Ameri-
can College of Physicians held October 4-5 at St.
Simons Island, Georgia.
A*
Dr. Russell C. Smith of Daytona Beach dis-
cussed the increasing use of multiple intravenous
fluids in anesthesia and demonstrated improved
methods of dosage control at the recent meeting
of the Florida Society of Anesthesiologists.
A-*-
Santford Russell Wilson of the class of 1960,
University of Florida College of Medicine, Gaines-
ville, has been selected as the first recipient of the
Dr. Stewart Thompson Memorial Award. This
award, made available by Dr. Richard C. Cum-
ming of Ocala, is awarded for high scholarship.
It was presented Mr. Wilson at the General Uni-
versity Scholarship Convocation on September 23.
A^
Dr. James C. Patterson of Tampa has re-
turned from New Orleans where he assisted in
the examination given by the American Board of
Pathology at Louisiana State University School
of Medicine. Dr. Patterson also attended the
meetings of the American Society of Clinical
Pathologists and the College of American Path-
ologists.
J. Florida, M. A.
November, 1957
COMPONENT SOCIETY NOTES
505
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
qualifications in writing. The Miami-Battle Creek,
Miami Springs, Fla.
WANTED: General surgeon desires location alone
or with associate. Board eligible, married, Florida li-
cense. Prefer smaller city. Write 69-238, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner to join three
man group in clinic practice in Miami. Florida li-
cense necessary. Adequate salary first, followed by
partnership. Give details first letter. Write 69-241,
P. O. Box 2411, Jacksonville, Fla.
WANTED: General Practitioner or Pediatrician
to share office with M.D. in N. W. Miami. Florida
license required. Excellent opportunity for young
man. Write 69-246, P. O. Box 2411, Jacksonville, Fla.
WANTED: A General Practitioner, an Ophthal-
mologist, an Otolaryngologist to associate with group
in Brevard County. Florida license necessary. Write
age, training, medical experience and references. Write
Box 368, Rockledge, Fla.
MIAMI LOCATION: Have your own building
in Miami. Accommodates two or more doctors. Park-
ing no problem. Strategic location on 4 Bus routes.
Good terms. One mortgage, low payments. All
equipped for General Practice or Gastroenterology
practice. Very clean condition. Call or write Frank
Gergen Company, 430 S. W. 6th Avenue, Miami,
Fla. Phone FR 1-3779.
HOSPITAL FOR SALE: 30 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
FOR SALE: Fifty milligrams of radium element
in five platinum needles, ten milligrams each. Price
$750. Write or call W. T. Simpson, M.D., Winter
Haven, Fla.
WANTED: Full time physician for new medical
building in Longwood, Florida. Rent free. Physician
to pay utilities. Contact H. S. (Lew) Arnold, Box 43,
Longwood.
OTOLARYNGOLOGIST: Board certified; Mayo
Clinic trained, desires association with individual or
group. Will consider solo practice. Write 69-243,
P. 0. Box 2411, Jacksonville, Fla.
WANTED: Physician desires temporary position
beginning January while awaiting residency. Have
two years surgical training. Any type practice con-
sidered. Florida license. Married. Age 28. Write
69-244, P. 0 Box 2411, Jacksonville, Fla.
OBSTETRICIAN - GYNECOLOGIST completing
military service in March, 1958 desires coastal loca-
tion with group, general practitioner or obstetrician-
gynecologist. Write 69-245, P.O. Box 2411, Jackson-
ville, Fla.
FOR RENT: Completely equipped office lower
Florida east coast. Large reception room, consultation
room, two treatment rooms, laboratory, X-ray, dark
room and ample parking area. Air conditioned. Write
Mrs. Edwin B. Davis, 235 Phipps Plaza, Palm Beach,
Fla.
COMPONENT SOCIETY NOTES
Brevard
The first fall meeting of the Brevard County
Medical Society was held September 10. Mem-
bers of the Woman’s Auxiliary met jointly with
the Society. Refreshments preceded the dinner
which was attended by 59 members, wives and
guests. Following dinner, the Society and Aux-
iliary were addressed jointly by Mr. Bruce S.
Bucher and Mr. Eugene W. Boylston, of Merrill,
Lynch, Pierce, Fenner and Bean, who spoke on
the position of common stocks in the physician's
investment program.
Broward
A film, “The Doubting Doctor,” was featured
at the October meeting of the Broward County
Medical Association. Dr. Ernest B. Howard, As-
sistant Secretary of the American Medical As-
sociation, was scheduled as principal speaker on
the program for the Association’s November
meeting.
Dade
The October meeting of the Dade County
Medical Association was highlighted by a discus-
sion of “The Physician’s Role in Atomic War-
fare” by Dr. Julian A. Rickies, of Miami and Dr.
William M. Schiff, also of Miami. Dr. Rickies
is chairman of the Association’s Medical Com-
mittee for Civilian Defense.
Duval
Dr. Malcom E. Phelps, President of the Amer-
ican Academy of General Practice, was principal
speaker for the October meeting of the Duval
County Medical Society. The title of his address
was “A Doctor’s Duty Professionally and Other-
wise.”
Dr. Manson Meads, Professor of Internal
Medicine at the Bowman Gray School of Med-
icine of Wake Forest College, Winston-Salem,
N. C., was scheduled as principal speaker for
the November meeting.
Hillsborough
Dr. Richard T. Farrior, of Tampa, was prin-
cipal speaker on the program of the October
meeting of the Hillsborough County Medical As-
sociation. The title of his address was “Detection
and Treatment of Head and Neck Cancer.”
506
Volume XLIV
Number 5
Lake
Dr. Lorenzo L. Parks, of Jacksonville, Direc-
tor of the Bureau of Special Health Services of
the Florida State Board of Health, was principal
speaker for the September meeting of the Lake
County Medical Society. Dr. Parks discussed
the licensing of hospitals and the indigent hos-
pitalization program.
Dr. Benjamin F. Perry Jr., of Leesburg, was
speaker for the October meeting. The subject of
his address was “Problems in Bone and joint
Surgery.”
Members of the Society voted to have a joint
meeting in November with the Bar Association
and its Auxiliary.
Marion
Congressman A. S. Herlong, of Leesburg, dis-
cussed recent Congressional action affecting med-
icine at the first fall meeting of the Marion Coun-
ty Medical Society held the latter part of Septem-
ber. Also on the program with Air. Herlong were
Dr. Henry J. Babers Jr., of Gainesville, and Mr.
Joe Stansell, of Jacksonville. Dr. Babers and
Mr. Stansell reviewed the developments of Blue
Shield.
Members of the Woman’s Auxiliary to the
Society were guests at the meeting which was
preceded by dinner.
Polk
The Polk County Medical Association has
paid 100 per cent of its state dues for 1957.
Volusia
An address by Dr. Robert E. Zellner, of Or-
lando, was a feature of the September meeting
of the Volusia County Medical Society. Dr. Zell-
ner discussed Blue Shield.
BIRTHS, MARRIAGES AND DEATHS
Births
Dr. and Mrs. John J. Fisher, of Jacksonville, an-
nounce the birth of a daughter, Sara Ann, on August
24, 1957.
Dr. and Mrs. Floyd L. Pichler, of Jacksonville, an-
nounce the birth of a son, Daniel Lester, on August 8,
1957.
Marriages
Dr. Wm. E. Van Landingham, of West Palm Beach,
and Miss Florence E. Grois, also of West Palm Beach,
were married in Atlanta, Ga., early in September.
Deaths — Members
McEvvan, John S., Orlando September 26, 1957
Deaths — Other Doctors
Wallace, Albert W., Tulsa, Okla. December 25, 1956
Bubis, Jacob Louis, Miami Beach July 23, 1957
Edmundson, Susan 0., Clearwater July 15, 1957
_ Announcing The Twenty-First Annual Meeting
THE NEW ORLEANS GRADUATE MEDICAL ASSEMBLY
Conference Headquarters — - Roosevelt Hotel
March 3, 4, 5, 6, 1958
GUEST SPEAKERS
Carleton B. Chapman, M.D., Dallas, Tex.
Cardiology
Herbert Rattner, M.D., Chicago, 111.
Dermatology
Charles A. Flood, M.D., New York, N. Y.
Gastroenterology
Robert A. Davison, M.D., Memphis, Tenn.
General Practice
Lawrence M. Randall, M.D., Rochester, Minn.
Gynecology
Bayard T. Horton, M.D., Rochester, Minn.
Internal Medicine
Perrin H. Long, M.D., Brooklyn, N. Y.
Internal Medicine
George N. Raines, Capt., MC, USN, Washington, D. C.
Neuropsychiatry
Robert H. Barter, M.D., Washington, D. C.
Obstetrics
Ralph O. Rychener, M.D., Memphis, Tenn.
Ophthalmology
C. Leslie Mitchell, M.D., Detroit, Mich.
Orthopedic Surgery
Frank D. Lathrop, M.D., Boston, Mass.
Otolaryngology
Arthur H. Wells, M.D., Duluth, Minn.
Pathology
James Marvin Baty, M.D., Boston, Mass.
Pediatrics
Harold O. Peterson, M.D., Minneapolis, Minn.
Radiology
Jere W. Lord, Jr., M.D., New York, N. Y.
Surgery
Claude E. Welch, M.D., Boston, Mass.
Surgery
Ormond S. Culp, M.D., Rochester, Minn.
Urology
LECTURES, SYMPOSIA, CLINICOPATHOLOGIC CONFERENCES. ROUND-TABLE LUNCHEONS,
MEDICAL MOTION PICTURES AND TECHNICAL EXHIBITS.
(All-inclusive registration fee — $20.00)
THE POSTCLINICAL TOUR TO MEXICO CITY, CUERNAVACA,
TAXCO AND ACAPULCO
Leaving March 7 from New Orleans and returning March 18, 1958
For information concerning the Assembly meeting and the tour
write, Secretary, Room 103, 1430 Tulane Avenue, New Orleans 12, La.
J Florida, M. A.
November, 1957
507
Pro-Banthlne® “proved almost invariably
effective in the relief of ulcer pain,
in depressing gastric secretory volume and in
inhibiting gastrointestinal motility”*
“Our findings were documented by an in-
tensive and personal observation of these
patients over a 2-year period in private prac-
tice, and in two large hospital clinics with
close supervision and satisfactory follow-up
studies.”*
Among the many clinical indications for
Pro-Banthlne (brand of propantheline bro-
mide), peptic ulcer is primary. During
treatment, Pro-Banthlne has been shown
repeatedly to be a most valuable agent when
used in conjunction with diet, antacids and
essential psychotherapy.
Therapeutic utility and effectiveness
of Pro-Banthlne in the treatment of peptic
ulcer are repeatedly referred to in the recent
medical literature.
Pro-Banthlne Dosage
The average adult oral dosage of Pro-
Banthlne is one tablet (15 mg.) with meals
and two tablets at bedtime.
G. D. Searle & Co., Chicago 80, Illinois.
Research in the Service of Medicine.
*Lichstein. J.; Morehouse, M. G., and Osmon, K. L.:
Pro-Banthlne in the Treatment of Peptic Ulcer. A
Clinical Evaluation with Gastric Secretory. Motil-
ity and Gastroscopic Studies. Report of 60 Cases,
Am. J. M. Sc. 232: 156 (Aug.) 1956.
s
■XNT RAVE N OUST Compatible with commo
IV fluids. Stable for 24 hours in
solution at room temperature. Ava
age IV dose is 500 mg. given at 12
hour intervals. Vials of 100 mg.,
250 mg. , 500 mg.
THERAPEUTIC BLOOD LEVELS ACHIEVED
Many physicians advantageously use
the parenteral forms of ACHROMYCIN j
in establishing immediate, effecti/(
antibiotic concentrations. With
ACHROMYCIN you can expect prompt
NTRAMUSCUIAjfr Used to start a pa-
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r for patients unable to take oral
edication. Convenient, easy-to-use,
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n office or patient's home. Supplied
n single dose vials of 100 mg., (no
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Tetracycline HCVW
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ERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
i. U.S. Pol. Oil.
510
Volume XI.1V
Number 5
Emory University School of Medicine
Atlanta, Georgia
Announces
SIX DAYS
°f
CARDIOLOGY
(January 13-18, 1938)
Major Problems of Heart Disease
will be discussed by
Members of the Emory University Faculty
and the following visitors:
A. Carlton Ernstene, M.D.,
Chairman, Division of Medicine,
Cleveland Clinic, Cleveland, Ohio
Dwight E. Harken, M.D.
Assistant Clinical Professor of
Surgery, Harvard Medical School;
Surgeon, Peter Bent Brigham
Hospital; Chief of Department of
Thoracic Surgery, Mount Auburn
and Malden Hospitals, Boston,
Mass.
Helen B. Taussig, M.D.,
Associate Professor of Pediatrics,
The Johns Hopkins University
School of Medicine; Director of
the Children's Heart Clinic of
the Harriet Lane Home, The
Johns Hopkins Hospital, Balti-
more, Md.
Eugene A. Stead, M.D.,
Professor and Chairman, Depart-
ment of Medicine, Duke Univer-
sity School of Medicine, Durham,
N. C.
Ancel B. Keys, M.D.,
Professor of Medicine, University
of Minnesota; Director of the
Laboratory of Physiological Hy-
giene, University of Minnesota
School of Public Health, Minnea-
polis, Minn.
Edward S. Orgain, M.D.,
Professor of Medicine, Duke Uni-
versity School of Medicine; Di-
rector, Cardiovascular Disease
Service, Duke Hospital, Durham,
N. C.
E. Grey Dimond, M.D.,
Professor and Chairman of the
Department of Medicine; Director
of the Cardiovascular Laboratory,
University of Kansas Medical
Center, Kansas City, Kansas.
Gene H. Stollerman, M.D.,
Associate Professor of Medicine,
Northwestern University, Chicago,
III.
Tuition fee: $100.00
Write: Postgraduate Teaching Program, Emory
University School of Medicine, 69 But-
ler Street, Atlanta 3, Georgia
Sfrecialcjed Service
«« doctor deeper
THEJ
MEDIGAI;BRQr.E(EfTI^Et
F.ortVWay?te. Inpiatja.
Professional Protection Exclusively
since 1899
i
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. PLAZA 4-2703
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Akes, Charles D., Boynton Beach
Astler, Vernon B., Hollywood
Bryan, Frank M., Fort Myers
Dell, George A., Gainesville
Eichert, Arnold H., Hollywood
. Eyster, William H. Jr., Indialantic
Johnson, Reginald H. Jr., Fort Myers
Jowett, John C., Orlando
Latty, Samuel G., Winter Park
Norris, Franklin G., Orlando
Olson, Edgar L., Winter Park
Tomlinson, John L., Fort Lauderdale
Wilcoxon, George M., Fort Lauderdale
Medical Licenses Granted
Dr. Homer L. Pearson Jr., Secretary of the
State Board of Medical Examiners, has reported
that of the 420 applicants who took the examina-
tion of the Board, held June 24 and 25, 1957, in
Miami Beach, 300 passed and have been issued
licenses to practice medicine in Florida. The
names and addresses of the 300 successful appli-
cants follow:
Abel, Marling Leo, Coronado, Calif. (Ohio U. 1954)
Aidem, Howard Philip, Miami (U. Illinois 1956)
Ajac, Ian Kalman, Brooklyn (Bowman Gray 1957)
Alexander, Bronson Raye, Hanover, N. H. (U. Okla.
1954)
Alexander, Stephen John Jr., Crawfordsville, Ind. (U.
Cinn. 1941)
Allen, Norma Royse, St. Petersburg (Woman’s Med. Pa.
1956)
Allison, Joseph, Mount Vernon, N. Y. (N. Y. U. 1947)
Ammons, John Carl, Jacksonville (Emory 1957)
Anderson, Robert Milton, Winter Haven (Tulane 1957)
Arnall, Robert Esric, Griffin, Ga. (Emory 1957)
Artzibushev, Constantin, Jacksonville (Leopold Francens
U. 1950)
Babcock, Kenneth Belknap, St. Petersburg (U. Mich.
1956)
Bates, James Sewell Jr., Atlanta, Ga. (Ala. 1952)
Bauer, Robert Edward, Baltimore (U. Md. 1946)
Bell, Lewis Barclay, Chicago (Northwestern 1946)
Benet, Armando Fernandez, Tampa (U. Havana 1946)
Bennett, Joseph Jacob, Hollywood (U. Ga. 1932)
Benway, Robert Emphy, Miami (U. Miami 1957)
Berg, Charles Frederick Jr., Coral Gables (U. Pitts-
burgh 1956)
Berg, Leonard, Boston (U. Tenn. 1956)
Berken, Arthur, Miami (Washington U. 1957)
Berman, Donald Abel, Washington, D. C. (Tulane 1957)
Berman, Leonard David, New Orleans (N. Y. U. 1957)
Berner, Clifford Leeland, Tallahassee (U. Louisville 1947)
Bernhard, Ernest Rubin Jr., Tampa (Southwestern 1956)
Bevilacqua, Michael, South Miami (Long Island M. C.
1933)
Bishop, Charles Sidney, Boston (Tufts 1939)
J. Florida, M. A.
November, 1957
511
NEW. . . intranasal synergism
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CwJbOuM:
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Neo-Synephrine® HCl 0.5 %
ANTI-INFLAMMATORY
Hydrocortisone 0.02%
ANTI-ALLERGIC
Thenfadil® HCl 0.05%
ANTIBACTERIAL
Neomycin (as sulfate)
0.6 mg./cc.
Polymyxin B
(as sulfate)
3000 u/cc.
cn
LABORATORIES
NEW YORK 18, N. Y,
Neo-Synephrine (brand of
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POTENTIATED ACTION for
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i
COLDS
SINUSITIS
ALLERGIC RHINITIS
512
Volume XLIV
Number 5
Blanks, Marguerite, Miami (U. Miami 1957)
Blum, Lawrence Michael, Brooklyn (Duke 1955)
Blumberg, Edward, Jacksonville (U. Miami 1957)
Boulware, James Richmond III, Durham, N. C. (Har-
vard 1957)
Bowcock, James Zitzer, Atlanta, Ga. (Emory 1957)
Bowers, John Edward, Montclair, N. J. (Yale 1947)
Braden, Frederick Richard, New Orleans (Tulane 1952)
Brewton, Samuel Alton Jr., Thomaston, Ga. (Ga. M.
C. 1956)
Brickler, Alexander Dumas, (Col.) Longbranch, N. J.
(Meharry 1953)
Brinson, John Bradford Jr., Monticello (U. Miami 1957)
Brooks, Beach Alexander, Chattanooga, Tenn. (Temple
U. 1953)
Brown, Leonard, Darby, Pa. (Hahnemann 1954)
Brown, Trave Lavell Jr., Parrish (Bowman Gray 1956)
Burford, Fred Jeff, St. Petersburg (Emory 1956)
Burnam, Robert Rodes, Louisville, Ky. (U. Louisville
1951)
Bush, Charles William Jr., Raiford (Boston U. 1936)
Cahoon, Stuart Newton, Miami (Temple 1943)
Campbell, Alan Brooks Jr., St. Petersburg (U. Tenn.
1955)
Campbell, William Rogers, (Col.) Miami (Meharry 1957)
Cannon, Stanley Joel, Coral Gables (Duke 1957)
Cardinale, Anthony Joseph, San Antonio, Tex. (Long
Island M. C. 1923)
Carnahan, Lloyd Gerald, Rochelle, 111. (U. Illinois 1954)
Carratt, James Angelo, Starke (Vanderbilt 1957)
Catanzaro, Santino Joseph, Mount Vernon, N. Y. (Jef-
ferson 1936)
Chakmakis, Apostolos George, Miami (Boston P & S
1948)
Chiat, Harold, New York (Harvard 1952)
Chriss, George Samuel, Jacksonville (Marquette 1957)
Cohen, Matthew, Minneapolis, (Tulane 1957)
Cole, Sanford Howard, Newark, N. J. (Chicago 1957)
Connor, James Davis, Miami (South Carolina 1953)
Cooke, Stanford Bernard, No. Miami Beach (Hahnemann
1954)
Cooper, Floyd Childs III, Orlando (U. Tenn. 1957)
Cooper, Leonard Selby, Sarasota (Jefferson 1943)
Coury, Oswald Harry, Miami (Western Reserve 1953)
Cox, Don Rawlis, Miami (U. Miami 1957)
Creighton, James Burns Jr., Tampa (Duke 1957)
Crews, Frederick Ferris, Flomaton, Ala. (Ala. 1953)
Crotzer, Malcolm Columbus, Jackson, Miss. (U. Tenn.
1946)
Danielson, Harry Edward Jr., Miami (Indiana U. 1951)
DeFelice, Eugene Anthony, Miami Beach (Boston U.
1956)
DeLand, Frank Howard, Lakeland (U. Louisville 1952)
Demos, Menelaos Peter, Chicago (U. Miami 1957)
Dennis, Joel Bernard, Miami (U. Cinn. 1954)
Denser, Clarence Hugh Jr., Chattahoochee (Tulane 1948)
Denton, Peyton Steele, Coral Gables (St. Louis 1952)
Dieter, Donald Dean, Salina, Kansas (Yale 1942)
Dill, Leslie Van Dyke, Washington, D. C. (Duke 1936)
Downing, John Dent Jr., Tampa (U. Md. 1956)
Drewry, Garth Richard, Tampa (Harvard 1952)
Duncan, Thomas Anderson, Washington, D. C. (Emory
1957)
Dunham, Charles Thomas, Bartow (Marquette 1950)
Eason, John Richard, Tampa (U. Miami 1957)
Edwards, Jefferson Rathburn Jr., Charlottesville, Va.
(St. Louis 1952)
Eff, Jack Simon, Jacksonville (U. Miami 1957)
Ehrenkranz, Nathaniel Joel, Miami (Yale 1949)
Elkins, John Thomas Jr., Havana (U. Miami 1957)
Ellis, Woodrow George, Jacksonville (U. Tenn. 1946)
Eyster, William Henry Jr., Melbourne Beach (U. Penn.
1943)
Ezzo, Joseph Anthony, St. Louis (St. Louis 1953)
Farrell, James Francis, Miami (N. Y. U. 1946)
r
v.
PHENAPHEN
('"ASIATIC''
Phenaphen Plus is the physician-requested
combination of Phenaphen, plus an anti-
histaminic and a nasal decongestant.
Available on prescription only.
each coated tablet contains: Phenaphen
Phenacetln (3 gr.) 194.0 mg.
Acetylsalicylic Acid (2 Vi gr.) . 162.0 mg.
Phenobarbital (Vi gr.) .... 16.2 mg.
Hyoscyamine Sulfate .... 0.031 mg.
plus
Prophenpyridamine Maleate . . 12.5 mg.
Phenylephrine Hydrochloride . 10.0 mg.
\
J
J. Florida, M. A.
November, 1957
513
tor certain disorders of menstruation and pregnancy
TRULY EFFECTIVE PROGESTATIONAL THERAPY
BY MOUTH
oral progestogen
with
unexcelled potency
and
unsurpassed efficacy
Now, with small oral doses of this new and dis-
tinctive progestogen, you can produce the
clinical efFects of injected progesterone. In
amenorrheic women for example, “As little as
50 mg. of [norlutin] administered in divided
doses over a five-day period was sufficient to
induce withdrawal bleeding.”1
CASE SUMMARY 2
Amenorrhea of 4 years’ duration in a
24-year-old married woman. A course of 10 mg.
NORLUTIN twice daily for 5 days was followed
after 3 days by menses lasting about 5 days.
Since no spontaneous menstruation occurred
during the following 35 days, she was given
another course of treatment with NORLUTIN,
10 mg. twice daily for 5 days. This was followed
by menses.
When this patient was given ethisterone, 40 mg.
twice daily for 5 days, no bleeding had ensued
when she was seen 41 days later.
indications for norlutin ■ conditions involving
deficiency of progestogen such as primary and second-
ary amenorrhea, menstrual irregularity, functional
uterine bleeding, endocrine infertility, habitual abor-
tion, threatened abortion, premenstrual tension, and
dysmenorrhea.
rackagingi 5-mg. scored tablets (C. T. No. 882),
bottles of 30.
REFERENCESi (1) Greenblatt, R. B.: /. Clin. Endocrinol.
16:869, 1956. (2) Hertz, R.; Waite, J. H., & Thomas, L. B.:
Proc. Soc. Ex per. Biol. & Med. 91:418, 1956.
PARKE, DAVIS & COMPANY
lb)* DETROIT 32, MICHIGAN
E A
50191
514
Volume XLIV
Number 5
Favis, Edward Alfred, Fort Washington, Pa. (U. Phil-
lippines 1947)
Fealy, Jack, Miami Shores (George Washington U. 195 1 )
Fernandez, Manuel C., El Paso, Texas (Jefferson 1953)
Ferre’, George Allan, Great Lakes, 111. (U. Va. 1957)
Figueroa, Miguel Jr., Santurce, P. R. (New York M. C.
1948)
Finney, Roy Pelham Jr., Lakeland (South Carolina 1952)
Firestone, Melvin P., Eglin A. F. B. (Northwestern 1955)
Fitch, Charles Walter, Tampa (U. Tenn. 1953)
Fitzgerald, Joseph Hodges, Miami (U. Va. 1957)
Fleet, Harvey Meyer, Fort Walton Beach (Vanderbilt
1957)
Flipse, Thomas Edward, Miami (U. Miami 1957)
Foard, Milton Cowan, Leesburg (South Carolina 1953)
Ford, Elbert Sylvester Caldwell, Merion Station, Pa.
(Vanderbilt 1939)
Frv, Richard McGruder, Ann Arbor, Mich. (Temple
’ 1954)
Fuzy, Paul James Jr., Youngstown, Ohio (Harvard 1946)
Fyvolent, Joel David, Tampa (Lausanne U. 1955)
Gachet, Fred Smith Jr., Lakeland (Johns Hopkins 1957)
Genest, Aloria Stephen, Miami (St. Louis 1957)
Gerspacher, Thomas Stone, Miami (U. Louisville 1933)
Getz, Morton Ernest, Miami (Bowman Gray 1956)
Gibson, James Franklin, Tampa (Duke 1956)
Giddings, Marvin Alvin, Tampa (Emory 1957)
Gilbert, Arthur Ira, Miami Beach (U. Miami 1957)
Gillman, Arthur, Miami (U. Geneva 1954)
Giordano, Robert Paul, Sarasota (Chicago 1952)
Giovinco, Joseph, Tampa (Tulane 1957)
Gleich, Gerald, Canajoharie, N. Y. (U. Mich. 1956)
Golubovic, Zivomir, Miami Beach (U. Munich 1951)
Gould, Louis Nathan, Coral Gables (New York M. C.
1927)
Gray, Gene Woodrow, Birmingham, Ala. (Ala. 1957)
Groover, Robert Vann, Atlanta, Ga. (Emory 1957)
Haimes, Leonard, Miami (Hahnemann 1953)
Hall, James Alden, Lake City (Med. Evang. 1955)
Hamner, Bennie Rodgers, Birmingham, Ala. (Ala. 1957)
Harden, David Lee, Pensacola (Tulane 1957)
Hardman, William Wallace Jr., Winter Haven (Emory
1957)
Harris, Joan Osheroff, Miami Beach (U. Miami 1957)
Heiss, Harold Burgess, Miami (U. Miami 1957)
Helsper, James Thomas, Cocoa Beach (Jefferson 1947)
Hirsh, John Henry, New Rochelle, N. Y. (Flower, 5th
Ave. Hosp. 1953)
Hodges, Charles Hubert Jr., Marianna (Emory 1957)
Holford, Fred DeWitt, Miami (U. Vermont 1956)
Holladav, William Edward Jr., Augusta, Ga. (Virginia
1952)
Holland, Charles Phillip, Palm Beach (U. Louisville
1954)
Holly, John Hayes Jr., Jacksonville (U. Miami 1957)
Howard, Woods Abernathy, Lakeland (U. Texas 1947)
Ifft, Robert Charles, Iowa City (Temple 1953)
Johnson, Curtis Corydon, Lake Worth (U. Buffalo 1953)
Johnson, Walter Hughes, New York (U. Tenn. 1940)
Jones, David Lewis, St. Petersburg (Western Reserve
1954)
Joseph, Julius Mortimer, New York (N. Y. U. 1934)
Kafka, Maximilian Martyn, Miami Beach (U. Md. 1924)
Kandel, William Isadore, Miami Beach (U. Miami 1957)
Kaszuba, Alexander, St. Petersburg (Friedrich Alexander
U. 1948)
Kathe, John Henry, Coral Gables (Ohio U. 1957)
Kaye, Donald, Yonkers, N. Y. (N. Y. U. 1957)
Kesler, Robert Milton, Orlando (U. Va. 1954)
Killoran, Paul Joseph, Fort Lauderdale (Boston U. 1954)
Kirk, Michael James, South Miami (George Washington
U. 1954)
HUGH LAUBHEIMER AND WALTER BURKHARDT
ARTIFICIAL EYE SPECIALISTS
FORMERLY WITH MAGER & GOUGELMAN
HAVE OPENED
L&B LABORATORIES, INC.
1431 N.E. 26th Street Fort Lauderdale, Florida
LOgan 6-1878
PLASTIC OR GLASS EYES • CUSTOM-MADE OR STOCK
PRIVATE FITTINGS • SELECTIONS SENT UPON REQUEST
VISITS TO OTHER CITIES TO BE SCHEDULED
PROBLEM FITTINGS ARE OUR SPECIALTY
J. Florida, M. A.
November, 1957
515
CLINICAL COLLOQUY
1 1
My patients complain that
the effect of the pain tablet I prescribe
often wears off in less than 3 hours.
Why not try the new analgesic
that gives faster,
longer- lasting pain relief?
D 1
You mean something that
doesn't require repeat dosage so often?
1 1
ce
Yes — it’s called Percodan.®
It not only works in 5 to 15 minutes but
one tablet sustains its pain-relieving effect
for 6 hours or longer!
How about side effects?
1 1
No problem. For example,
the incidence of constipation
is rare with Percodan. *
93
I 0
Sounds worth trying — what's the average adult dose?
I I
; > (D
One tablet every 6 hours. That’s all.
V I
Where can I get literature on Percodan?
1 1
Just ask your Endo detailman or write to:
ENDO LABORATORIES
Richmond Hill 18, New York
*U.S. Pat. 2,628,185. PERCODAN contains salts of dihydrohydroxycodeinone and
homatropine, plus APC. May be habit-forming. Available through all pharmacies.
516
Volume XC7V
Number S
How +o win -friends ...
I FLftVOftgn
Childrens Si;
ASPIRIN
tablets
The Best Tasting
Aspirin you can prescribe.
The Flavor Remains Stable
down to the last tablet.
25tf Bottle of 48 tablets (13 4 grs. each)
We will be pleased to send samples on request.
THE BAYER COMPANY DIVISION
of Sterling Drug Inc.
1450 Broadway, New York 18, N. Y.
J. Florida, M. A.
November, 1957
517
Kirkpatrick, James Leroy Jr., Atlanta, Ga. (Emory 1957)
Kitaif, James Myron Collins, Macon, Ga. (Ga. M. C.
1955)
Klein, Harry Adolph, St. Louis (St. Louis 1929)
Knorr, Keith Howard, Fort Walton Beach (Iowa M. C.
1954)
Knowles, John Little, Jacksonville (Ala. 1955)
Lampert, Ronald Marvin, New York (U. Tenn. 1957)
Lampkin, John Chadwick, Toledo, Ohio (U. Mich. 1956)
Landy, Jerome Jacob, Miami (U. Illinois 1950)
Lansden, Frank True, Winter Haven (Ohio U. 1956)
Lasichak, Andrew Gregory, Detroit (Jefferson 1940)
Lawrence, Joseph Woodruff, Fort Myers (Iowa U. 1937)
Levine, Robert Lee, Tampa (U. Md. 1953)
Levitt, Alan Bruce, Riverdale, N. Y. (Chicago 1956)
Lieberman, Warren Jay, Miami (Tulane 1957)
Lieurance, Richard Edward, Jacksonville (Tulane 1946)
Lindsey, Edwin Leon, Orlando (U. Tenn. 1956)
Lindsey, William Frederick, Augusta, Ga. (Ga. M. C.
1954)
Locke, Margaret Marie, St. Petersburg (U. Miami 1957)
Logan, John Bronson, Sarasota (Jefferson 1948)
Lynch, Harold John Jr., Miami Beach (Georgetown 1957)
MacCubbin, Don Aubrey, Durham, N. C. (Johns Hop-
kins 1957)
McCallum, Charles Alexander Jr., Birmingham, Ala. (Ala.
1957)
McDonald, James Kenneth, Augusta, Ga. (Ga. M. C.
1956)
McDonald, Lawrence Patton, Atlanta, Ga. (Emory 1957)
McNeil, James Porter Jr., New York (U. Va. 195*2)
Maercks, Ralph Owen, Winston-Salem, N. C. (Bowman
Gray 1957.)
Marine, William Murphy, Fairhope, Ala. (Emory 1957)
Marsh, Robert Leslie, Lake Worth (New York M. C.
1949)
Martin, Calvin Wallace, Columbus, Ga. (U. Tenn. 1957)
Maxwell, Edgar James Jr., Thomson, Ga. (Ga. M. C.
1943)
Miles, George Gregory, New Orleans (Long Island, M. C.
1944)
Milledge, Robert Dempsey, South Miami (Emory 1957)
Mitchell, Joseph Alexander, Los Angeles (U. Miami 1957)
Moore, John Beveriv III, Mount Vernon, 111. (U. Illinois
1952)
Morris, John de LaSalle, Tampa (Cornell 1950)
Moses, Robert Jerome Jr., Miami Beach (Loyola 1948)
Nalebuff, Edward Alan, Brighton, Mass. (Tufts 1953)
Nash, Seymour Cy, Palm Beach (Washington U. 1956)
Nichols, Thomas Howard, Evansville, Ind. (Indiana U.
1952)
Oliver, George Charles Jr., Jacksonville (Harvard 1957)
O’Neill, James Frank, Miami (Duke 1957)
Onkey, Richard Gale, Hialeah (U. Tenn. 1957)
Ott, Franklin Bernard, Maplewood, N. J. (Loyola 1945)
Pace, Leonard D., Forest Hills, N. Y. (George Washing-
ton U. 1957)
Palmer, David Bartow, Stamford, Conn. (Columbia
1954)
Palmer, Henry George Jr., Atlanta, Ga. (Emory 1957)
Park, Fred Eugene, Long Island, N. Y. (U. Miami 1957)
Parrish, Henry Mack, Ocala (U. Penn. 1953)
Paschall, Homer Alvin, Plant City (Bowman Gray 1957)
Pauk, Zdenek Daniel, Miami (Iowa U. 1956)
Perle, Martin Harold, West New York, N. J. (Indiana
U. 1949)
Perlman, Aaron Martin, Jacksonville (U. Miami 1957)
Perry, Ronald Howard, Jacksonville (U. Tenn. 1956)
Phillips, Curtis Manning Jr., Jesup, Ga. (Ga: M. C. 1943)
Phillips, Morton Fred, Milwaukee (Marquette 1953)
Pittman, Roy Clinton, Clearwater (South Carolina 1956)
Platt, Marvin Stanley, Pikesville, Md. (U. Md. 1956)
Platten, Phillip Matthew, Cleveland (Ohio U. 1954)
Pooser, Francis Shingler, Lake Wales (Emory 1957)
Porto-Perez, Francisco, Tampa (U. Havana 1949)
Potash, Irwin Michael, Miami Beach (Jefferson 1953)
Poteete, Floyd Herod Jr., Pahokee (Northwestern 1951)
when anxiety and tension "erupts” in the G. I. tract...
IN GASTRIC ULCER
PATHIBAMATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of gastric ulcer — without fear of barbiturate loginess, hangover or
habituation . . .with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
’Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
518
Volume XI.IV
Number 5
Price, Robert Cornelius Jr., Tampa (U. Cinn. 1953)
Principato, Dominick Joseph, New York (Tulane 1952)
Quick, James Chilton, Clendenin, West Va. (Washington
U. 1943)
Radigan, Leo Robert, Indianapolis (Indiana U. 1947)
Radin, Arthur, Miami (U. Miami 1957)
Ranes, Raymond David, Key Biscayne (Bowman Gray
1956)
Rape, William Chalmers, New Smyrna Beach (Emory
1957)
Redd, Henry Jefferson Jr., Baltimore, Md. (Johns Hop-
kins 1957)
Resnick, Benjamin, New Rochelle, N. Y. (U. Edinburgh
1932)
Ribot, Seymour, Orange, N. J. (U. Louisville 1946)
Richards, James Fred Jr., Atlanta, Ga. (North Carolina
1957)
Roberts, Daniel, Miami (Bowman Gray 1957)
Robinson, James Lee Jr., Brooklyn (U. Penn. 1932)
Robinson, John Ritchey, Kankakee, 111. (Northwestern
1940)
Rogers, Robert Ernest, West Palm Beach (U. Miami
1957)
Rogers, Robert Jay, Richmond, Ind. (Med. Evang. 1956)
Rosemond, Robert Malone, Charleston, S. C. (Duke
1953)
Ryon, Alden Billings, Miami (U. Cinn. 1953)
Sachs, Julian Spencer, Washington, D. C. (U. Geneva
1954)
Sacks, Sidney, Miami Beach (U. Md. 1946)
Sadwin, Arnold, Miami (Chicago 1956)
Sager, Samuel Ott, Bartow (Duke 1953)
Sanders, Jack Ernest, Panama City (U. Miami 1957)
Sarlin, Morton Bruce, New York (Tulane 1957)
Saunders, Earl Nicholas, Danville, Va. (U. Miami 1957)
Schulman, Martin Lewis, Brooklyn (Albany 1957)
Schwartz, Melvin Jay, Wilmington, N. C. (Duke 1957)
Selzer, Melvin Lawrence, Ann Arbor, Mich. (Tulane
1952)
Serrins, Alan Jack, Coral Gables (U. Miami 1957)
Setnor, Jules Roswell, Longmeadow, Mass. (Syracuse U.
1935)
Shapiro, Daniel Martin, Miami (N. Y. U. 1944)
Shapiro, Jerome Benjamin, Coral Gables (N. Y. St. U.
1957)
Sherman, Marion Moore Jr., Hampton, Va. (U. Va.
1952)
Shively, John Adrian, Bradenton (Indiana U. 1946)
Siek, Hilmer Gerard Jr., Belleair Beach (Columbia 1952)
Simonson, Louis, Miami (U. Leyden 1956)
Small, David, Miami (U. Miami 1957)
Smith, Henry Roy III, Coral Gables (Ga. M. C. 1956)
Smith, Norman Ty, Fort Lauderdale (Harvard 1957)
Smotrilla, Margaret Mary, Miami (U. Miami 1957)
Solomon, Alan, New York (Duke 1957)
Southerland, W'esley LaMarr, Miami (U. Miami 1957)
Spanjers, Arnold Joseph, Winter Haven (U. Minn. 194.
Sporn, Max, Miami Beach (Chicago 1954)
Spoto, Angelo Peter Jr., Tampa (Duke 1957)
Steir, Bruce Saul, Miami Beach (U. Miami 1957)
Stephen, Ralph Merrill, Atlanta, Ga. (Chicago 1951)
Stewart, Charles Calloway, Donaldsonville, Ga. (Em<
1952)
Stolove, Sender, Miami (Tulane 1956)
Stone, James Lovell, Tampa (Jefferson 1956)
Strasser, Noel Faine, Westchester, 111. (George Washin
ton U.)
Stuckey, Walter Jackson Jr., Metarie, La. (Tulane 195
Sussman, Herbert Bernard, Los Angeles (Tulane 1957
Sylvan, Melvin Manuel, Miami Beach (Wayne 1941)
Tannozzini, Joseph Richard, Miami (Georgetown 195
Taubel, David Edward, Fort Lauderdale (U. Penn. 19*
(Continued on page 521)
Active relief
in
cough
both allergic and infectious
HYDRYLUN
COMPOUND
• allays bronchial spasm • liquefies tenacious secretions • suppresses allergic manifestations
The ingredients of Hydryllin Compound are proportioned to provide high therapeutic response.
Each 4 cc. (one teaspoonful) contains:
Aminophyllin
Diphenhydramine
Ammonium chloride
32.0 mg.
8.0 mg.
30.0 mg.
Chloroform . . .
Sugar
Alcohol 5% (v/v)
. . 8.0 mg.
. . 2.8 Gm
G. D. Searle & Co., Chicago 80, Illinois.
s
Research in the Service of Medicine
J. Florida, M. A.
November, 1957
519
when treating
Tablets
Each tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Syrup
Each teaspoonful (5 cc.) contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1
125 mg.
Phenacetin
1 20 mg.
Salicylamide
150 mg.
Ascorbic Acid (C)
25 mg.
Pyrilamine Maleate
15 mg.
Methylparaben
4 mg.
Propylparaben
1 mg.
Available on prescription only
The Achrocidin formula is particularly valuable in treating acute re-
spiratory infections during epidemics and other outbreaks.
In addition to rapid symptomatic improvement, Achrocidin offers
prompt control of the bacterial superinfection frequently responsible
for such disabling complications as pneumonia, otitis media, sinusitis,
bronchitis, pneumonitis to which the patient may be vulnerable.
The comprehensive Achrocidin formulation includes both Achro-
mycin Tetracycline — broad-spectrum antibiotic action — and analgesic
components recommended for rapid relief of malaise, headache, mus-
cular pain, pharyngeal and nasal discharge.
Adult dosage for Achrocidin Tablets and new, caffeine-free Achro-
cidin Syrup is two tablets or teaspoonfuls of syrup three or four times
daily. Dosage for children according to weight and age.
ACHROCIDIN
*
TETRACYCLINE-ANTIHISTAMINE-AN ALOES 1C COMPOUND
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
*Trademark
520
Volume XLIV
N V M HER 5
just two tablets
at bedtime
for gratifying
rauwolfia response
virtually free from side actions
Rauwiloid ®
\ Mm)
^ "~7oS ANGERS'
ie
J. Florida, M. A.
November, 1957
521
(Continued from page 518)
Taylor, William Gramer, West Palm Beach (U. Term.
1956)
Teichner, Ronald, Miami (U. Illinois 1953)
Terezakis, George Ernest, Orlando (Emory 1957)
Tillman, Ralph Allen, Spartanburg, S. C. (Ga. M. C.
1957)
Tolmach, Robert Scott, Houston, Texas (N. Y. U. 1945)
Towbin, Samuel, Pompano Beach (U. Colorado 1929)
Treadwell, Tandy Walter Jr., Miami (Vanderbilt 1957)
Tumlin, Paul Franklin, Milledgeville, Ga. (Ga. M. C.
1955)
Unger, Hugh Sheldon, Brooklyn (U. Tenn. 1957)
Ungerleider, John Thomas, Shaker Heights, Ohio (West-
ern Reserve 1957)
Updegraff, Ambrose Gavitt, St. Petersburg (Iowa U. 1955)
Vaughen, Justine Liesel (f), Ann Arbor, Mich. (Temple
1954)
Vizzi, Ferdinando Freddie, Metairie, La. (Tulane 1956)
Weiner, Myron Frederick, Dallas, Texas (Tulane 1954)
Weisbart, Mvron Herbert, Delmar, N. Y. (Columbia
1950)
Weiser, Albert, Fall River, Mass. (Boston P&S 1941)
Weiser, Frank Morton, Boston (Harvard 1957)
Weiss, Sherwyn Lee, Columbia, S. C. (U. Illinois 1954)
Wells, Leonard Rudolph Jr., Lake City (U. Louisville
1946)
Wells, Sarah Lou, Miami (U. Miami 1957)
Wenner, Robert Bruce, Pensacola (Temple 1954)
White, Robert Campbell, Pensacola (U. Miami 1957)
Wilbur, Ronald Eugene, Rochester, Minn. (U. Kansas
1946)
Wilcox, William Curtis-Nash, Atlantic Beach (Tulane
1957)
Williams, Moke Wayne, Fort Lauderdale (U. Cinn. 1953)
Williams, Sylmar Nance, (Col.), Lake Wales (Howard
U. 1957)
Wilson, Robert Manton Jr., Richmond, Va. (Virginia
1943)
Winslow, Kenneth Lane, Detroit (U. Mich. 1949)
Wolff, Theodore Martin, Miami (Emory 1957)
Wood, James Garland Jr., Birmingham, Ala. (U. Color-
ado 1945)
Woolsey, Robert Dean, St. Louis (Harvard 1937)
Wunderlich, Ray Charles Jr., Tyndall A. F. B. (Columbia
1955)
Yates, Basil Manley, Houston, Texas (U. Tenn. 1950)
Zaias, Nardo, Miami Beach (U. Miami 1957)
Zimmerman, Aaron Harold, Miami (U. Miami 1957)
Zucker, Reuben, Waterbury, Conn. (Yale 1944)
OBITUARIES
Gail Ellsworth Chandler
Dr. Gail Ellsworth Chandler of Miami died
in that city on Dec. 15, 1956. He was 63 years
of age.
Born in Carman, 111., on Aug. 2, 1893, Dr.
Chandler received his elementary education in
the public schools of his native state. He attend-
ed the Jefferson Medical College of Philadelphia,
where he was awarded the degree of Doctor of
Medicine in 1918. For some years he served in
the United States Navy as a lieutenant com-
mander.
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 mg.)t he most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexefhyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
522
Volume XLIV
Number 5
In 1925, Dr. Chandler came to Miami from
Evanston. 111., and entered the private practice
of medicine there, specializing in ophthalmology
and otolaryngology. He was associated with the
late Dr. Bascom H. Palmer from 1925 until the
death of Dr. Palmer in September 1954. Local-
ly, he was a member of the Miami Rotary Club
and was a Mason.
Dr. Chandler had for more than three decades
been a member of the Dade County Medical As-
sociation, the Florida Medical Association and the
American Medical Association. He was also a
fellow of the American College of Surgeons and
was certified by the American Board of Otolaryn-
gology. He held membership in the Florida So-
ciety of Ophthalmology and Otolaryngology and
the American Academy of Ophthalmology and
Oto-Laryngology.
Alexis Merritt Melvin
Dr. Alexis Merritt Melvin of South Miami
died suddenly on June 18, 1957, of a heart attack.
He was 77 years of age.
A native of Philadelphia, Dr. Melvin received
his medical training in that city. He was awarded
the degree of Doctor of Medicine by the Jefferson
Medical College of Philadelphia in 1904. Before
locating in Miami, he practiced medicine in Roy-
ersford, Pa. During World War I, he served as a
captain in the Medical Corps in the European
theater. His interests in Miami included active
membership in the Camera Club of Miami and
the Blue Lodge of the Masons.
Dr. Melvin was licensed to practice medicine
in Florida in 1933, and his specialty was in-
ternal medicine. He was a member of the Dade
County Medical Association, the Florida Medical
Association, the American Medical Association,
the Southern Medical Association, and the Ameri-
can Congress of Physical Medicine.
Surviving are the widow, Mrs. Dorothy F.
Melvin, of Miami; one brother, Frank Melvin,
and two sisters, Mrs. William Trimble and Mrs.
Jay Schmidt, all of Philadelphia.
Merrick D. Thomas Sr.
Dr. Merrick D. Thomas Sr. of Miami died
in a local hospital on July 9, 1957. He was 80
years of age and had been hospitalized for two
months following his wife’s death.
( Continued on page 537 )
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MEMBER
TELEPHONE 5-4362
9th ST. & 6th AVE.. SO.
ST. PETERSBURG, FLORIDA
J. Florida, M. A.
November, 1957
523
Incremin offers 1-Lysine for protein utilization, and es-
sential vitamins noted for outstanding ability to stimulate
appetite, overcome anorexia.
Specify incremin in either Drops (cherry flavor) or
Tablets (caramel flavor). Same formula. Tablets, highly
palatable, may be orally dissolved, chewed, or swallowed.
Drops, delicious, may be mixed with milk, milk formula,
or other liquid; offered in 15 cc. polyethylene dropper
bottle.
Dosage only 1 incremin tablet or 10-20 incremin
Drops daily.
Problem-eaters, the underweight, and generally below
par patients of all ages respond to incremin.
Each incremin Tablet
or each cc. of incremin Drops contains:
1-Lysine
Vitamin B12
Thiamine (Bi)
300 mg.
25 mcgm.
10 mg.
Pyridoxine (B 6) 5 mg.
(incremin Drops contain 1% al-
cohol)
Reg, U. S. Pat. Off.
The many thousands of patien
successfully treated wi
Signemycin* over the past ye
have confirmed the value of th
safe and effective antibiot
agent. One further therapeut
resource is thereby provide
the practicing physician who
faced daily in office and hon
practice with immediate diagnos
of common infections and tl
immediate institution of tl
most broadly effective theraj
at his command, in his continuii
task of the ever-extendii
control over human pathogen
Now buffered to produce high* I
faster blood levels; specify tl
V form on your prescriptioi I
Supply: Signemycin V Capsull
250 mg. Signemycin Capsui I
250 mg. and 100 mg. Signemyl
for Oral Suspension, 1.5 Gil
125 mg. per 5 cc. teaspoonf I
mint flavor. Signemycin Intraveno I
500 mg. vials and 250 mg. vk I
buffered with ascorbic ac I
Pfizer Laboratori I
Division, Chas. Pfizer & Co., Ill
Brooklyn 6, N. f
zer) World leader in antibio ||
development and productil
iighty-seven patients with various
[ections of the skin were treated over
period of six weeks with [Signe-
,cin]. Excellent or good results were
hieved in sixty-seven, including
ven of twenty-two patients refrac-
•y to other antibiotics.”
wis, H. If.; Frumess, G. M., and
•nschel, E. J.: Rocky Mountain M. J.
:806 (Aug.) 1957.
esults of treatment with oleando-
cin-tetracycline of 50 infections
lostly respiratory] due to resistant
nanisms and 40 infections [respira-
v, skin, urinary infections] due to
isitive organisms are very encour-
ing. In some of these patients,
ignemycin] was lifesaving, and in
lers surgery was made unnecessary,
is confirms other reports.”
ubin, H.: Antibiotic Med. & Clin,
lerapy 4:174 (March) 1957.
sed on case reports documented by
lependent investigators in 26 coun-
es abroad, the clinical response
tained with Signemycin in 1404 pa-
nts with a wide variety of infections
s successful in 1329 patients; in 13
ses only was it necessary to discon-
ue therapy because of side effects.
port on 1404 Cases Treated with
gnemycin: Medical Department,
Pfizer International. Available on
request.
In 50 nonselected patients, Signemy-
cin “...appears to be effective in the
treatment of most general surgical in-
fections, including virulent staphylo-
coccus aureus infections. In some cases
these infections had been clinically
resistant to other antibiotics. The drug
is apparently well tolerated.”
Levi, W. M., and Kredel, F. E.: J.
South Carolina M. A. 53:178 (May)
1957.
Of 50 patients with various infectious
processes, 26 had not responded to
previous antibiotic therapy. With Sig-
nemycin “Ninety-six per cent of the
mixed infections were clinically con-
trolled. . . . and in none of the cases
was there any reason to discontinue
the drug.”
Winton, S. S., and Chesrow, E.: Anti-
biotics Annual 1956-1957, New York,
Medical Encyclopedia, Inc., 1957,
p. 55.
Signemycin in 79 patients with severe
soft tissue infections: “The average
response of these cases was excellent
and inflammatory symptoms subsided
with almost uniform rapidity The
magnitude and incidence of surgical
intervention was reduced Side re-
actions were minimal. . . .”
LaCaille, R. A., and Prigot, A.: Anti-
biotics Annual 1956-1957, New York,
Medical Encyclopedia, Inc., 1957,
p. 67.
Five groups of patients (total 211)
with acne were treated with one of five
antibiotic agents, including Signemy-
cin (55 cases). “The results were
evaluated taking into consideration the
usual response to such conservative
conventional therapy and the rapidity
of response.” In 8 weeks, Signemycin
rapidly attained and maintained the
highest percentage of efficacy of anti-
biotic agents tried.
Frank, L., and Stritzler, C.: Antibiotic
Med. & Clin. Therapy 4:419 (July)
1957.
In the treatment of 78 patients with
tropical infections, some complicated
by multiple bacterial contamination or
present for years, Signemycin was
found to be “. . . an exceptionally effec-
tive agent,” requiring smaller doses
and less extended periods of therapy
than with the tetracyclines alone, and
“caused no notable toxic reactions.”
Loughlin, E. H., and Mullin, W. G.:
Antibiotics Annual 1956-1957, New
York, Medical Encyclopedia, Inc.,
1957, p. 63.
AYCIN
OLEANDOMYCIN TETRACYCLINE-PHOSPHATE BUFFERED
PROVED CLINICALLY EFFECTIVE
oleandomycin tetracycline
trademark
When specifying
buffered Signemycin V
be sure to write the
V on your Rx
526
Volume XLIV
Number 5
If wil! pay you well
to check
and double check
Check these facts!
Baker's Modified Milk is a complete infant food
— contains all requirements for complete infant
nutrition ... It is available in two time-saving
forms — easy - to - prepare Baker's Liquid and
Baker s Pouder, the latter particularly adaptable
for prematures and for complemental and sup-
plemental feedings. Both forms are low in cost
— less than a penny per ounce of formula.
%
FeedinS Dhedidd v
modimd M UK 7-
newborn K <l,1
D°k«r's to 2 „ JS (Hospi,o|)
Double Check the results you get!
In the hospital — and at home.
BAKER’S MODIFIED MILK
THE BAKER LABORATORIES. INC.
/Pluk fitaohicZa tfe /Medical* 'P/u^pAeUoro
Main Office: Cleveland 3, Ohio • Plant: East Troy, Wisconsin
Liq
J. Florida, M. A.
November, 1957
527
The
Upjohn Company
announces
a major
corticosteroid
improvement
minor
chemical
changes
can mean
major
therapeutic
improvements
The most
efficient of all
anti-inflammatory
steroids
• Lower dosage
(Vi lower dosage
than
prednisolone)
• Better tolerated
(less sodium
retention, less
gastric irritation)
Supplied: Tablets of 4 mg., in bottles
of 30 and 100.
♦TRADEMARK FOR M ETHYLPREDN ISOLON E, UPJOHN
For
complete information, consult
your Upjohn representative,
or write the Medical Department,
The Upjohn Company,
Kalamazoo, Michigan.
Upjohn
528
Volume XI.I V I
Number 5
“the value of analgesic and tranquilizing agents
should be clearly recognized in the management of [ angina ] . .
new for angina
{p^TT+fWARAXs
RENTACWVtHAlTOL BAA NO Of
TETRANITRATC HYOHOXrEWIC
1
*
—
—
•mmoLi *4isa I
_
links freedom from anginal attacks with a shelter of tranquility
~~T,
"""■■ ■»; — mm mm
In pain. Anxious. Fearful. On the road to cardiac in-
validism. These are the pathways of angina patients.
For fear and pain are inextricably linked in the
angina syndrome.
For angina patients — perhaps the next one who
enters your office— won’t you consider new cartrax?
This doubly effective therapy combines petn (pen-
taerythritol tetranitrate) for lasting vasodilation and
atarax for peace of mind. Thus cartrax relieves
not only the anginal pain but reduces the concomi-
tant anxiety.
Dosage and supplied: begin with 1 to 2 yellow tab-
lets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. This may be increased for maximal effect by
switching to pink tablets (20 mg. petn plus 10 mg.
atarax). In bottles of 100.
cartrax should be taken before meals, on a contin-
uous dosage schedule. Use with caution in glaucoma.
1. Russek, H. I.: J. Am. Geriat. Soc. *:877 (Sept.) 1956.
•Trademark
J. Florida, M. A.
November, 1957
529
<- READ THIS
530
Volume XLIV
Number 5
Current Concepts in
Feeding Newborns
Successful infant feeding depends on effective
planning of the newborn’s nutritional regimen.
The first feeding, 12 hours after birth, may
consist of a prelacteal solution of KARO®
Syrup. This should be offered in one or two
ounce amounts at two hour intervals for 24 to
48 hours to fulfill the high water requirement
during the first week of life. Breast feeding may
be initiated on the second day for five minute
intervals to obtain colostrum and stimulate
breast secretion. However, the prelacteal feed-
ing is continued thereafter and between nursings.
Artificial feeding is offered on the second
day if breast feeding is denied. Small infants
are fed at three hour intervals and large infants
at four hour intervals. The initial formula usu-
ally is a low caloric milk mixture to enable
gradual adaptation of the feeding to the infant’s
tolerance. Concentration of the formula is grad-
ually increased at intervals of several days, in
the absence of digestive disturbances. The in-
fant should be fed in a semi-reclining position,
burped during and after feeding, and kept on
his right side or abdomen undisturbed for an
hour.
The same problems of infant feeding recur
from generation to generation, but solutions
may differ with each era. The carbohydrate
requirement for all infants is as completely
fulfilled by KARO Syrup today as a generation
ago. Whatever the type of milk adapted to the
individual infant, KARO Syrup may be added
confidently because it is a balanced mixture
of low molecular weight sugars, readily miscible,
well tolerated, palliative, hypoallergenic, resis-
tant to fermentation in the intestine, easily di-
gestible, readily absorbed and non-laxative. It
is readily available in all food stores.
first formulas for newborns
ADAPTED ACCORDINO TO TOIERANCE
FORMULA I ”
•Whole Milk ^ oz.
Water \/2 oz.
Karo
31/2 oz. x 6 q 4n.
**Evap. milk 14 oz.
Water . .Vi oz.
Karo * * V, ’ ‘
31/2 oz. x 6 q 4h.
FORMULA. ”
Dried milk 20 oz.
Water
Karo I' "A!'
31/2 oz. x 6 q 4h.
FORMULA 111 '“"Vf,:
Whole milk 10 oz.
Water j oz.
Karo
31/2 OZ. x 6 q 4h.
FORMULA...
Evap. milk 12 oz.
W°,er 1 oz.
Karo I*"/.'
3 oz. x 6 q 4h.
formula
Dried milk 20 oz.
Water , OI.
Karo
31/2 oz. x 6 q «h.
•Whole lactic acid milk for-
mulas may also be prepared
from whole cow's milk.
• •Whole lactic acid milk for-
ties may also be prepared
from evaporated cow s
ilk.
MEDICAL DIVISION
CORN PRODUCTS REFINING CO.
17 Battery Place, New York 4, N. Y.
formula 13 5 caU9/°z.
Whole milk ^ oz
Water ‘ °z.
31/2 oz. x 6 q 4h.
FORMULA..
Evap. milk 13 oz.
Water '.‘.’.'.3/4 oz.
Kar° 3 oz. x 6 q 4h.
formula..
Dried milk 20 oz.
Water _
Karo I---//
31/2 oz. X 6 q 4n.
Adapted from Nelson's Pediatrics,
Saunders, Phila. 1 954
Produced by
Corn Products Refining Co.
J. Florida, M. A.
November, 1957
531
Achrostatin V combines Achromycin! V . . .
the new rapid-acting oral form of
Achromycin! Tetracycline . . . noted for its
outstanding effectiveness against more than
50 different infections . . . and Nystatin . . . the
antifungal specific. Achrostatin V provides
particularly effective therapy for those
patients who are prone to mondial overgrowth
during a protracted course
of antibiotic treatment.
•applied :
Achrostatin V Capsules
contain 250 mg. tetracycline
HC1 equivalent (phosphate-
buffered) and 250,000
units Nystatin,
dosage :
Basic oral dosage (6-7 mg.
per lb. body weight per day)
in the average adult is
4 capsules of Achrostatin V
per day, equivalent to
1 Gm. of Achromycin V.
*Trademark
fReg. U. S. Pat. Off.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. N. Y.
Flu Fight
Drug Firms Speed
Vaccine Output, Bu
Will the U.S. Need
Asiatic Virus Raises Th
Government Buys, F
:l nd Hens Have to H(
8 STUDENTS ON
FLIGHTS TO U.S. en Attack, Rapid Sj
HAVE ASIAN FLU
War on Mutant A
Florence was in the grip of an epi-
: of colds, coughs and fevers, astrolo-
. . . declared that it was caused by
ifluence of an unusual conjunction of
ts. This sickness
known as “infl
-Chronicles of
1200-1470.
combat new r
:e,” a worldwide
.veek in respons
the Far East. Si
: World Health
which collects i
around the globe
nens of the ene
In more than a
Asian Flu: the Outlook
Asian influenza will hit the U.S. this
fall before mass immunization can be
effective, and the nation faces an epi-
demic which may strike 15 million to
30 million people. The disease is relatively
mild (in no way comparable to the kill-
ing “Spanish flu’’ of 1918-19), and is
likely to cause only a small number of
deaths among the feeble young and En-
feebled old. But it may compel 10% to
20% of the population in affected areas
to tal
j New York, Aug. 15 V?
; Laboratory tests on e
foreign exchange student
arrived Aug. 8 show they
victims of Asiatic flu, the
health department repo
today. The eight arrived
plane from Europe.
Twenty-nine other studi
suffering from influenza
rived Tuesday from Roiwt
dam on the ship Arosa Sky.
One, Nicholas Memmos, y
Greek exchange student. tnc'T
yesterday. Six of these stu-
dents were released today
the others are to be v ' if
tomorrow. It has not /
’ termined whether,
died from Asiatic
THE INFLUE
How Deadly Will it
What Can We Do a
IF
Ansv
States
l>ng those of th'
thus
W
quie'
a co:
pect
Ser
non
The War On Asiatic Flu
There's cause for concern about Asiatic
flu, but scientists and public health officials
*ce no reason for anyone to panic.
First shipments of the vaccine against the
new influenza strain have arrived in Chi-
cago, setting off a flood of telephone calls
from worried patients to doctors, and from
doctors to drug suppliers. This is a nor*"
pattern of mass fear and is understan
>f tho r
Even though Salk vaccine priorities were
necessary, the regulation produced adminis-
trative headaches, public complaints and
probably a gray, if not a black market. When
V . .
regulation 1
0 PUBLIC HEALTH
invoke it.
would u '
Influenza I
► INFLUENZA, one of the most
dictable of communicable diseases,
ing “on cat feet" across the natioi
now. It has already struck once th
in mild epidemic form at an Air
base in Colorado. When and how s
it will strike again is a perennial rl
public health authorities.
It will probably not lie dorma
flic rest of the winter months. At 1 1’
:mic
using It?
to counteract
complications from
ORIENTAL FLU
UCH "ASIATIC" FLU-
e New Virus Threat From Orient
it" flu
there
1 cases
l' ' '
QMtrtt
ucture of the vir.
534
Volume XLIV
Number 5
SELECTION OF SUITABLE SULFONAMIDE
IS OF PRIME IMPORTANCE IN LONG-TERM THERAPY
OF URINARY TRACT INFECTIONS
Drug Must Meet High Standards of Efficacy and Safety
In recent years sulfonamide therapy for urinary tract in-
fections has gained new popularity because the original
drugs have been replaced by more soluble, less toxic
and more effective sulfas.1 Gram for gram, a single sul-
fonamide featuring high solubility and low acetylation is
unsurpassed for efficacy and safety — especially in pro-
longed therapy.
An editorial in the Journal of the Amer-
ican Medical Association states that sul-
fonamides are successful in 90 per cent
of urinary tract infections, and . . should
be tried first.”2 There are many properties
a sulfonamide should possess before it can
be claimed to be efficacious and safe.
“Thiosulfil,”® brand of sulfamethizole, is
considered to be one of the . . most accept-
able sulfonamides for treatment of urinary
tract infections . . .”3
Broad Bacteriostatic Index
“Thiosulfil” is effective against most gram
negative and gram positive organisms com-
monly found in the urinary channels.
High Plasma — Urine Levels
“Thiosulfil” is rapidly absorbed and ex-
creted, achieving high antibacterial levels
in the urine and throughout infected tissue,
with negligible penetration into red blood
cells.
High Solubility
“Thiosulfil,” in both the active and acet-
ylated forms, is highly soluble in urine over
a wide pH range, thus permitting effective
action with minimal side effects. Alkalini-
zation is not required; fluids may be re-
stricted rather than forced.
Low Acetylation
“Thiosulfil” is virtually unacetylated. As
much as 90-95 per cent remains in the free
therapeutically active form. Virtually all of
a given dose is therefore available for anti-
bacterial action.
In a long-term clinical study, patients
with incurable chronic urinary infections
were kept symptom free for as long as five
or six years on a maintenance dose of one
or two tablets of “Thiosulfil” daily.4 In an-
other evaluation, 20 patients were given
25-100 grams of “Thiosulfil” over a period
of 20-90 days without incidence of side re-
actions.5 Goodhope6 reports that during 30
months of clinical use with “Thiosulfil,” nc
evidence occurred of exanthemata, urti-
caria, emesis, fever, hematuria and crystal-
luria.
Recommended Dosages: 0.5 Gm. four times
daily. The pediatric dosage is 30 to 45 mg.
daily per pound of body weight. If voiding
occurs during the night, an extra half-dose
should be given. Fluids may be restricted
rather than forced.
Availability: Tablets, 0.25 Gm. (bottles
of 100 and 1,000) . Suspension, 0.25 Gm. per
5 cc. (bottles of 4 and 16 fl. oz.).
Bibliography on request.
Ayerst Laboratories ^
New York, N. Y. • Montreal, Canada «
J. Florida, M. A.
November, 19S7
535
why wine
in digestive
disorders?
Although the effects of wine on the
digestive system have been discussed
years that many of its physiological
attributes have been determined.
for centuries, it has been only in recent
WINE AND THE SALIVARY GLANDS— The increase in salivary flow following a
moderate intake of wine is apparent almost immediately,1 such increase being
attributed to direct sensitization of secretory nerve endings.2
WINE AND GASTRIC SECRETION— With a pH averaging 3.2, wine resembles
gastric juice more closely than does any other natural beverage. Its tannins, organic
acids and salts of these acids serve as buffering agents to maintain this pH.
Relatively low in content of alcohol, table wine has been found to stimulate gastric
secretion and induce production of gastric juice high in hydrochloric
acid, sodium chloride, rennin and pepsin.3
WINE AND THE DIGESTIVE TRACT— With its low concentration of alcohol, wine
in moderate consumption has been found to induce a marked increase in
biliary flow.4 This, together with increased function of pancreatic enzymes, may
thus encourage better digestion of fatty foods.
THEREFORE — IN THE TREATMENT OF DIGESTIVE DISORDERS-Wine is being
widely recommended in the treatment of anorexia, hypochlorhydria without
gastritis, mucous colitis, spastic constipation and diarrhea, and in digestive disorders
stemming from emotional tension and anxiety.
These and other modern 3^ uses for wine are discussed in the brochure
“Uses of Wine in Medical Practice.” For your free copy write— Wine
Advisory Board, 717 Market Street, San Francisco 3, California.
1. Winsor, A. L. ond Sfrongln, E. !.: J. Exper. Psychol. 16.589 (1933).
2. Beozell, J. M., ond Ivy, A. C.: Quart. J. Studies on Ale. 1.45 (1940).
3. Foroy, G., and Weissenbach, R. J.: Hopital 25:306 (1937).
4. Okada, S.: J. Physiol. 49:457 (1915).
536
For Speedy Return To Normal Nutrition
VOLUME XLIV
Number 5
in the congestive phase
of cardiac disease
Meat fits well into the moderate-protein, restricted-sodium,
acid-ash diet currently recommended for many patients with
congestive cardiac failure.1
The protein of meat — in the proportionate arrangement
of its essential amino acids — closely approaches the quanti-
tative proportions needed to promote human tissue synthesis
and repair. For this reason lean meat proves important in
maintaining positive nitrogen balance without excessive pro-
tein intake.
The sodium content of meat prepared without added
salt is relatively low. Per 100 grams, beef muscle meat shows
approximately 50 mg. of sodium, lamb 90 mg., pork 60 mg.,
and veal 50 mg.2
The acid ash of meat aids in the promotion of diuresis.
The easy digestibility of meat is a prime requisite of
foods specified for the patient with congestive cardiac disease.
In addition to these important features, meat contrib-
utes other nutritional factors essential in any convalescence
— the B vitamins thiamine, riboflavin, niacin, pantothenic
acid, B6, and Bi2, and the minerals iron, phosphorus, potas-
sium, and magnesium.
1. Odell. W. M.: Nutrition in Cardiovascular Disease, in Wohl, M. C., and Goodhart, R. S.:
Modern Nutrition in Health and Disease, Philadelphia, Lea & Febiger, 1955, p. 699.
2. Bills. C. E.; McDonald. F. G.; Niedermeier, W., and Schwartz, M. C.: Sodium and Potassium
in Foods and Waters, J. Am. Dietet. A. 25:304 (Apr.) 1949.
American Meat Institute
Main Office, Chicago...Members Throughout the United States
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nutri-
tion of the American Medical Association and found
consistent with current authoritative medical opinion.
J. Florida, M. A.
November, 1957
537
( Continued from page 522 )
Born in Gold Hill, Ala., in 1877, Dr. Thomas
received his medical training at Columbia Univer-
sity College of Physicians and Surgeons in New
York, where he was graduated in 1904. He served
internships at the New York Lying-In Hospital
and the City Hospital at Blackwell’s Island, New
York.
Dr. Thomas entered the private practice of
medicine in New Rochelle, N. Y., and one year
later returned to his native state, locating in
Opelika. In 1921 he left Alabama for Florida
and established an active practice in general med-
icine in Miami, which he continued to conduct
until two months prior to his death. Locally, he
was for many years an active member of the Or-
der of Shrine and of the Benevolent and Protec-
tive Order of Elks.
A member of the Dade County Medical As-
sociation, Dr. Thomas was also a member of the
Florida Medical Association, in which he had held
membership for three decades. In addition,
through the years he was affiliated with the Amer-
ican Medical Association.
Survivors include one son, Dr. Merrick D.
Thomas Jr., of Miami; two daughters, Mrs. Eu-
gene King, of Miami; and Mrs. Minette Scar-
brough, of Hollywood; three brothers including
Dr. Edwin C. Thomas, of Miami; two sisters,
three grandchildren and three great-grandchildren.
William Daniel Nobles
Dr. William Daniel Nobles of Pensacola died
on Oct. 3, 1956 in that city. He was 76 years
of age.
Born in Escambia County, near Pensacola, on
April 7, 1880, Dr. Nobles acquired his elemen-
tary education in the schools of that county and
then attended the Pensacola Business College.
He received his medical training at the Atlanta
College of Physicians and Surgeons, later Emory
University School of Medicine, and was awarded
the degree of Doctor of Medicine in 1907. Re-
turning immediately to Pensacola, he engaged
in the practice of general surgery there for al-
most half a century.
In 1909, Dr. Nobles was elected city physi-
cian and health officer, a post he held for 22 years.
He then became company surgeon for the Louis-
ville and Nashville Railroad, retiring from this
position in 1954 after 20 years of service. Fra-
ternally, he was a thirty-second degree Scottish
For Treatment of Chronic or Acute
Respiratory Conditions The
BENNETT INTERMITTENT POSITIVE
PRESSURE BREATHING APPARATUS
is the ANSWER
Send for Literature . . .
1050 W. Adams St.
T. B. SLADE, JR.
P. O. Box 2580
Jacksonville, Fla.
J. BEATTY WILLIAMS
538
Volume XLIV
Number 5
Rite Mason, a Shriner and a member of Zellica
Grotto No. 60. He held membership in the Gads-
den Street Methodist Church. His business asso-
ciations included membership on the Board of
Directors of the First Bank and Trust Company
and the Pensacola Loan and Savings Bank.
This veteran Pensacola surgeon received wide
recognition as a pioneer of the medical profes-
sion in the area and also for his service to the
state. He was for years a member of the Florida
State Board of Health and a member of the State
Medical Examining Board.
Dr. Nobles had for nearly 50 years been a
member of the Escambia County Medical Society
and was a past president of that organization. He
was a life member of the Florida Medical Asso-
ciation, having become a member in 1908. He
also held membership through the years in the
American Medical Association and the Southern
Medical Association.
Noah Tilden Counts
Dr. Noah Tilden Counts of Cocoa died at the
Wuesthoff Memorial Hospital in Rockledge on
June 24, 1957, after suffering a heart attack at
his home. He was 81 years of age.
Born near Counts, Va., in 1876, Dr. Counts
was educated in his native state. He received his
medical training at the Medical College of Vir-
ginia, where he was awarded the degree of Doc-
tor of Medicine in 1907. After practicing in Vir-
ginia for 10 years, he came to Florida in 1917.
He located in Cocoa and continued to practice
there for nearly 40 years. For 12 years he had
been in somewhat poor health following an auto-
mobile accident, but continued to engage in the
practice of his specialty of opthalmology and
otolaryngology until two and a half years prior to
his death.
Dr. Counts was a member of the Brevard
County Medical Society and had held member-
ship in the Florida Medical Association since
1927. He also was a member of the American
Medical Association and of his specialty groups.
Surviving are the widow, Mrs. Helen Varr
Counts, of Cocoa; three sons, Willard Counts,
of Aily, Va., Wade Counts, of Royal Oak, Mich.,
and Arvill Counts, of Birmingham, Mich.; and
two daughters, Mrs. G. C. Rasnick and Mrs. G.
W. Powers, both of Hazel, Va.
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
420 W. Monroe St. 329 N. Orange Ave.
Telephone EL 4-6661 Telephone 3-3537
J. Florida, M. A.
November, 1957
539
therapeutic potency
among nonhormonal antiarthritics
unexcelled
Its well-established advantages
o
include remarkably prompt action,
broad scope of usefulness,
and no tendency to development
of drug tolerance. Being
nonhormonal, Butazolidin
causes no upset of normal i
endocrine balance. I
Butazolidin relieves pain, 1
improves function,
resolves inflammation in:
Gouty Arthritis
Rheumatoid Arthritis
Rheumatoid Spondylitis
Painful Shoulder Syndrome
In the nonhormonal treatment of arthritis
and allied disorders no agent surpasses
Butazolidin in potency of action.
Butazolidin being a potent therapeutic
agent, physicians unfamiliar with its
use are urged to send for detailed
literature before instituting therapy.
Butazolidin® (phenylbutazone
Geigy). Red coated tablets of 100 mg.
GEIGY
Ardsley, New York
BUTAZOLIDIN'
(phenylbutazone Ckicy)
now...
unprecedented
Sulfa
therapy
WM ■■ WM m KM*
SULFAMETHOXYPYRIDAZINE LEDERLE
w authoritative studies prove that Kynex
iage can be reduced even further than that
ommended earlier.1 Now, clinical evidence
5 established that a single (0.5 Gm.) tablet
intains therapeutic blood levels extending
rond 24 hours. Still more proof that Kynex
nds alone in sulfa performance—
lowest Oral Dose In Sulfa History— 0.5 Gm.
tablet) daily in the usual patient for main-
iance of therapeutic blood levels
ligher Solubility— effective blood concentra-
ns within an hour or two
effective Antibacterial Range— exceptional
setiveness in urinary tract infections
’onvenience— the low dose of 0.5 Gm. ( 1 tab-
) per day offers optimum convenience and
eptance to patients
NEW DOSAGE
The recommended adult dose is 1 Gm. (2 tab-
lets or 4 teaspoonfuls of syrup) the first day,
followed by 0.5 Gm. ( 1 tablet or 2 teaspoonfuls
of syrup) every day thereafter, or 1 Gm. every
other day for mild to moderate infections. In
severe infections where prompt, high blood
levels are indicated, the initial dose should be
2 Gm. followed by 0.5 Gm. every 24 hours.
Dosage in children, according to weight; i.e.,
a 40 lb. child should receive 1/4 of the adult
dosage. It is recommended that these dosages
not be exceeded.
Tablets:
Each tablet contains 0.5 Gm. (7V& grains) of sulfamethoxy-
pyridazine. Bottles of 24 and 100 tablets.
Syrup :
Each teaspoonful (5 cc.) of caramel-flavored syrup contains
250 mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
1 Nichols, R. L. and Finland, M.: J. Clin. Med. 49:410, 1957.
ERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
U. S. Pot. Off.
542
Volume XLIV
Number 5
EVERY WOMAN
WOMAN’S AUXILIARY
TO THE
FLORIDA MEDICAL ASSOCIATION
OFFICERS
Mrs. Perry D. Melvin, President Miami
Mrs. Lee Rogers Jr., President-Elect Kocktedge
Mrs. William D. Rogers. 1st Vice Pres. .. .Chattahoochee
Mrs. Leffie M Carlton Jr., 2nd Vice Pres Tampa
Mrs. Edward W. Ludwig, 3rd Vice Pres Jacksonville
Mrs. James M. Weaver, 4th Vice Pres.. .Fort Lauderdale
Mrs. Wendell J. Newcomb, Recording Sec’y ....Pensacola
Mrs. Willard L. Fitzgerald, Treasurer Miami
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
"premarin:
widely used
natural, oral
estrogen
AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
56-45
The President Reports
This is being written in the first hours of quiet
in the morning, with the children in school, feel-
ing the cool breeze that portends relief from the
long summer’s heat. It seems only the other day
that summer was just beginning and with it an-
other year for the Woman’s Auxiliary.
We have been busy with primary responsi-
bilities; our husbands, children and homes. Now,
back in the regular routine, we can turn our
thoughts to helping our husbands in their chosen
profession. That is the underlying purpose of our
activities and the sole reason for our existence as
an organization. It is toward this end that we are
faced with what proved to be the busiest month
of the year, at least for two people, the President
and President-Elect of the Auxiliary.
The first of October found us in Pensacola for
the Fall Board Meeting and Conference for State
Officers, State Chairmen, District Chairmen,
County Presidents, Presidents-Elect and Chair-
men. We met in Pensacola because the Board
believed it would benefit the entire Auxiliary to
meet in that section. With the annual convention
in south Florida for some time past, it posed an
undue hardship on members from north and west
Florida to come to the southern section of the
state for our Board meeting also.
We had an unusual program in that we de-
voted the day of the Conference to group dis-
cussion under the inspired leadership of Mrs.
Paul C. Craig, of Wyomissing, Pa., President of
the Woman’s Auxiliary to the American Medical
Association. The problems were those that Con-
ference members desired discussed as determined
by questionnaires sent out in mid-summer.
We had a fruitful session where we learned
from each other to look objectively at our activi-
ties and to evaluate our methods of achieving
them.
We were royally entertained by the Woman’s
Auxiliary to the Escambia County Medical So-
ciety, with dinner one night at the Country Club
( Continued on page 545 )
. Florida, M. A.
November, 1957
543
now . . care of the man
rather than merely his stomach”1
antichol
controls
gastrointestinal dysfunction
at cerebral and peripheral levels
tranquilization without
barbiturate loginess
spasmolysis without
belladonna-like side effects
for duodena! ulcer • gastric ulcer • intestinal colic
spastic and irritable colon • ileitis • esophageal spasm
G. I. symptoms of anxiety states
prescribe
1 tablet t.i.d. at
mealtime and
2 at bedtime.
Formula:
Miltown® (meprobamate)
400 mg. ( 2 - methyl -2 - n -
propyl- 1, 3- propanediol
dicarbamate)
U. S. Patent 2,724.720
tridihexethyl iodide 25 mg.
( 3 - diethylamino * 1 - cyclohexyl •
I - phenyl - 1 - propanol -rthiodidel
WALLACE LABORATORIES New Brunswick, N. J.
/. Wolf & Wolff, Human Gastric Function
Literature, samples, anil
personally imprinted peptic ulcer
diet booklets on request.
544
Volume XLIV
Number 5
Avoid “BOTTOM OF THE VIAL” reactions
Each cc. of Globin Insulin
—including the last one—
provides the same
unvarying potency.
Of the intermediate-acting insulins,
only Globin Insulin is a clear solution.
24-hour control for the majority
of diabetics
GLOBIN INSULIN
‘B. W. & CO.'*
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
J. Florida, M. A.
November, 1957
545
( Continued from page 542 )
at which we had the honor of hearing Dr. Wil-
liam C. Roberts, of Panama City, President of
the Florida Medical Association, as our speaker.
For those of us who know and love that section
of the state, it was a most pleasant visit and for
those who had never been there it was an eye-
opening experience.
October 19th found the Auxiliary President
and President-Elect, Mrs. Perry D. Melvin of
Miami and Mrs. Lee Rogers Jr., of Rockledge,
on their way to the Fall Conference of the
Woman’s Auxiliary to the American Medical As-
sociation in Chicago. There we spent three days
in meetings and group discussions. This was one
of the most valuable experiences a person inter-
ested in the work of the Auxiliary could have.
Those of us who have had the inspiration and
advantage of these Conferences will be forever
grateful to the members of the Woman’s Auxili-
ary to the Florida Medical Association, who as-
sume the major portion of the cost of sending us
there.
October 28th found the traveling pair in Pan-
ama City for the first of the District Meetings.
These are also quite an experience but in an en-
tirely different way. In Chicago, we were the
neophytes. At the district meetings, we were
the authorities who were supposed to know all
the answers and be able to solve all the problems.
If it were not for the former we could never at-
tempt the latter.
Besides being Auxiliary authorities, you have
the feeling of an actress playing one night stands.
Drive like mad, starting early in the morning in
order to make the next town, catch a quick bite
to eat, freshen up, change clothes to make a more
presentable appearance, then on to a meeting
where you are to speak. Leave the meeting with
a few minutes to rest and change clothes again,
then on the social activities with the doctors and
their wives, always under the kindly guiding wing
of your hostess, the President of the local Auxili-
ary and her husband. Back to the motel for an
all too short night’s sleep, then up and away in
the early hours and on the road to the next stop,
feeling very smug if you get away before the
doctors who are also making the circuit.
We enjoyed this opportunity of meeting and
knowing the women all over the state, who might
be missed at the convention or who could not go
to the Conference because it is too far away.
each coated tablet contain*: Phenaphen
Phenacetln (3 g r.) 194.0 mg.
Acetylsalloyllc Acid (2V4 gr.) . 162.0 mg.
Phenobarbital (V4 gr.) .... 10.2 mg.
Hyoscyamlne Sulfate .... 0.031 mg.
plus
Prophenpyrldamlne Maleate . . 12. S mg.
Phenylephrine Hydrochloride . 10.0 mg.
Phenaphen Plus is the physician-requested
combination of Phenaphen, plus an anti-
histaminic and a nasal decongestant.
Available on prescription only.
546
Volume XLIV
Number 5
Whatever the Rectal Pathology . . .
Whatever the Etiology . . .
Whatever Adjunctive Measures are Needed . . .
PRURITIC IRRITATION
First neutralize proteolytic enzymes' and alkaline
mucosal drip2,3,4 associated with PRURITUS ANI
Provide immediate and prolonged relief in a high percentage
of stubborn cases3,5 with the natural biochemical buffer —
HYDRO LAM INS’
TOPICAL AMINO ACID PRURITUS THERAPY
BEFORE
Reddened, fissured and
excoriated perianal skin,
and whitening of the anal
folds, accompanied by in-
tense burning and itching
of 3 years' duration.
AFTER
Same case after treat-
ment with Hydrolamins.
Note healing of the in-
flamed, fissured and ex-
coriated areas and of the
whitened anal folds.
Why Effective —
Hydrolamins-pH around 6 — this enables it to
buffer against the irritating alkaline mucosal
secretions2. 3. 4 with resultant rapid, prolonged,
soothing neutralization.
Why Safe —
Biochemical in its composition and having a
hydrogen-ion concentration in harmony with
normal skin, Hydrolamins — unlike steroids or
“caine” type anesthetics — avoids treatment der-
matitis. Hydrolamins actually encourages
wound healing.
Hydrolamins Indications Include —
Pruritus ani and vulvae . . . fissures . . . diaper
rash . . . anal irritations and erythemas . . .
pruritus due to pinworms . . . ileostomy and
colostomy irritations . . .
1. Arthur, R. P., and Shelley, W. B.: A.M.A. Archives of Derm. 76:296 (Sept.) 1957.
2. Ehrlich, R.: Am. J. Proctol. 7:497 (Dec.) 1956. 3. Slocumb, L. H.: Am. J. Digest. Dis.
10:227 (June) 1943. 4. Bacon, H. E.: Anus-Rectum Sigmoid Colon, Diagnosis and Treat-
ment, Philadelphia, J. B. Lippincott Co., 1949. 5. Bodkin, L. G., and Ferguson, E. A., Jr.-.
Am. J, Digest. Dis. 18 59 (Feb.) 1951. 6. McGivney, J.: Texas J. Med. 47:770 (Nov.) 1951.
SUPPLIED: 1 oz. and 2.5 oz. tubes.
LEWAL PHARMACEUTICAL COMPANY Chicago 14, Illinois
J. Florida, M. A.
November, 1957
547
After four days of such constant companionship
and feeling as though your companion has been
your life long friend, your whole life is richer
for the entire trip.
After the district meetings, it was back home
for a short time, thankful for an understanding
and sympathetic husband. Then there are plans
for the Annual Convention of the Southern Medi-
cal Association and its Auxiliary. We will be
official hostess for doctor’s wives from all over the
South. Everyone is expecting the same wonderful
time they have always had in Florida at pre-
vious meetings of the Association and we feel
proud as compliments for Florida hospitality are
received.
We will especially welcome Mrs. Oscar W.
Robinson of Paris, Texas, President of the Wom-
an’s Auxiliary to the Southern Medical Associa-
tion, who said on taking office last year in Wash-
ington, that no one could ask for more than to
have been “elected in my home state of Texas,
installed in the Nation’s capital and to preside in
paradise, Miami.” We will also welcome Mrs.
Paul C. Craig again and will be happy to have
the opportunity of showing her another section
of our home state.
Mrs. Perry D. Melvin
BOOKS RECEIVED
The Changing Patient-Doctor Relationship.
By Martin G. Vorhaus, M.D., F.A.C.P. Pp. 310. Price,
$3.95. New York, Horizon Press, 1957.
The result of 35 years of experience in treating men
and women of every age, this book explores the need of
both patient and doctor to arrive at a healthier under-
standing of each other. Clearly written, easy to under-
stand, it is as interesting to a healthy person as to a pa-
tient troubled by his relationship with his doctor. “The
needs of the patient can be satisfied,” says the author.
“The doctor has, to a very large degree, the means to
satisfy these needs. This study is a means to an end:
that is, to bring these two into the closest possible rap-
port with each other so that the doctor may fulfill his
obligations to the patient.” Five detailed case histories
of absorbing interest are presented in a new way, through
revealing conversations over long periods of time between
patient and physician. Full of penetrating insights into
people, and wisdom about the actual roots of the most
frequent complaints and a lments, this book grows more
meaningful and important with each reading.
William Harvey. His Life and Times: His Dis-
coveries: His Methods. By Louis Chauvois. Pp. 271.
Price, $7.50. New York, Philosophical Library, 1957.
The fame of William Harvey increases with, the years.
Even in this year marking the tercentenary of his death,
the magnitude of the revolution in medical thought
brought about by his discovery of the circulation of the
blood is not sufficiently realized; it not only served as
the foundation of physiology but also showed how re-
search should be conducted. It should therefore be in-
( Continued on page 554)
when anxiety and tension "erupts” in the G. I. tract...
IN ILEITIS
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of ileitis — without fear of barbiturate loginess, hangover or
habituation...*^1^* PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
Chemotherapy
ARALEN
iMj
RHEUMATOID
ARTHRITIS
o
Extensive studies of rheumatoid arthritis and related
collagen diseases— in this country and abroad-
have shown the antimalarial Aralen phosphate to be highly effective
and well tolerated in a large percentage of patients.
Clinical Results with Aralen
in Rheumatoid Arthritis
Author
No. of
Cases
Major
Improvement
Minor
Improvement
No Effect
Haydul
2B
22
5
i
Rinehart7
25
12
4
Freedman7
50
43
3
4
Bagnall4
103
77
12
19
Bruckner7
36
32
0
4
Cohan and Calkins*
22
17
3
2
Scherbel at al.7
25
9
B
ANALGESICS AND STEROIDS:
Requirements usually reduced
eliminated
JOINT EFFECTS:
Total
294
212 (72%)
35(12%)
47 (16%)
Success dependent upon persistent treatment
Often of benefit where other agents have failed
Remissions on therapy well maintained
Remission of 3 to 12 months possible even if
treatment is interrupted
Tachyphylaxis not evident
GENERAL EFFECTS:
Patient feels better
Patient looks better
Exercise tolerance increases
Walking speed and hand grip improves
LABORATORY EFFECTS:
E. S. R. may fall slowly
• Pain and tenderness relieved
• Mobility increases
• Swellings diminish or disappear
• Muscle strength improves
• Rheumatic nodules may disa
• Even severe or advanced defo
may improve
• Active inflammatory process
subsides
• Joint effusion may diminish
DOSAGE:
Aralen is cumulative in action
requires four to twelve weeks
administration before theraj
become apparent.
Latest information indicates that an in:
dose of 250 mg. of Aralen phosphate is
to the higher doses sometimes recc
However, if side effects appear, wit'
Aralen for several days until they
subside. Reinstate treatment with 125
daily and, if well tolerated, increase to
The usual maintenance dose is 250 mg.
[Jew Chemotherapy
INDICATIONS:
>
• Rheumatoid arthritis, acute or chronic
—with or without adjunctive therapy.
• Spondylitis
• Arthritis associated with lupus
erythematosus or psoriasis
THEORY OF ACTION:
Aralen appears to suppress or
induce remission of rheumatoid
inflammatory processes by inhibiting
adenosinetriphosphatase.
HOW SUPPLIED:
Aralen phosphate: 250 mg. tablets in bottles of 100 and 1000.
125 mg. tablets in bottles of 100.
Tolerance :
Iralen is usually well tolerated. Toxic effects are
jsually mild and to date have been transitory in
lature, disappearing completely either on con-
inuance or cessation of therapy or on reduction in
losage.
Gastrointestinal disturbances (e.g. nausea,
arely vomiting, diarrhea, abdominal cramps,
norexia) are frequent manifestations of intoler-
nce. Temporary blurring of vision (due to inter-
erence with accommodation) is also relatively
requent.
Pleomorphic skin eruptions (e.g. lichenoid,
laculopapular, purpuric) .although generally mild,
lay preclude the use of an optimum dosage
chedule. If a skin reaction persists on a reduced
osage schedule, or recurs after reinstitution of
eatment with gradually increasing doses, discon-
nue Aralen till the lesion again disappears and
insider resuming treatment with Plaquenil®
brand of hydroxychloroquine).
Less frequently transitory vertigo, headache,
issitude, or neurological disturbances, such as
ervousness, irritability, emotional change, and
ightmares have been reported. Instances of unex-
■ained slight gradual weight loss as the patient’s
eneral health and arthritic condition improved
ave been mentioned. Occasional instances of
leaching (depigmentation) of the hair have been
an occasional instance of leukopenia,
rmal differential count, has been reported
about 3000), it has not proved troublesome
it has always been reversible on discontinu-
s, or diminution of the dose. Even spontaneous
1 may occur while full dosage is maintained.
ces
Caution :
Aralen is known to concentrate in the liver and,
although hepatic damage has never been reported,
the drug should be used with caution in the pres-
ence of liver disease. In the presence of severe
gastrointestinal, neurological, or blood disorders,
the drug should be used with caution or not at all.
If such disorders occur during the course of ther-
apy, the drug should be discontinued. Concomitant
use of gold or phenylbutazone with Aralen should
be avoided because of the tendency of these agents
to produce drug dermatitis.
Clinical Comments :
Of fifty patients receiving Aralen therapy, “43
have become really well ; that is, they have no stiff-
ness, and any pain that occurs can reasonably be
attributed to use of joints affected by secondary
degenerative changes. They have no evidence of
joint inflammation, but may have a raised erythro-
cyte sedimentation rate. They have little or no need
for analgesics.” Freedman 1 2 3 4 5 6 7
“One hundred and twenty-five private patients
have been carefully followed clinically and haema-
tologically while receiving well over 200 patient-
years of chloroquine [Aralen] therapy. The results
are considered good in 70%, one-half of these cases
being in remission. Improved work performance,
sedimentation rate, and hemoglobin levels para-
lleled the major objective gain in this 70%. 90% of
them remained on chloroquine [Aralen] therapy,
half for more than two years. Classical peripheral
rheumatoid arthritis, spondylitis, arthritis of
juvenile onset, and rheumatoid disease with
psoriasis, all appeared to respond about equally
well.
“It is suggested that chloroquine comes closer to
the ideal for long-term, safe, control of rheumatoid
disease than any other agent now available.”
Bagnall*
“Out of the 36 rheumatoid arthritis cases we
treated . . . favorable results were obtained in 32
Cases. Bruckner et al.1
1. Haydu. G.G.: Rheumatoid arthritis therapy: a rationale and the use of
chloroquine diphosphate. Am. J. M. Sc. 225:71, Jan., 1953.
2. Rinehart, R.E.: Chloroquine therapy in rheumatoid arthritis, Northwest Med.
64:713, July, 1955.
3. Freedman, A.: Chloroquine and rheumatoid arthritis, a short-term controlled trial,
Ann. Rheum. Die. 15:251, Sept., 1956.
4. Bagnall, A.W. : The value of chloroquine in rheumatoid disease, a four year study
of continuous therapy, read at the Ninth International Congress on Rheumatic Diseases
in Toronto, Canada, June 23-28, 1957.
5. Bruckner I., and Rosenzweig, S-: Treatment of chronic rheumatoid
arthritis with synthetic antimalarials, read at the Ninth International Congress
on Rheumatic Diseases in Toronto, Canada, June 23-28, 1967.
6. Cohen, A.S., and Calkins, Evan: A controlled study of chloroquine as an antirheumatic
agent, read at the Ninth International Congress on Rheumatic Diseases
in Toronto, Canada. June 23-28, 1957.
7. Scherbel, A. L., Schuchter, S.L., and Harrison, J.W. : Comparison of effects of two
antimalarial agents, hydroxychloroquine sulfate and chloroquine phosphate,
in patients with rheumatoid arthritis, Cleveland Clin. Quart. 24:98, April, 1967.
550
Volume XLIV
Number 5
CONFIDENCE
and well placed too!
The ophthalmologist knows that when he recommends
a guild optician, the service and quality which are a Guild
tradition help to make his patient satisfied. He has
confidence that his guild optician will get the job done right.
Guild of Prescription Opticians of Florida
S ALCOLAN
• TESTED • APPROVED • ACCEPTED
BURNS - SCALDS - ABRASIONS
★ "Initial rapid pain relief, early tissue
regrowth, control of secondary
infection.”
★ "A marked reduction in total healing
★ Clinical reports, samples, and descrip-
tive brochure may be had upon
request. Please write us on your
lettarhead.
RICH COMPANY, INCORPORATED
1
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y\
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m
tj
j
why Dimetane is the best reason yet for you to re-examii
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DIMETANE potency is unexcelled, dimetane has a therapeutic index unrivaled by
other antihistamine— a relative safety unexceeded
by any other antihistamine, dimetane, even in very
low dosage, has been effective when other antihis-
tamines have failed. Drowsiness, other side effects
have been at the very minimum.
» unexcelled antihistaminic action
Diagnosis
No. of
Patients
Response
Side Effects
Excellent
Good
Fair
Negative
Allergic
rhinitis and vaso-
motor rhinitis
30
14
»
5
2
Slight Drowsine
Urticaria and
angioneurotic
edema
3
1
i
t
Dizzy (1)
Allergic
dermatitis
2
i
i
Slight Drowsine
Bronchial asthma
Pruritus
1
1
1
1
Total
37
IS
13
7
2
Drowsiness (5) •
Dizzy (1)
From the preliminary Dimetane Extentabs studies of three investigators. Further clinical investigations will be reported as com
DIMETANE IS PARABROMDYLAMINE MALEATE - EXTENTABS 12 MG., TABLETS 4 MG., ELIXIR 2 MG. PER 5 CC.
anket of allergic protection, covering 10-12
rs— with just one Dfmetane Extentab » dimetane
ntabs protect patient for 10-12 hours on one tablet.
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mum coverage.
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Richmond, Virginia | Ethii
Dosage:
Adults— One or two i-mg. tabs,
or two to four tcaspoonfuls
Elixir, three or four times da ily.
One Extentab q.8-12 h.
or twice daily.
Children over 6— One tab.
or two tcaspoonfuls Elixir t.i.d.
or q.i.d., or one Extentab q,12h.
Children 8-6— V< tab.
Or one teaspoonful Elixir t.i.d.
Pharmaceuticals of Merit Since 1878
554
(Continued, from page 547)
cumbent on all medical students and practitioners to
know as much as can be known of the life and times,
the discoveries and methods of this great physician. In
this book, Dr. Chauvois, a distinguished French physician
and medical historian, has provided a most original and
scholarly life of Harvey, giving first an account of his life
and relations with his contemporaries. He then re-
examines the Latin texts and suggests that some current
interpretations of Harvey’s teaching are seriously at fault.
Dr. Chauvois maintains that Harvey’s line of thought,
if properly understood and pursued in the light of mod-
ern knowledge, leads to some modifications of practical
importance in the interpretation of the circulation of the
blood.
In the Foreword, Sir Zachary Cope writes that Dr.
Chauvois has produced a lifelike portrait of Harvey the
man and Harvey the scientist, adding, “He writes with
wit and charm, and with an imagination which adds
piquancy to the narrative while not going beyond the
probabilities of the case. . . . This very readable book
with its up-to-date information and review of Harvey’s
life and work comes at an opportune moment when all
the world is about to celebrate the tercentenary of his
death ; it deserves and should obtain wide recognition
and appreciation.”
Fluid and Electrolytes in Practice. By Harry
Statland, M.D. Ed. 2. Pp. 229. Price, $6.00. Philadel-
phia, J. B. Lippincott Company, 1957.
This book provides a simply written and practical
foundation in the fundamentals of fluid therapy and elec-
trolyte balance for the practicing physician. The author
has handled his subject matter in such a way that no
matter how far removed the reader may be from his
studies in the basic sciences he will still find the text com-
pletely understandable and its content easy to assimilate.
Part One presents the basic principles of fluid movements
Volume XI. IV
Number 5
and the major abnormalities of volume, concentration and
acid base balance. In this section the management of
the surgical patient is stressed. In Part Two the applica-
tion to management of special diseases is discussed more
fully.
In this second edition extensive revisions have been
made throughout. The section on potassium metabolism
and renal excretion of potassium has been largely re-
written. The description of electrocardiographic changes
cf electrolyte imbalance has been amplified, and a discus-
sion of salicylism added. The role of ADH in the post-
traumatic period is stressed.
Alcoholism: A Treatment Guide for General Prac-
titioners. By Donald W. Hewitt, M.D. Pp. 112. Price.
$.5.00. Philadelphia, Lea & Febiger, 1957.
The author, who is chief medical advisor at the
Charity Alcoholic Rehabilitation Center in Los Angeles
presents a clear, comprehensive analysis of the deep-
seated medical, sociologic and psychologic problems that
confront the alcoholic patient in this first book of its
kind intended primarily for the general practitioner. It
is the family physician who almost always sees the al-
coholic patient first, and in this book he will find a valu-
able aid to help him meet the widespread need for specif-
ic management, treatment and follow-up therapy of al-
coholism as it is encountered on all social levels. In ad-
dition to being an explicit treatment guide for general
practitioners, the book explains the nature of the problem
and shows psychiatrists, psychologists, ministers, social
workers, nurses, judges, probation and parole officers
teachers, lawyers, personnel managers and others whe
have contact with victims of alcoholism how to cooper-
ate with the general practitioner in reaching an effective
solution. The work is based on the successful result:
obtained from treating an average of 100 alcoholic pa-
tients a month in the largest alcoholic rehabilitation cen-
when anxiety and tension "erupts” in the G. I. tract . . .
in spastic
and irritable colon
PATHIBAMATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer. . . helps control the
“emotional overlay” of spastic and irritable colon — without fear of barbiturate loginess, hangover or
habituation . . .with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for Tridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
. Florida, M. A.
November, 1957
555
optimal dosages for atarax,
based on thousands of case histories:
•
for these 2 S adult indications:
mg. fcj.i.d.)
TENSION SENILE ANXIETY MENOPAUSAL SYNDROME ANXIETY PREMENSTRUAL TENSION
PHOBIA HYPOCHONDRIASIS TICS FUNCTIONAL G. 1. DISORDERS PRE-OPERATIVE ANXIETY
HYSTERIA PRENATAL ANXIETY • AND ADJUNCTIVELY IN CEREBRAL ARTERIOSCLEROSIS
PEPTIC ULCER HYPERTENSION COLITIS NEUROSES DYSPNEA INSOMNIA
PRURITIS ASTHMA ALCOHOLISM DERMATITIS PARKINSONISM PSORIASIS
perhaps the safest ataraxic known
pe^ce OF MIND ATARAX
Supplied: In tiny 10 mg. (orange) and 25 mg. (green)
tablets. Also now available in 100 mg.
tablets. Bottles of 100. ATARAX Syrup, 10 mg.
pertsp., in pint bottles. Prescription only.
(BRANO OF HYDROXYZINE)
Tablets-Syrup
NOW: SAFE... QUICK
| ATARAX* PARENTERAL SOLUTION
when Peace of Mind can't wait
In daily practice: always have it handy
• to calm the acutely disturbed or hysterical patient
• to rehabilitate the alcoholic
In hospitals: use it routinely
• to make overwrought patients manageable
without loss of alertness
• to allay anxiety and control vomiting
before and after surgery and childbirth
Supplied: 10 cc. multiple-dose vials. The adult dosage is
25 mg. to 50 mg. (1-2 cc.) intramuscularly, 3 to 4 times daily,
at 4 hour intervals. The moderated dosage level for children
under 12, when given intramuscularly, has not yet been
established, and the oral dosage should be used.
556
Volume XLI'
Number 5
r- - ' ' ^
in bronchial asthma and respiratory allergies
specify the buffered “predni-steroids”
to minimize gastric distress
combined, steroid-antacid therapy .
‘Co-Deltra’ or ‘Co-Hydel- Multiple
tra’ provides all the bene- Tablets”6
fits of “predni-steroid”
therapy and minimizes the
likelihood of gastric distress
which might otherwise im-
pede therapy. They provide
easier breathing — and
smoother control — in bron- 2-5 me: °r 5-0 mg*
, • , , , ^11 of prednisone or
chial asthma or stubborn prednisoione, plus
respiratory allergies. 300 mg. of dried
Co-Deltra
(Prednisone buffered)
CoMeltra
(Prednisolone buffered)
supplied: Multifile Compressed
Tablets ‘Co-Deltra’ or ‘Co-Hy-
deltra’ in bottles of 30, 100, and
500.
aluminum
hydroxide
gel and 50 mg.
of magnesium
trisilicate.
MERCK SHARP & DOHME
•CO-DELTRA’ an/l ‘CO-H YDELTRA’ are
registered trademarks uj Merck & Co.. Inc.
DIVISION OF MERCK a CO.. INC.
PHILADELPHIA I, PA.
J. Florida. M. A.
'’OVEMBF.R, 195/
557
ter of its kind in the western United States. Dr. Hewitt
establishes a new understanding and sympathy on the
part of the physician, and stresses the vital need to secure
the confidence and cooperation of his alcoholic patient’s
family and friends. The necessary steps and how to
take them are outlined clearly. Antabuse, Thorazine,
Sparine and other currently accepted drugs are included
in the sections on therapy.
Signs and Symptoms: Applied. Pathologic Phy-
siology and Clinical Interpretation. Edited by Cyril
Mitchell MacBryde, A.B., M.D., F.A.C.P. Ed. 3. Pp.
973. Ulus. 191. Philadelphia, J. B. Lippincott Com-
pany, 1957.
This third edition of a unique aid in the practice of
medicine offers a ready source of helpful information of
great practical value. It approaches diagnosis as any
physician must — through analysis and interpretation of
presenting signs and symptoms. In each chapter a major
symptom or sign is discussed, the mechanism of its pro-
duction clarified by the light thrown upon it by anatomy,
physiology, pathology, chemistry, or psychology, its cor-
relation with other symptoms and physical and labora-
tory findings described. The introductory chapter is an
able presentation of clinical relations between doctor and
patient and subsequent patient management. The chap-
ter on Pain is an especially valuable one since pain is
the commonest symptom that brings the patient to the
physician and no matter how distressing other symptoms
may be, it is pain that is the prime consideration of the
patient.
Every effort has been made by thorough revision to
improve and bring up to date all chapters in the book.
New chapters have been added on Growth and Sex De-
velopment, Generalized Vasospasm and Arterial Hyper-
tension, and Lymphadenopathy and Diseases of the
Lymphatic System. Each chapter concludes with a con-
cise summary of its content.
Surgery in World War II. Orthopedic Sur-
gery in the Mediterranean Theater of Operations.
Editor in Chief, Colonel John Boyd Coates, Jr., MC;
Editor for Orthopedic Surgery, Mather Cleveland, M. D.;
Associate Editor, Elizabeth M. McFetridge, M. A. By
Oscar P. Hampton, Jr., M. D., F. A. C. S., Colonel, MC,
USAR. Pp. 368. Washington. D. C., Office of the Sur-
geon General, Department of the Army, 1957.
This most recently published volume of the official
history of the Medical Department, United States Army
in World War II, is the second of the three planned vol-
umes on orthopedic surgery. The combat experience in
the Mediterranean area lasted from November 1942 until
May 1945. During this period of approximately 30
months, battle casualties were treated by the officers of
the LTnited States Army Medical Corps in the various
echelons of the theater. The medical officers in the
Mediterranean theater thus had a much longer experi-
ence in the treatment of battle casualties than the medical
officers in the European theater and had correspondingly
greater opportunities to gather data for the evaluation of
their technics of treatment. Developing by a process of
evolution, orthopedic surgery in this area served as a test-
ing ground for the principles and technics which were
applied with such success in the later campaigns in this
theater and by which these injuries were treated in the
European Theater of Operations in 1944 and 1945.
Colonel Hampton, consultant in orthopedic surgery for
the theater, was indefatigable in spreading throughout
the hospitals of the theater the principles upon which the
surgery of wounds of the bones and joints is based.
During the war and immediately thereafter, he, with the
assistance of many of his colleagues, collected invaluable
data on military orthopedic surgery. The studies which
were the result of these investigations and which are
presented in this volume form an unusually complete and
comprehensive analysis of orthopedic surgery in an over-
seas theater. The book should be of great interest to all
medical officers, including those who later served in
Korea, and should serve as a source of information and
inspiration to medical students who will almost inevitably
serve for a time in the medical service of the Armed
Forces.
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
SUN RAY PARK
SANITARIUM IN MIAMI
HEALTH RESORT
Medical Hospital American Plan
Hotel for Patients and their families.
REST, CONVALESCENCE, ACUTE and
CHRONIC MEDICAL CASES. Elderly
People and Invalids. FREE Booklet!
Acres Tropical Grounds, Delicious Meals,
Res. Physician, Grad. Nurses, Dietitian.
125 S.W. 30TH COURT, MIAMI, FLORIDA 7^,
MEMBER, AMERICAN HOSPITAL ASSOCIATION
MEMBER. FLORIDA HOSPITAL ASSOCIATION
Under New Medical
Direction and Man-
agement.
558
Volume XLIV
Number 5
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY TOOK PRINTING
rmu.ir.ATioNS ☆ iwocnuiu-s
Convention
PRESS ✓ *
2 18 W BST C II UK C II S T .
J A C K S O N V II. I, V. , F I. O It I I) A
Allen s Invalid Home
MILLEDGEVILLE, GA.
Established 1 890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D. James K. Ward, M.D.,
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala. Phone WOrth 1-1151
J. Florida, M. A.
November, 1957
559
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cas
will be accepted on
either permanent <
temporary basis.
Salety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St.
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9, Florida
560
Number 5
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therap)
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association ot
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D.
Medical Director
ALBERT F. BRAWNER, M.D.
Assistant Director
P. O. Box 218
Phone 5-4486
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
ASHEVILLE
APPALACHIAN HALL
Established 1916 NORTH CAROLINA
]. Florida, M. A.
November, 1957
INDEX TO ADVERTISERS
561
1 Abbott Laboratories 463, 532, 533
’ Allen’s Invalid Home 558
’ American Meat Institute 536
1 Ames Co., Inc. Third Cover
' Anclote Manor 561
1 Anderson Surgical Supply Co. 522
' Appalachian Hall 560
• Ayerst Laboratories 534, 534a, 542
• Baker Laboratories 526
• Ballast Point Manor 559
• Bayer Co 516
■ Brawner’s Sanitarium 560
■ Brayten Pharmaceutical Co. 455
• Burroughs Wellcome & Co. 454a, 460, 544
‘ Convention Press 558
• Corn Products Refining Co. 530
• Drug Specialties, Inc 464
• Duvall Home 557
• Emory University 510
• Endo Laboratories 515
• Geigy Pharmaceuticals 539
• Guild of Prescription Opticians 550
• Charles C. Haskell & Co., Inc. 458
• Highland Hospital, Inc 559
■ Hill Crest Sanitarium 558
• L. & B. Laboratories, Inc. 514
• Lakeside Laboratories 453
* Lederle Laboratories 508, 509, 517, 519, 521, 523,
531, 540, 541, 547, 554
• Lewal Pharmaceutical Co 546
• Eli Lilly & Co. 470
• Mead Johnson & Co. 467
• Medical Protective Co. 510
• Medical Supply Co. 538
• Merck Sharpe & Dohme 457, 461, 556
• Miami Medical Center 563
• New Orleans Graduate Medical Assembly 506
• Parke-Davis & Co. Second Cover, 451, 513
• Pfizer Laboratories 524, 525
• Picker X-Ray Corp. 456
• Rich Company, Inc. 551
• Riker Laboratories 520
• A. H. Robins & Co. 465, 512, 526a, 545, 552, 553
• Roerig & Co 528, 529, 555
• Schering Corp. 466, 466a, 468, 469
• Julius Schmid, Inc 459
• G. D. Searle Company 507, 518
• Smith, Kline & French Labs. Back Cover
• E. R. Squibb & Sons 454
• Sun Ray Park Health Resort 557
• Surgical Supply Co 537
• Tucker Hospital, Inc 562
• Upjohn Co 527
• Wallace Laboratories 542a, 543
• Westbrook Sanatorium 562
• Wine Advisory Board 535
• Winthrop Laboratories, Inc 458a, 462, 511,
518a, 548, 549
Hl’LOTE
mm
Information
Brochure
Rates
Available to Doctors
and Institutions
9 Modern Treatment Facilities
• Psychotherapy Emphasized
• Large Trained Staff
• Individual Attention
9 Capacity Limited
9 Occupational and Hobby Therapy
# Healthful Outdoor Recreation
9 Supervised Sports
9 Religious Services
9 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
SAMUEL G. WARSON, M.D.
TARPON SPRINGS •
Consultants in Psychiatry
ROGER E. PHILLIPS, M.D. WAITER H. BAILEY, M.D.
• ON THE GULF OF MEXICO • PH. VICTOR 2-1811
FLORIDA
562
Volume XLIV
Number 5
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
Westbrook l Sanction
■ Established lQ/l ■
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff PAULV. ANDERSON, M.D., President
REXBLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request - P. 0. Box 1514 • Phone 5-3245
da, M. A.
er, 1957
SCHEDULE OF MEETINGS
563
ORGANIZATION
PRESIDENT
SECRETARY
ANNUAL MEETING
Medical Association
Medical Districts
irthwest
irtheast
uthwcst
utheast
Specialty Societies
ly of General Practice
Society
biologists, Soc. of
>hys., Am. Coll., Fla. Chap,
and Syph., Assn of
Officers’ Society
ial and Railway Surgeons
i Gynec. Society
1. & Otol., Soc. of
;dic Society
igists, Society of
ic Society
& Reconstructive Surgery
ogic Society
trie Society
igical Society
is, Am. Coll., Fla. Chapter
cal Society
Science Exam. Board
i Banks, Association
Cross of Florida, Inc
Shield of Florida, Inc
er Council
etes Assn
al Society, State
t Association
ital Association
cal Examining Board
cal Postgraduate Course
e Anesthetists, Fla. Assn,
es Association, State
maceutical Assoc., State
ic Health Association
eau Society
rculosis & Health Assn
tan’s Auxiliary
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Joel V. McCall Jr., Daytona Beach
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
Edward R. Smith, Jacksonville
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal.
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Burns A. Dobbins Jr., Ft. L’d’dale
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Joseph J. Lowenthal, Jacksonville
G. J. Perdigon, D.D.S., Tampa ....
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami ....
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Clarence L. Brumback, W. P. B
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
Miami Beach, May 10-14, ’58
Miami Beach, May 1958
Clearwater, Nov. 30- Dec. 1, ’57
Jan. 58
Miami, Nov. 10, ’57
Miami Beach, May 1958
W. Palm Beach, Oct. 31-Nov. 3, ‘57
Miami Beach, May 1958
Nov. ’57
Miami Beach, May 1958
Miami Beach, May 11, ’58
Miami Beach, May 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
ff ft
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
Clearwater, Nov. 21-22, '57
Miami, Nov. 24-26, ’57
Jacksonville, May 18-21, ’58
Ft. Lauderdale, Oct. 31-Nov. 2, ’57
Miami Beach, May 10-14, ’58
an Medical Association
A. Clinical Session
n Medical Association
la Medical Association
i, Medical Assn, of
lospital Conference
astern Allergy Assn
astern, Am. Urological Assn.
astern Surgical Congress
oast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala.
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Miami Beach, Nov. 11-14, ’57
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Charleston, S.C., Nov. 1-2, ’57
Hollywood, Jan. 12-16, ’58
I MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy, Insulin, Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Memoer American Hospital Association
564
Volume XLI
Number 5
FLORIDA MEDICAL ASSOCIATION
Officers and
OFFICERS
WILLIAM C. ROBERTS, M.D., President ..Panama Cilv
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR„ M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas ....Jacksonville
SHALER RICHARDSON, M.D., Editor . .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville-
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama Cilv
EUGENE G. PEEK JR., M.D. AL-58 Ocala
GEORGE S. PALMER, M.D... A-58 Tallahassee
CLYDE O. ANDERSON, M.D. C-59 Si. Petersburg
REUBEN B. CHRISMAN JR., M.D.. .D-60. . Coral Gables
MEREDITH MALLORY, M.D...B-61 Orlando
JOHN D. MILTON, M.D. PP-58 Miami
FRANCIS H. LANGLEY, M.D.. PP-59 Si. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . Jacksonville
EDWARD JEl.KS, M.D. (Public Relations) . .Jacksonville
Committees
BLUE SHIELD LIAISON
HENItY J. BAIiERS JR., M.D., Chm AL 58 Cainesvil
HENRY L. SMITH JR., M.D A-58 Tallaliass,
JOHN J. CHELEDEN, M.D. B-58 Daytona Beai
JOHN M. BUTCHER, M.D. C-58 Saraso.
PAUL G. SHELL, M.D. D 58 Fort Lauderda
GRETCHEN V. SQUIRES, M.D A-59 Pensaco
HENRY L. HARRELL, M.D. B-59 Oca
JAMES R. BOULWARE JR., M.D C 59 L ahelat.
RALPH M. OVERSTREET JR., M.D. D 59 IV. Palm Heat
MERRITT R. CLEMENTS, M.D A 60 Tallaliass,
ROBERT E. ZELLNER, M.D B-60 O riant
WHITMAN C. McCONNEI L, M.D. C 60 St. Petersb w
RALPH S. SAPPF.NFIELD, M.D. D 60 Wiar,
HAROLD E. WAGER, M.D. A 61 Panama Ci.
CHARLES F. McCRORY, M.D B 61 Jackson vim
JOHN S. STEWART, M.D. 061 Fort Mye
DONALD F. MARION, M.D D 61 Mian I
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonvil
FRAZIER J. PAYTON, M.D. D 58 Mian
BARCLEY D. RHEA, M.D. A 59 Pensaco.
ALFONSO F. MASSARO, M.D C-60 Tamp
WILLIAM A. VAN NORTWICK, M.D B 61 Jacksonvil ,
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm D 58 Coral Oablt
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama Cit
WILLIAM S. JOHNSON, M.D. C-59 Lakelan
GEORGE S. PALMER, M.D. A 60 Tallahasst
J. K. DAVID JR., M.D. B 61 Jacksonvil
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK II. BOWEN, M.D. Jacksonville
GEORGE M. STUBBS, M.D. Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS. M.D. Fort Lauderdale
JAMES L. BRADLEY, M.D. Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL 58 ..Brooksville
First— ALPHEUS T. KENNEDY, M.D. 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2 59 Tallahassee
Third— LEO M. WACHTEL, M.D. 3 58 Jacksonville
Fourth— DON C. ROBERTSON, M.D. 4 59 Orlando
Fifth — JOHN M. BUTCHFR. M.D. 5 59 Sarasota
Sixth— GORDON H. McSWAIN, M.D 6-58 Arcadia
Seventh — RALPH M. OVERSTREET JR., M.D.
7-58 IV. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8 59 Miami
ADVISORY TO SELECTIVE SERl’ICE
TOR PHYSICIANS AND ALLIED SPECIALISTS
J. RCKTIF.R CHAPPELL, M.l)., Chm. Orlando
THOMAS H. BATES, M.D “A” Lake City
FRANK L. FORT, M.D “B” Jacksonville
ALVIN L. MILLS, M.D “C” St. Petersburg
JOHN D. MILTON, M.D "D” Miami
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAFPELL, M.D., Chm AL-58 Orland
WILLIAM W TRICE JR., M.D C 58 T amp
JOHN V. HANDWERKER JR., M.D D 59 Mian.
WALTER C. PAYNE JR., M.D. A 60 Pensacol
W. DEAN STEWARD, M.D B 61 Orland
CONSER I M77 ON OE VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orland
HUGH E. PARSONS, M.D. C-58 Tamp
CHARLES C. GRACE, M.D. B-59 St. Augustin
ALAN E. BELL, M.D. A-60 Pensacol
LAURIE R. TEASDALE, M.D D 61 W. Palm Beac.
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beac.
FRANCIS H. LANGLEY, M.D St. Petersbur
IOHN D. MILTON, M.D Miam
DUNCAN T. McEWAN, M.D Orland
ROBERT B. McIVER, M.D Jacksonvill
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tamp
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdal
EDWARD JELKS, M.D. B 58 Jacksonvill
CECIL M. PEEK, M.D. D-60 W. Palm Bead
GEORGE H. GARMANY, M.D A 61 Tallahasse
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama Cit
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonvill
BLOOD
I AMES N. PATTERSON, M.D., Chm C 61 Tampa
LEO E. REILLY, M.D. AL-58 Panama C.itv
ROBERT II. McIVER. M.D. II 58 Jacksonville
GRETCHEN V. SQUIRES, M.D A-59 Pensacola
DONALD W. SMITH, M.D D-60 Miami
MATERNAL ]V ELF ARE
E. FRANK McCAI.L, M.D., Chm. B-60 Jacksonvill,
WILLIAM C. FONTAINE, M.D. AL 58 Panama Cit-
J. LLOYD MASSEY M.D. A-58 Quine j
RICHARD F. STOVER, M.D. D-59 Miam
S. L. WATSON, M.D C-61 Lakelan,
J. Florida, M. A.
November, 1957
565
MEDICAL ECONOMICS
ROBERT E. ZELLNF.R, M.D., Chm AL-58 Orlando
DEWITT C. DAUGHTRY, M.D. D-58 Miami
S. CARNES HARVARD, M.D C-59 Brooksville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
FLOYD K. HURT, M.D B 61 lachsonville
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm. B 60 ..Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD RF.F.SF.R JR., M.D C-59 Sr. Petersburg
GRETCHEN V. SQUIRES, M.D. A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
IACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
’AUL J. COUGHLIN, M.D. AL-58 Tallahassee
IVILI.IAM G. MERIWETHER, M.D. C 59 Plant City
iV ALTER E. MURPHREE, M.D. B 60 Gainesville
RAYMOND B. SQUIRES, M.D. A-61 Pensacola
Subcommittee
l. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL 58 Gainesville
MERRITT R. CLEMENTS. MI)., A 60 Tallahassee
HENRY H. GRAHAM, M.D B-58 Gainesville
AMES N. PATTERSON, M.D. C 61 Tampa
EDWARD W. CULLIPHF.R, M.D D 59 Miami
HOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 Miami
3EORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
l. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm A 60 Chattahoochee
NELSON H. KRAEI T, M.D AL 58 Tallahassee
WILLIAM L. MUSSER, M.D. B 58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D D-61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D.. Chm. B 61 Jacksonville
HENRY I. LANGSTON, M.D AL-58 Apalachicola
JOHN G. CHESNEY, M.D. D 58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D. A 60 Weivahitchka
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURSE
rURNER Z. CASON, M.D., Chm B-59 Jacksonville
,EO M. WACHTEL, M.D AL-58 Jacksonville
FRANK CHUNN, M.D C-58 Tampa
VILLIAM D. CAWTHON, M.D. A-60 DeFuniak Springs
I. MARKLIN JOHNSON, M.D D-61 W. Palm Beach
MENTAL HEALTH
ULLIVAN G. BEDELL, M.D., Chm B 61
VILLIAM M. C. WILHOIT, M.D AL-58
. LLOYD MASSEY, M.D. A- 5 8
V. TRACY HAVERFIF.LD, M.D D 59
IASON TRU’PP, M.D C-60
NECROLOGY
. BASIL HALL, M.D., Chm AL-58
VALTER W. SACKETT JR., M.D D-58
,EO M. WACHTEL, M.D.....B-59
lLVIN L. STEBBINS, M.D A 60
1AYMOND H. CENTER, M.D C-61
NURSING
HOMAS C. KENASTON, M.D., Chm B-59 Cocoa
JARL M. HERBERT, M.D AL-58 Gainesville
IERBERT L. BRYANS, M.D A-58 Pensacola
■IORVAL M. MARR SR., M.D C-60 St. Petersburg
AMES R. SORY, M.D D-61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
IICHARD G. SKINNER JR., M.D., Chm B 59 Jacksonville
OH^ J. BENTON, M.D AL-58 Panama City
1EORGE S. PALMER, M.D. A-58 Tallahassee
DWARD W. CULLIPHER, M.D D 60 Miami
RANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
’ASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
VILLIAM J. HUTCHISON, M.D AL-58 Tallahassee
DAS. I,. FARRINGTON, M.D. C-58 Sr. Petersburg
:HOMAS N. RYON, M.D. D-59 Miami
tAYMOND R. KILLINGER, M.D B 61 Jacksonville
'pedal Assignment
■ Industrial Health
C. W. SHACKELFORD, M.D., Chm. A 61 Panama City
FRANK V. CHAPPELL, M.D AL-58 Tampa
A. BUIST LITTERER, M.D. l)-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.D. B 60 Jacksonville
WOMAN’S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
JOHN H. TERRY, M.D. AL 58 Jacksonville
WILEY M. S.VMS, M.D. D 58 .Miami
G. DEKI.i: TAYLOR, M.D. 11 59 Jacksonville
CHARLES McC. GRAY, M.D C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate ..Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 _ lachsonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 _ _ Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
JOSEPH S. STEWART, M l).. 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M I)., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. Mcl VEIL M.D., 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M I)., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
Jacksonville
Pensacola
Quincy
Miami
Tampa
Tayares
Miami
Jacksonville
Pensacola
Clearwater
566
Volume XLlI
Number 5
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safe . . . for your little patients, too
“a definite relaxant effect”1
With Nostyn “...almost without exception the children responded by becoming more ame-
nable, quieter and less restless.’’1
without depression, droiesiness, motor incoordination
“The most striking feature is that this drug does not act as a hypnotic. . . .”1 “No toxic side-
effects were noted, with particular attention being paid to the hematopoietic system.’’2
dosage: Children: 150 mg. (14 tablet) three or four times daily. Adults: 150-300 mg. (14 to 1 tablet)
three or four times daily.
supplied: 300 mg. scored tablets, bottles of 48 and 500.
(1) Asung, C. L.; Charcowa, A. I„ and Villa, A. P: Sea View Hosp. Bull. 76:80. 1956. (2) Asung, C. L.; Charcowa, A. I., and
Villa, A. P: New York J. Med. 57:1911 (June 1) 1957. (3) Report on Field Screening of Nostyn by 99 Physicians in 1,000
Patients, June, 1956.
AMES COMPANY, INC • ELKHART, INDIANA
41057
sV calmative nostyn
Ectylurea, Ames
(2-ethyl-c/i-crotonylurea)
I
“of value in the hyperactive as well
as the emotionally unstable child
0
Compazine
tablets, ampuls, Spansulet capsules
Smith , Kline & French Laboratories , Philadelphia
f. " Y CP, '■* ACADEMY OF
r.vED \ C I U\l
C 1 0 3RD ST
CW YORK !l V 2 9 j C-£
stops nausea and vomiting-
mild and severe—
from virtually any cause
★T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
tT.M. Reg. U.S. Pat. Off. for sustained release capsules. S.K.F.
Vol. XLIV
DECEMBER, 1957
OF THE FLORIDA MEDICAL ASSOCIATION
OFFICIAL PUBLICATION OF THE
FLORIDA MEDICAL ASSOCIATION
FOR PERSISTENT INFECTIONS
CHLOROMYCETIN
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
Acquired resistance seldom imposes restrictions on
antimicrobial therapy when CHLOROMYCETIN (chlor-
amphenicol, Parke-Davis) is selected to combat gram-
negative pathogens involving enteric and adjacent
structures of the urinary tract. The acknowledged effec-
tiveness with which CHLOROMYCETIN suppresses highly
invasive staphylococci1-9 extends to persistently patho-
genic coliforms.6'10-15 Experience with mixed groups of
Proteus species, for example, “...shows chloramphenicol
to be the drug of choice against these bacilli . . .”15
CHLOROMYCETIN is a potent therapeutic agent and, because
certain blood dyscrasias have been associated with its administra-
tion, it should not be used indiscriminately or for minor infections.
Furthermore, as with certain other drugs, adequate blood studies
should be made when the patient requires prolonged or intermit-
tent therapy.
REFERENCES:
(1) Petersdorf, R. G.; Bennett, I. L., Jr., & Rose, M. C.: Bull. Johns Hopkins
Hosp. 100:1, 1957. (2) Yow, E. M.: GP 15:102, 1957. (3) Altemeier, W. A.,
in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957, New
York, Medical Encyclopedia, Inc., 1957, p. 629. (4) Kempe, C. H.: California
Med. 84:242, 1956. (5) Spink, W. W.: Ann. New York Acad. Sc. 65:175,
1956. (6) Rantz, L. A., & Rantz, H. H.: Arch. Int. Med. 97:694, 1956.
(7) Wise, R. I.; Cranny, C., & Spink, W. W.: Am. J. Med. 20:176, 1956.
(8) Smith, R. T.; Platou, E. S., & Good, R. A.: Pediatrics 17:549, 1956.
(9) Royer, A.: Scientific Exhibit, 89th Ann. Conv. Canad. M. A., Quebec City,
Quebec, June 11-15, 1956. (10) Bennett, I. L., Jr.: West Virginia M. J. 53:55,
1957. (11) Altemeier, W. A.: Postgrad. Med. 20:319, 1956. (12) Felix, N. S.:
Pediat. Clin. North America 3:317, 1956. (13) Metzger, W. I., & Jenkins,
C. J., Jr. : Pediatrics 18:929, 1956. (14) Woolington, S. S.; Adler, S. J.,& Bower,
A. G., in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957,
New York, Medical Encyclopedia, Inc., 1957, p. 365. (15) Waisbren, B. A.,
& Strelitzer, C. L.: Arch. Int. Med. 99:744, 1957.
V
►
PARKE, DAVIS & COMPANY DETROIT 32, MICHIGAN
50168
COMPARATIVE SENSITIVITY OF MIXED PROTEUS SPECIES TO CHLOROMYCETIN
AND SIX OTHER WIDELY USED ANTIBIOTIC AGENTS*
90
80
40
30
20
10
0
ANTIBIOTIC A 38%
ANTIBIOTIC C 34%
ANTIBIOTIC F 5%
‘This graph is adapted from Waisbren and Strelitzer.16 It represents in vitro data obtained with clinical material isolated between the years
1951 and 1956. Inhibitory concentrations, ranging from 3 to 25 meg. per ml., were selected on the basis of usual clinical sensitivity.
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
VOLUME xliv, No. 6 ♦ December, 1957
CONTENT S
Scientific Articles
Extracorporeal Circulation for Open Heart Surgery,
Robert S. Litwak, M.D., Frank T. Kurzweg, M.D., Rufus
K. Broadaway, M.D., John J. Foman, M.D., and John J.
Farrell, M.D
The Clinical Value of Right and Left Heart Catheterization
in the Selection of Patients for Valvular Heart
Surgery, Philip Samet, M.D., William H. Bernstein, M.D.,
Robert S. Litwak, M.D., H. Turken, M.D.. Leonard
Silverman, M.D., and Milton E. Lesser, M.D.
The Diagnosis and Management of Ectopic Pregnancy,
Frank R. Smith, M.D., and William H. Whiteside, M.D.
Carcinoma of the Esophagus, John R. Doster Jr., M.D.,
and John A. Dyal Jr., Ai.D.
Syphilis in Polk County, J. H. Ackerman. M.D., and
James A. Donaldson, M.D.
Virological Findings on Polio and Polio-Like Diseases — 1956,
M. M. Sigel, t'n.D., G. Schiaepier, B.A., L. Moewus, M.S.,
and A. Branch, B.S.
587
592
599
604
607
610
Abstracts
Drs. Alvan G. Foraker, H. Clinton Davis, Irwin S. Morse, L. P. Carmichael 613
Editorials and Commentaries
A Prayer for Physicians 614
The Voice of Reason, Frank G. Slaughter, M.D. 615
Whole Truths to Combat Misconceptions 616
Distinguished Florida Physician Sponsored for Highest National Office 617
Announcing Dr. Orr’s Candidacy 617
Laying of Cornerstone University Teaching Hospital 618
Midwinter Seminar Ophthalmology and Otolaryngology,
Miami Beach, Jan. 27 — Feb. 1, 1958 619
Florida Diabetes Association Annual Meeting Held 619
The New Orleans Graduate Medical Assemoly 62C
“Jacksonville Blood Bank, Inc.” A Review 620
General Features
Others Are Saying 622
Deaths 62 1
State News Items 63C
Classified 638
Component Society Notes 64C
New Members 64 d
Obituaries 64t
Woman’s Auxiliary 668
Schedule of Meetings 675
Florida Medical Association Officers and Committees 676 1
County Medical Societies of Florida 678
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price S5.00 a year: single numbers, 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411, 735 Riverside Ave., Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail-
ing at special rate of postage provided for in Section 1103. Act of Congress of October 3, 1917; authorized October 16
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville
Florida, October 23, 1924
J. Florida, M.A.
December, 1957
573
your patients with generalized gastrointestinal
complaints need the comprehensive benefits of
Tridal
(DACTIL® + PIPTAL® — in one tablet)
rapid, prolonged relief throughout the G.I. tract
with unusual freedom from antispasmodic
and anticholinergic side effects
One tablet two or three times a day and one at bedtime. Each TRIDAL tablet
contains 50 mg. of Dactil, the only brand of N-ethyl-3-pipendyl
diphenylacetate hydrochloride, and 5 mg of Piptal. the only brand
of N-ethyl-3-pipendyl-benzilate methobromide.
AKESIDE
574
Volume XLIV
Number C
an incomparable protectant
and healing agent
for the SKIN of the AGED
H
v.T
DESITIN
ointment
sustained soothing, lubricating, antipruritic—
and healing — effects in . . .
rash and excoriation due to
• incontinence
• senile pruritus
• external ulcers
• stasis dermatitis
• excessive dryness
DESITIN OINTMENT— rich in cod liver oil— has a 30 year clinical background of
success in the treatment of many skin conditions.
SAMPLES and literature on request
DESITIN CHEMICAL COMPANY
812 BRANCH AYE., PROVIDENCE 4, R. I.
T. Florida, M.A.
December, 1957
575
(dihydroxy aluminum aminoacetate with belladonna alkaloids and phenobarbltal)
no wonder . . .
It’s no wonder that of the many antacid-
spasmolytic formulations promoted to the
medical profession, so many physicians have
found Malglyn the most consistent in clinical
effectiveness.
Here's a startling adsorption story
involving simultaneous adminis-
tration of antacid and spasmoly-
tic drugs!
BKULADONNA ALKALOID!
ALONK
100
LD 90%*
* 1 5 mg. dose
of spasmolytic
proved lethal
in 90" „ of
test animals
BELLADONNA ALKALOIDS
WITH
ALUMINUM HYDROXIDE
IB
■
MBRHj
j
■
AI(OH),
w/spasmolytic
substantially
reduces spasmolytic
drug effect
BELLADONNA ALKALOIDS WITH
DIHYDROXY ALUMINUM AMINOACETATE
(alolyn®. brayten)
1
j
LD 83%
Malglyn Compound
provides maximal
spasmolytic effect
atrjgjBF
| Alglyn
! adsorbed only
1 -to/
7%
of alkaloids
passu
1
The above laboratory study clearly indicates that the antacid Alglyn,
contained in the Malglyn formula, does not materially interfere
with the therapeutic effectiveness of its contained belladonna alka-
loids. On the other hand, the marked adsorptive properties of
aluminum hydroxide renders its combination with belladonna alka-
loids both uneconomical and therapeutically unreliable.
each tablet contains
dihydroxy
aluminum
aminoacetate, 0.0 omi
N.N.R.
belladonna
alkaloids o.taa m<b.
(as sulfates)
phenobarbital ie.a mo.
For both rapid and prolonged antacid effect, with consistently
effective spasmolytic and sedative action, rely upon Malglyn
Also supplied: ALGLYN* (dihydroiyaluml-
mim aminoacetate, N.N i. 0.5 Cm per tablet).
for treatment of peptic ulcer and epigastric distress.
BEIGLYN* (dihydroiy «lumlnum amlnoacatata,
N.N.R., 0.5 Gm and balladonna alkaloids. 0.162 m|.
pet tablat).
Specialities for the Medical Profession only
BRAYTEN PHARMACEUTICAL COMPANY
CHATTANOOGA J, TENNESSEE
576
Volume XLIV
Number 6
" . -
NEW . . . intranasal
synergism
Biosvnephrine
I 15 cc. (j
\ \
CmtDM:
DECONGESTIVE
Neo-Synephrine ® HCl 0.5 %
ANTI-INFLAMMATORY '
Hydrocortisone 0.02%
ANTI-ALLERGIC
Thenfadil ® HCl 0.05 %
ANTIBACTERIAL
Neomycin ( sulfate )
1 mg./cc.
( equivalent to
0.6 mg. neomycin
base/cc.)
Convenient plastic,
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Leakproof, delivers
a fine mist.
Polymyxin B POTENTIATED ACTION for
(os sulfate) ■ i* * ■ ■>
3000 u/cc. better clinical results
LABORATORIES
NEW YORK 18, N. X.
Neo-Synephrlne (brand of
phenylaphrlna) and Thenfadil
(brand of thenyldiamine),
trademarks re g. U.S. Pat. Off,
COLDS
SINUSITIS
ALLERGIC RHINITIS
f. Florida, M.A.
December, 1957
577
FOR THE ENTIRE RANGE OF RHEUMATIC-ARTHRITIC
DISORDERS-from the mildest
to the most severe
many patients with MILD involvement can be effectively
controlled with
MEPROLONE
many patients with MODERATELY SEVERE involvement
can be effectively controlled with
MEPROLONE
The first meprobamate-prednisolone therapy
*he one antirheumatic, antiarthritic that
simultaneously relieves: (i) musclespasm
(2) joint inflammation (3) anxiety and
tension (4) discomfort and disability.
SUPPLIED: Multiple Compressed Tablets
in three formulas: 'MEPROLONE'-5 —
5.0 mg. prednisolone, 400 mg. meproba-
mate and 200 mg. dried aluminum hy-
droxide gel. ‘MEPROLONE’-2 — 2.0 mg.
prednisolone, 200 mg. meprobamate and
200 mg. dried aluminum hydroxide
gel. ‘MEPROLONE’-i supplies 1.0 mg.
prednisolone in the same formula as
*MEPR0L0NE’-2.
MERCK SHARP & DOHME
Ol VISION OF MERCK ft CO.. INC.
PHILADELPHIA I. PA.
"MEPROLONE’ U a trademark of Merck 6 Co.. Inc,
578
Volume XLIV
Number 6
in acne
“results were uniformly encouraging >n
{[Hex’-
1 1 ** nonalkaline
antibacterial
detergent —
nonirritating,
hypoallergenic.
The acne skin that is “surgically
clean” is the one most likely to clear
completely. Hodges1 found that
standard acne treatment usually re-
sults in “mediocre success” for most
patients. The addition of pHisoHex ®
washings to standard treatment pro-
duced results that far excel any ob-
tained previously.
pHisoHex, a powerful antibacterial
skin cleanser containing hexachloro-
phene, removes oil and virtually all
the bacteria from the skin surface.
For best results prescribe from four
to six pHisoHex washings of the
acne area daily.
1. Hodges, F. T.: GP, 14:86. Nov., 1956.
pHisoHex, trademark reg. U. S. Pat. Off.
LABORATORIES
New York 18. N.Y.
J. Fl ORIDA, M.A.
December, 1957
579
• six years of experience ivith Penticls in mil-
lions of patients confirm clinical effectiveness
and safety
• excellent results ivith 1 or 2 tablets t.i.d. for
many common bacterial infections
• may be given without regard to meals
• economical . . . Pentids cost less than other
penicillin salts
Just 1 or 2 tablets t.i.d. Bottles of 12, 100 and 500
NEW! PENTIDS FOR SYRUP. Orange flavored powder
which, when prepared with water, provides 60 cc. of
syrup with a potency of 200,000 units of penicillin G
potassium per 5 cc. teaspoonful.
Also available: Pentids Capsules, Pentids Soluble Tab-
lets. Pentid-Sulfas.
Squibb
Squibb Quality— the Priceless Ingredient
•fCNTIO*» I* A SQUIBS TAADCMABR
580
Volume XLIV
Number 6
announcing
a new lifesaving antibiotic
T. Florida, M. \.
December, 1957
581
discovered by Abbott Laboratories
SPONTIN
A new, important antibiotic, Spontin, is now being made availa-
ble— in limited supply — to the medical profession.
Discovered and developed by Abbott Laboratories, Spontin
proved highly effective — even lifesaving — in clinical trials with
patients in whom other antibiotics had failed.
Because of intricate and technical production problems, only
a limited supply of Spontin is available currently. But, as soon
as these problems are solved, Spontin will be offered to all
hospitals.
For, essentially, Spontin is a drug for hospital use — for
patients who are seriously ill, or even dying, from organisms that
have become resistant to present-day therapy.
In its present form Spontin is administered intravenously,
using the drip technique. The required dosage is dissolved in 5%
Dextrose in water and administered in 35 to 40 minutes.
You’ll find Spontin effective against a wide range of gram-
positive coccal infections. And especially in those dangerous
staphylococcal problems that resist other antibiotics. Some of
the important therapeutic points include:
1 ) successful short-term therapy for acute or subacute endocarditis
2) new antimicrobial activity — no natural resistance to Spontin
was found in tests involving hundreds of coccal strains
8) antimicrobial action against which resistance is rare — and ex-
tremely difficult to induce
4) bactericidal action at effective therapeutic dosages.
Spontin comes as a sterile, lyophilized powder in vials repre-
senting 500 mg. of ristocetin A activity. While distribution is
limited, your emergency needs will be handled by your Abbott
representative, or at the nearest Abbott
(Ristocetin, Abbott)
branch. Literature is available on request.
711285
582
Volume XLIV
Number 6
KNOX PROTEIN PREVIEWS
TWO NEW
CLINICAL
REPORTS
REAFFIRM
THE
BENEFITS OF
GELATINE F(l
J. Florida, M.A.
December, 1957
583
"Evidence continues to accumulate verifying tlie effectiveness of Gelatine in the
treatment of brittle fingernails. Investigators report that the nails show objective
evidence of improvement. I-2-3-4 Furthermore, patients often volunteer that their nails
“feel stronger,” “look smoother," and “I can pick up things without them hurting.”1
Evidently the subjective sensations associated with improvement are nearly as im-
portant to some patients as the positive physical change in the nails’ appearance.
Improvement Noted in 81% of Patients
See the chart below fora summary of the effect of Knox Gelatine in brittle fingernails
as observed in all published reports. Photographic evidence of improvement, much
of it in color taken before and during treatment, is available for most of the
patients. '•2-3 Please note, however, that where Gelatine was used in the treatment of
pathological conditions associated with brittle fingernails only in psoriasis did the
data show definite improvement. '-3- 4
Response to Gelatine in Brittle Fingernails
No. patients
w/ brittle No
Duration of
No. patients w/
No patients
nails and other
patients
References
Dosage
treatment
brittle nails
improved
pathology
improved
I. Rosenberg. S.. Oster, K. A..
7 Gm/
3 months
50
43 (867.)
32a
9
Kallos, A. and Burroughs. W.:
A. M.A. Arch. Dermat 76:330,
(September) 1957
day
2. Schwimmer. M. and Mulinos. M.G.
7 5 Gm /
11-16 weeks
18
15 (837.)
Antibiot. Med. & din. Therapy
4:403, (July) 1957
day
3. Rosenberg. S. and Oster. K. A:
7 to 21
15 weeks
36
26b (727.)
Conn. State Med. J
19:171. (March) 1955
Gm./day
4. Tyson, T. L:
J. Invest. Dermat
7 Gm./day
13 weeks
12
10' (837.)
14:323, (May) 1950
Totals
7-21 Gm.
11-16 weeks
116
94 (817.)
32
9(28%)
a. Gelatine improved psoriatic nails in 5 out of 12 cases. In onychomycosis and other pathological
conditions of the nail it was of no appreciable help.
b. Of the failures, 2 had congenital disease of the nails, 3 were diabetics and 3 took the medication
for less than one month.
c. One patient with psoriasis and arthritis and one patient with psoriasiform nail changes showed
improvement in 2 and 3 months respectively.
rithe fingernails
Important Note
The pharmacodynamic effects of Gelatine are manifested through its high Specific
Dynamic Action, and therefore, depend upon adequate and prolonged intake. All
published clinical research has been conducted using 7 to 21 grams (1-3 envelopes)
of Knox Gelatine per day for the three to four months that are required for complete
regrowth of the nails. Smaller dosage would induce a lesser specific dynamic action
and thus prove ineffectual in correcting the brittle nail defects. More detailed infor-
mation on brittle fingernails and reprints of the two more recent clinical reports are
available on request. Please use the attached coupon.
I
Knox Gelatine Company
Professional Service Department SJ-27
Johnstown, N. Y.
Please send reprints of the following articles:
□ Rosenberg, S., Oster, K. A., Kallos, A. and Burroughs, W. : A. M.A. Arch. Dermat.
76:330, (Sept.) 1957.
Q Schwimmer, M. and Mulinos, M.G.: Antibiot. Med. & Clin. Therapy 4:403,
(July) 1957.
1
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RICH COMPANY, INCORPORATED
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in tlie eyes of industry
more visible results...
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METIMYD
OPHTHALMIC SUSPENSION
(prednisolone acetate and sulfacetamide sodium)
antiallergic . . . antibacterial . . . anti-inflammatory
visible results, MORE quickly— Prednisolone,
the corticosteroid component in Metimyd, acts
more rapidly on topical application in the eye
than either hydrocortisone or cortisone.1
more man-hours saved— Sulfacetamide sodium,
the sulfonamide component in Metimyd,
possesses unsurpassed antibacterial activity for
ophthalmic use. In extensive clinical use it has
reduced the number and duration of return visits,2
thereby saving precious man-hours.
and especially for
nighttime use and
as a protective
dressing
METIMYD
OINTMENT with
NEOMYCIN
“Meti”*steroid plus potentiated antibacterial action
References
1. King, J. H., Jr.; Passmore, J. W.; Skeehan, R. A., Jr., and Weimer, J. R.: Tr. Am.
Acad. Ophth. 59: 759, 1955.
2. Kuhn, H. S.: Tr. Am. Acad. Ophth. 55:431, 1951.
MM.J.JS7
*T. M.
PENICILLIN SERUM LEVELS, UNITS/CC.
586
Volume XLIV
Number 6
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, December, 1957 No. 6
Extracorporeal Circulation for Open
Heart Surgery
I. Physiologic and Metabolic Studies
Robert S. Litwak, M.D., Frank T. Kurzweg, M.D.,
Rufus K. Broadaway, M.D., John J. Fomon, M.D.
AND
John J. Farrell, M.D.
MIAMI
The past decade has seen remarkable ad-
vances in cardiac surgery. Fundamental to its
development has been the concept of ‘‘indirect”
visualization by means of the intracardiac ex-
ploring finger. Use of this modality has resulted
in the successful attack on stenotic lesions of the
mitral and aortic valves and, more recently,
mitral insufficiency.
Nevertheless, it is apparent that it is better
to see than not to see. Although open heart sur-
gery may be accomplished for short periods by
hypothermia, it is clear that prolonged open
cardiac corrective procedures require total body
perfusion with bypass of the heart and lungs
utilizing a pump-oxygenator. It is the purpose
of this report to describe a relatively simple gas
dispersion oxygenating mechanism of the DeWall
type1 and certain experimental physiologic and
metabolic observations.
The Apparatus (Fig. 1)
The oxygenating unit consists of a simple
nylon oxygen injector nipple through which large
oxygen bubbles can be delivered into a vertical
blood mixing tube, thereby creating a column of
bloody foam. Oxygen and carbon dioxide ex-
change takes place in the upper portion of the
mixing tube and throughout the entire length
of a large defoaming chamber. In the latter, the
bloody foam is reverted into a solid blood column
From the Department of Surgery, University of Miami
School of Medicine, and the Jackson Memorial Hospital, Miami.
This work was supported by the Heart Associations of
Greater Miami and Palm Reach County, as well as the Hardt
Foundation.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957.
by exposing it to Antifoam A,* which lines the
defoamer. The blood is then delivered to a helical
vinyl plastic reservoir mechanism. The theoretic
advantages of a graduated helix over vertical
debubbler mechanisms have proved to be sound
in the laboratory. In the former, the blood col-
umn gradually descends, and any free gas bubbles
tend to move away from the line of flow along
the upper edge of the tubing. In the latter or
vertical mechanism, the blood flow toward the
reservoir runs in 180 degree opposition to the
flow of the injected oxygen and the released car-
bon dioxide. Thus, the possibility of gas emboli
is far greater in the vertical units.
The pumping mechanism consists of a model
TM-1 valveless finger pump** capable of an out-
put of approximately four liters of blood per
minute.
Method
Mongrel dogs, weighing 8 to 30 Kg., were
anesthetized with fractional doses of Pentothal
Sodium, intubated and placed on a mechanical
respirator. Surgery was performed clean but not
aseptically. The chest was entered through the
right fourth intercostal space. The right common
carotid artery was exposed as was the right fem-
oral artery. The pericardium was opened wide-
ly, and the inferior and superior venae cavae were
mobilized and ligatures passed around these struc-
tures. After completion of all dissection, heparin
was administered (1 mg. per kilogram). The
femoral artery was then connected to a mercury
*Dow Corning Company, Midland, Mich.
**Sigmamotoi, Inc., Middleport N. Y.
588
LITWAK et al: OPEN HEART SURGERY
Volume XLIV
Number 6
Fig. 1. — Fully assembled pump-oxygenator. The shunt between efferent and afferent lines is clamped.
manometer. Plastic cannulas were inserted into
both cavae and the right common carotid artery.
Following this procedure the arterial and venous
connections with the pump-oxygenator were ac-
complished promptly.
During the initial preparations, the previous-
ly described apparatus was filled with freshly
drawn blood heparinized with 18 mg. per 480 ml.
of unmatched dog blood. Utilizing a shunt con-
necting the afferent and efferent limbs of the cir-
cuit, the entire reservoir volume of blood is re-
circulated through the oxygenating system im-
mediately prior to total bypass. This measure
effectively removes any trapped air bubbles.
Bypass of the heart and lungs was accom-
plished by occluding the shunt and tightening the
caval ligatures about the cannulas. In the ma-
jority of animals, a right ventriculotomy was per-
formed, and the blood returning to the right
atrium via the coronary sinus and anterior car-
diac veins was collected in a plastic reservoir by
means of a low pressure suction device and re-
turned to the oxygenator (fig. 2). At the con-
clusion of the perfusion, protamine sulfate, 2 mg.
per kilogram, was administered to counteract the
heparin effect.
Results
Seventy-three dogs have been perfused from
15 to 63 minutes. Induced potassium citrate
cardiac arrest was performed in six animals. The
data pertaining to the latter procedure will not
be included in this report.
Forty-one (61 per cent) of the 67 animals
survived perfusion, awoke, moved about and were
alert to commands. Twenty-six animals (39 per
cent) succumbed in the early postoperative pe-
riod. The deaths were related to bleeding (9), j
atelectasis (12), acute cardiac failure (2), and
cerebral ischemia (3). Seven dogs died on the
first or second postoperative day of heart block
produced during creation and repair of large
ventricular septal defects. As might be expected,
nine dogs succumbed from the third to seventh
J. Florida, M.A.
December, 1957
LITVVAK et al: OPEN HEART SURGERY
589
postoperative days from empyema or massive
wound infection.
A direct correlation between perfusion period
and survival was demonstrable (fig. 3). Ten of
15 animals (67 per cent) perfused for 15 to 30
minutes survived. A second group of 42 dogs
was perfused for 30 to 45 minutes. Thirty of
these perfusions varied from 30 to 35 minutes.
The remaining 12 bypasses varied from 35 to 45
minutes. There was an over-all survival of 26
dogs (61 per cent). Of 10 dogs perfused be-
tween 45 and 63 minutes only five survived.
A similar direct relationship between survival
and flow rate is apparent in figure 4. Ten of 15
animals (67 per cent) perfused for 15 to 30
minutes survived. This number included six sur-
vivors in a group of eight dogs perfused at from
40 to 70 cc./Kg./min. while only three of six dogs
lived after perfusion at 25 to 35 cc./Kg./min. One
surviving dog was excluded from the analysis
since the flow rate was varied significantly during
the run. A second group of 52 dogs was perfused
at the two rates described for periods of 30 to
60 minutes. There were 31 survivors (60 per
cent). Four surviving animals were again ex-
cluded from analysis because of significant and
frequent variations of flow rates during the runs.
Twenty-four of 39 animals (61 per cent) per-
fused at 40 to 70 cc./Kg./min. survived while
only three of 13 dogs (23 per cent) survived per-
fusion at 25 to 35 cc./Kg./min.
Acid Base Changes During Total Body Perfusion
A consistent fall in arterial pH occurred dur-
ing perfusion. During the first 10 minutes of the
run, the fall was small but significant. Beyond
10 minutes, the pH declined more rapidly. The
fall in arterial pH could also be related to flow
rate as well as perfusion period (fig. 5). Fur-
ther, a direct correlation is demonstrable be-
tween survival and arterial pH at the end of the
run (fig. 6). The lowest pH recorded was 6.9 (60
and 63 minute runs). There were no survivors in
this group.
Figure 7 illustrates the essential metabolic
picture during perfusion. These data were ob-
tained from 14 animals perfused for 30 minutes
at 25 to 77 cc./Kg./min. The pH drop described
is again noted. There is a sharp fall in the arte-
rial carbon dioxide content while the oxygen
saturation remains at 96 to 98 per cent. By utiliz-
ing the arterial pH and carbon dioxide content
data, it is possible to calculate the carbon dioxide
Fig. 2. — Diagramatic representation of unit in opera-
tion. The right ventricle is open and the low pressure
cardiotomy suction system (A) is demonstrated. The
helix (B) is immersed in a water bath maintained at 39
to 40 C. to maintain normothermic blood temperatures.
tension of the arterial blood by application of the
Henderson-Hasselbalch equation. As will be
noted, there is a rise of considerable degree in
the calculated pCCD. On the basis of these deter-
minations, it is apparent that a significant meta-
SURVIVAL (%)
IOO-
80-
60-
40-
20-
15-30
PERFUSION
1
30-45
TIME (MIN)
45-63
Fig. 3. — There is a linear relationship between sur-
vival and perfusion time.
590
LITWAK et al: OPEN HEART SURGERY
Volume XLIV
Number 6
SURVIVAL (*/.)
IOOi
20-
15 -JO 30-60
PERFUSION TIME (MIN.)
- flow raft 25-35cc. /kg /min
flow rote 40 -70 cc./ kg. / min.
Fig. 4. — Effect of varying flow rates on survival.
pH AT END OF
30 MIN. RUN (14 ANIMALS)
flow rote 25-35 cc. /kg
r flow rate 40-70cc /kg.
Fig. 5. — Effect of varying flow rates on pH.
SURVIVAL (%)
Fig. 6. — Relation between pH and survival.
bolic acidosis occurs during total heart-lung
bypass. The probability that a significant degree
of the acidosis is related to the accumulation of
acid metabolites is suggested by the decided rise
in lactic acid during the runs (table 1).
Alterations in the Blood and Blood Elements
Table 1 summarizes the influence of perfusion
on hemolysis, potassium, sodium and leukocyte
and thrombocyte counts. Although dog blood
hemolyzes readily and the degree of hemolysis
is often related to the care taken in obtaining
the sample, plasma hemoglobin levels range from
79.2 to 143.1 mg. per hundred cubic centimeters
with a mean value of 84.6 mg. These values are
well within the realm of safety.
Serum sodium levels revealed no significant
change, but there was a consistent lowering of
potassium.
There were decided falls in leukocyte and
thrombocyte counts during the perfusions, but
these were transient and these elements rapidly
reconstituted themselves shortly after perfusion
was discontinued.
Discussion
It has been demonstrated that bubbling oxy-
gen through a blood medium is a satisfactory
method of rapidly oxygenating venous blood.1-3
Despite varying flows, it has been uniformly pos-
sible to achieve oxygen saturations of 96 to 98
per cent. At the same time, the blow-off of car-
bon dioxide is quite efficient. A disquieting fea-
ture, however, has been the appearance of a sig-
nificant metabolic acidosis. The magnitude of
the acidosis is apparently related to both per-
fusion rate and time and materially influences
ultimate survival. The rise in carbon dioxide
Fig. 7. — Metabolic data in 14 dogs. Discussion in
text.
December,' ?957 LITWAK et al: OPEN HEART SURGERY 591
Table 1. — Alterations in Blood and Blood Elements
Lactic Acid
Plasma
Potassium
Sodium
WBC
Thrombocytes
Time
(mg. %)
Hb.
(6 dogs)
(14 dogs)
(14 dogs)
(14 dogs)
(25 dogs)
(14 dogs)
Before bypass
12.2
6.2
4.2
125
18,900
220,000
End of 30-45 min. bypass
37.6
84.6
3.6
128
5,000
49,000
hour post perfusion
31.2
76.2
3.7
125
7,600
72,000
Perfusion rate 40 to 63 cc./Kg./min.
tension of the arterial plasma accounts for only
a portion of the metabolic derangement, and it
is probable that the major drop in pH is related
to accumulation of fixed acid metabolites, there-
by effectively tying up the buffer systems.
Whether or not a pronounced depression of renal
function is responsible for the inability of the
organism to cope with the acidosis is unclear at
this time and must await further laboratory in-
quiry. It is of interest that an elevation of fixed
acids and an associated fall in arterial pH occur
at flow rates approximating normal cardiac out-
put. It is conceivable that there may be pro-
found disturbances in the enzyme systems of the
tissues so that adequate function of the normal
metabolic pathways does not occur despite per-
fectly adequate delivery of blood to the tissues.
If the acidosis were merely a function of tissue
hypoxia, it would seem that there should be an
associated elevation of potassium.4 The fact that
there was a distinct fall in the cation suggests a
possible epinephrine effect since the latter has
been shown to be of significant importance in
lowering serum potassium.5 Further, it is known
that administration of epinephrine alone produces
decided elevations of fixed acids.6 Thus, it is pos-
sible that an epinephrine-like effect (perhaps
mediated through the adrenal medulla) is one
of the basic mechanisms underlying the acidosis.
The rapid fall in leukocytes and platelets dur-
ing the perfusions is not surprising and is con-
sistent with the findings of other investigators.7-8
As indicated previously, these two elements
rapidly reconstitute themselves to a large extent
within one hour after perfusion. Hemolysis was
of moderate degree and never reached dangerous
levels.
Summary
Experimental data on 67 animals subjected
to total heart-lung bypass by utilization of a
simple pump-oxygenator are presented. Oxygen-
ation was consistently above 96 per cent at vary-
ing flow rates, and elimination of carbon dioxide
was most efficient. A significant metabolic aci-
dosis developed during the runs, which correlated
with both perfusion time and rate. A definite
relationship between drop in pH and survival is
demonstrable. The possible mechanism of the
acidosis is discussed.
References
1. Lillehei, C. W., and others: Direct Vision Intracardiac Sur-
gery in Man Using Simple Disposable Artificial Oxygenator,
Dis. Chest 29:1-8 (Jan.) 1956.
2. Clark, L. C. Jr.; Gollan, F., and Gupta, V. B. : Oxygenation
of Blood by Gas Dispersion, Science 111:85-87 (Tan. 27)
1950.
3. Gimbel, N. S.. and Engelberg. J.: Oxygenator for Use in a
Heart-Lung Apparatus, S. Forum 3:154-157 (1952).
4. Mullin, F. J. ; Dennis, J., and Calvin, D. B. : Blood Potas-
sium in Tetany and Asphyxia of Dogs, Am. J. Physiol.
124:192-201 (Oct.) 1938.
5. Brewer, G. ; Larson, P. S., and Schroeder, A. R.: On Ef-
fect of Epinephrine on Blood Potassium, Am. J. Physiol.
126:708-712 (July) 1939.
6. Griffith, F. R. Jr.; Lockwood, J. E., and Emery, F. E. :
Adrenalin Lactacidemia : Proportionality with Dose, Am. J.
Physiol. 127:415-421 (Oct.) 1939.
7. Stephenson, S. E. Jr., and others: Metabolic Changes As-
sociated with Use of Micro-Bubble Type Pump-Oxygenator
LTnder Normothermic and Hypothermic Conditions, S.
Forum 7:257, 1956.
8. Kolff, W. J., and others: Disposable Membrane Oxygenator
(Heart-Lung Machine) and Its Lise in Experimental Sur-
gery, Cleveland Clin. Quart. 23:69-97 (April) 1956.
1000 N. W. Seventeenth Street (Dr. Litwak).
592
Volume XLIV
Number 6
The Clinical Value of Right and Left Heart
Catheterization in the Selection of Patients
For Valvular Heart Surgery
Philip Samet, M.D., William H. Bernstein, M.D., Miami Beach
Robert S. Litwak, M.D., Miami
H. Turken, M.D., Leonard Silverman, M.D., Milton E. Lesser, M.D.
Miami Beach
The successful surgical intervention on stenotic
lesions of the mitral and aortic valves has focused
attention on the necessity for critically selecting
possible candidates for surgical therapy. In the
past, physiologic evaluation of these lesions con-
sisted of right heart catheterization alone. The
value of this procedure is limited because of the
difficulty in separating the effects of mechanical
valvular block from those of myocardial insuffi-
ciency (the myocardial factor1 •'-) and from those
of pulmonary vascular lesions. This is especially
true in aortic stenosis, in which direct measure-
ment of left ventricular dynamics is manifestly
impossible since the most distal point reached by
the catheter is the pulmonary “capillary bed." Ele-
vated pressures in this condition (“pulmonary
capillary pressure”) have been employed as evi-
dence of left atrial hypertension due to a stenotic
mitral valve. Normal “pulmonary capillary pres-
sure” has been interpreted as evidence for the ab-
sence of physiologically significant mitral stenosis.
Preliminary studies with right and left heart
catheterization have shown that these concepts
are open to serious doubt.
The demonstration of pulmonary hypertension
at rest or on exercise1-- (in the absence of left
ventricular failure) has emerged as the most valid
criterion of mitral valve obstruction when right
heart catheterization is employed alone. It will
subsequently be demonstrated, however, that the
absence of severe pulmonary hypertension at rest
From the Cardio-Pulmonary Laboratory, Mt. Sinai Hospi-
tal, Miami Beach, and the Division of Cardiology of the De-
partment of Medicine, and the Department of Surgery, Uni-
versity of Miami School of Medicine, and Jackson Memorial
Hospital, Miami.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957.
Director, Cardio-Pulmonary Laboratory, Mt. Sinai Hospital,
and Assistant Professor of Medicine (Dr. Samet), Assistant
Professor of Surgery, University of Miami School of Medicine
(Dr. Litwak), and Public Health Service Research Fellow, Na-
tional Heart Institute (Dr. Silverman).
or on exercise does not necessarily preclude the
existence of physiologically and clinically signif-
icant mitral stenosis.
Recognition of the limitations of right heart
catheterization led to the development of methods
permitting direct measurement of left atrial and
left ventricular pressures. These methods include
transbronchial, suprasternal, and posterior per-
cutaneous approaches.3-8 A modification of the
Fisher percutaneous technic has been employed in
the studies reported herein.
In the normal subject, left atrial and left ven-
tricular pressures are virtually identical in dias-
tole as are left ventricular and central aortic pres-
sures during systole. The existence of a left atrial
-left ventricular diastolic pressure difference, or
a left ventricular-aortic systolic pressure differ-
ence is indicative of mechanical obstruction of
the mitral or aortic valves respectively. This pres-
sure differential across either valve is defined as
a gradient. Mean gradient is a planimetrically de-
termined average gradient in either diastole or
systole. These gradient concepts are specifically
applicable to conditions of normal blood flow. It
is not known with certainty whether or not small
systolic or diastolic gradients may occur normally
when the cardiac output is high, that is, during
exercise, with congenital or acquired left-right
heart shunts, or with such entities as hyperthyroid
heart disease.
In order to maintain blood flow across the
stenotic mitral valve, left atrial pressure must rise.
As a result, a diastolic left atrial— left ventricular
gradient appears (fig. 2). Similarly, a left ven-
tricular-aortic systolic gradient develops con-
sequent to a stenotic aortic valve (fig. 3). Since
the magnitude of the mean valvular gradient is
dependent upon both the size of the valve orifice
and the flow across the valve, that is, the cardiac
593
[ FT o«i a, If. ' .
December, 1957
SAMET et al: VALVULAR HEART SURGERY
M S— BEFORE COMMISSUROTOMY ( D.D.)
REST EXERCISE
Fig. 1. — Right heart catheterization data on a 40 year old white man with mitral stenosis (case 1). There
is pronounced pulmonary hypertension at rest with a further increase on exercise. Paper speed is 25 mm. per
second; the time lines are at 0.04 second intervals. P.
brachial artery. The baselines and sensitivities are ind
output (as well as upon the heart rate), it is
clear that the recorded gradient is materially in-
fluenced by variations in flow.
Cardiac output (flow) is determined by right
heart catheterization utilizing the Kick formula;
the valvular gradient is obtained by left heart
catheterization. Thus, combined left and right
heart catheterization is necessary to assess the
true physiologic significance of the gradient across
the valve. Fifty-four such studies form the basis
of this report.
MS. — BEFORE COMMISSUROTOMY (D.D.)
[160 —
Fig. 2. — Preoperative left heart catheterization data
in the same patient. The left atrial hypertension and the
mean diastolic left atrial-left ventricular pressure
gradient are readily noted. The blackened areas out-
line the gradient. L.V. — left ventricle. L.A. — left
atrium.
\. — pulmonary artery. R.V. — right ventricle. B.A. —
icated on either side of the figure.
As illustrated by Braunwald and his associ-
ates,9 simultaneous recording of left heart pres-
sures in the operating room, before and immedi-
ately after mitral commissurotomy, is of primary
importance in helping to decide whether an ade-
quate commissurotomy has been performed.
Method
Right heart catheterization was performed in
the usual manner in the supine position in the ba-
sal postabsorptive state. Multiple steady state
pressure and cardiac output determinations were
PREDOMINANT AS. (S.M.)
Fig. 3. — Aortic stenosis in a 50 year old white man.
The mean systolic left ventricular-brachial artery pres-
sure gradient is 68 mm. Hg (the blackened areas).
594
SAMET et al: VALVULAR HEART SURGERY
Volume XLIV
Number 6
MS — OR. PRESSURE BEFORE COMMISSUROTOMY (DD)
Fig. 4. — Operating room precommissurotomy pres-
sures in the same patient as in figures 1 and 2. Paper
speed 75 mm. per second; the time lines are at 0.04
second intervals.
MS — OR PRESSURE AFTER COMMISSUROTOMY (DD)
", ' ' ■ E CG
\
160-
AORTA
Fig. 5. — Operating room postcommissurotomy pres-
sures. The decided fall in the left atrial-left ven-
tricular gradient is to be noted.
made at rest, during exercise, and on recovery.
With the right heart catheter and brachial artery
needle in situ, the patient was turned into the
prone position. Repeat right heart pressures were
obtained. Fifty to 100 mg. of Demerol was sub-
sequently given via the catheter to some patients.
Left heart catheterization was performed via
a modification of the posterior percutaneous punc-
ture technic of Fisher.8 Fluoroscopic visualiza-
tion of the left atrium was carried out with the
patient in the prone position. Two 6 inch No. 17T
thin-walled styletted needles were inserted into
the left atrium. Polyethylene tubing was passed
through these needles into the left atrium and
left ventricle. On several occasions, the aorta was
successfully catheterized by this left heart route.
Simultaneous pressures were then obtained (from
the same baseline and at identical or similar
strain gauge sensitivities9) from the left atrium,
left ventricle, and aorta or brachial artery. Ini-
tially, these latter pressures were recorded with
Statham P23 AA strain gauges, on a six channel
cathode ray photographic recorder.* Of late,
the latter gauges have been employed for right
heart and brachial artery curves and Statham
P23D or P23G gauges for the left heart curves.
In the more recent studies, the 6 inch needles
have been removed over the left heart polyethylene
catheters in the prone position. The patient is
^Electronics for Medicine, White Plains, N.Y.
M.S.-ONE MONTH AFTER COMMISSUROTOMY (DD.)
REST EXERCISE
Fig. 6. — Right heart catheterization one month after surgery,
monary hypertension both at rest and on exercise.
There has been a decrease in the level of pul-
J. Florida, M.A.
December, 1957
SAMET et al: VALVULAR HEART SURGERY
595
MS. — ONE MONTH AFTER COMMISSUROTOMY
(DD- SUPINE)
REST EXERCISE
Fig. 7. — Left heart catheterization data at rest and on exercise one month after surgery. A small gradient
(1 mm. Hg) is present at rest; the gradient rose to 4 mm. Hg during exercise.
then rotated back into the supine position and
repeat cardiac output and pressure studies re-
corded from the left atrium, left ventricle and pul-
monary artery at rest, during exercise, and on re-
covery. Nineteen studies have been performed in
this fashion.
Simultaneous pressures, from the same base-
line and at identical strain gauge sensitivities,
were obtained from the left atrium, left ventricle,
and aorta in the operating room, both prior to
and subsequent to the mitral commissurotomy.
Pulmonary artery pressures were recorded at the
same time. These served as a guide to adequate
opening of the stenotic left heart valve.
Results
Preoperative data on a 40 year old white man
are illustrated in figures 1 and 2 (case 1). There
is severe pulmonary hypertension at rest with a
further increase on exercise. This suggests the
presence of a mechanical block at the mitral valve
M.S. BEFORE COMMISSUROTOMY (E.C.)
Rest
Exercise
Fig. 8. — Right heart catheterization data on a 48 year old white man (case 2). There is minimal pulmon
ary hypertension at rest with a slight rise during exercise.
596
SAMET et al: VALVULAR HEART SURGERY
Volume XLIV
Number 6
M S. BEFORE COMMISSUROTOMY (EC)
Fig. 9. — The "pulmonary capillary pressure” is at
the upper limit of normal at rest; same patient as in
figure 8.
M S. BEFORE COMMISSUROTOMY
(EC- PRONE)
Fig. 10. — Despite the normal "pulmonary capillary
pressure” (fig. 9), there is a pronounced left atrial-
left ventricular diastolic gradient.
since there was no evidence of left heart failure.
The existence of a mean diastolic left atrial-left
ventricular gradient of 11 mm. Hg (at rest prone)
is unequivocal proof of such a block. The findings
at surgery substantiated the postulation of tight
mitral stenosis. The valve was opened widely
without production of regurgitation. Figure 4 il-
lustrates the precommissurotomy operating room
data, and figure 5 the postcommissurotomy data.
The postoperative left atrial-left ventricular
mean diastolic gradient is only 2 mm. Hg; there
has also been a sharp fall in pulmonary artery
pressure. The findings on repeat cardiac catheter-
ization one month after surgery are shown in fig-
ure 6. There has been a considerable decrease in
the level of pulmonary hypertension both at
rest and during exercise. The residual left atrial-
left ventricular gradient, in the supine position, is
1 mm. Hg at rest and 4 mm. Hg on exercise
(fig. 7). Current data do not permit a decision
as to whether this represents a minimal degree of
residual stenosis or is a physiologic phenomenon
related to increased flow across the valve. The
preoperative catheterization data described rep-
resent what is considered to be the classical hemo-
dynamics of tight mitral stenosis. The residual
pulmonary hypertension noted one month post-
operatively is in all probability secondary to pul-
monary vascular lesions, in the absence of left
ventricular failure and in the presence of so small
a residual left atrial-left ventricular mean dias-
tolic gradient. Repeat study 10 months after
surgery revealed further regression in the level of
pulmonary hypertension with gradients of 1 and
3 mm. Hg at rest and exercise respectively.
The physiologic data on a 48 year old white
man are shown in figures 8 to 10 (case 2). Right
heart catheterization (fig. 8) revealed borderline
pulmonary hypertension at rest with a minimal in-
crease on exercise. The mean “pulmonary capillary
pressure” at rest (fig. 9) was at the upper limit
of normal, 12 mm. Hg. These data might well
suggest the absence of a significant mechanical
mitral block. The left heart tracings, however,
clearly demonstrate dynamically significant mitral
MS. M.l. (J.S.)
40-
RA.
20-
5-
o-
PC.
E.C.G
Fig. 1 1. — Mitral stenosis and regurgitation in a 48
year old white man. The mean "pulmonary capillary
pressure” is zero.
Fig. 12. — Same patient as in figure 11. The mean
diastolic left atrial-left ventricular gradient is ap-
parent. In addition, the left atrial tracing is most sug-
gestive of mitral insufficiency. Left atrial hypertension
is present.
J. Florida, M.A.
December, 1957
SAMET et al: VALVULAR HEART SURGERY
597
stenosis, which was subsequently proved at sur-
gery (fig. 10).
Further illustration of the limited value of
the ‘‘pulmonary capillary pressure” is shown in fig-
ures 11 and 12 (case 3.). The patient, a 48 year
old white man, has both mitral stenosis and in-
sufficiency. The mean “pulmonary capillary pres-
sure” (fig. 11) is well within normal limits. The
existence of left atrial hypertension and the pres-
ence of a diastolic gradient across the mitral valve
are revealed solely by left heart catheterization
(fig. 12). The atrial curve is consistent with the
clinical evidence of associated mitral regurgitation.
The value of operating room pressure curves
is illustrated in figures 13 to 15. The precom-
missurotomy gradient is 23 mm. Hg. Upon com-
pletion of the first attempt at commissurotomy,
the gradient was still 11 mm. Hg (a level indicat-
ing the need for surgical intervention in a preoper-
ative study) despite the statement by an experi-
enced cardiac surgeon that an adequate commis-
surotomy had been performed. Further valve
R.R (M S.)
OR.
PRE-COMMISSUROTOMY
'5 i '
'S 's ^
— L.V.
80 —
0— ^ . . v— ' ^ id
Fig. 13. — Operating room precommissurotomy pres-
sures in a 30 year old white woman. The left atrial-
left ventricular gradient is 23 mm. Hg.
R.R.(M.S)
O.R.
AFTER FIRST SURGICAL MANEUVER
Fig. 14. — The gradient is 11 mm. Hg.
R.R.IM.S.)
OR.
AFTER SECOND SURGICAL MANEUVER
Fig. 15. — The gradient is 2 mm. Hg.
CABDIAC OUTPUT DATA
S.J. 11/29/56 B.S.A. 1.73
OUTPUT
NUMB EE
CARDIAC.IIOEX
(L./Mln./MT B.S.A. )
OXYGEN CONSUMPTION
(ml. /Min. /M? B.S.A.)
A-V DIFFERENCE
Vol. %)
B
1.
2.33
138
5.9
.77
2.
2.30
136
5.9
.84
3.
2.32
135
5.8
.84
4. (2<i Min
) 2.49
192
7.7
.85 (exer. )
5. (6 3/4 Min.) 2.68
217
8.1
.85 (exer.)
6.
2.37
138
5.8
.81
7. (7 Min.
2.70
227
8.4
.84 (exer.)
Fig. 16. — Multiple cardiac output determinations
during right and left heart catheterization. Note the
similarity in the resting cardiac outputs, oxygen con-
sumption and respiratory quotient.
fracture reduced the gradient to 2 mm. Hg.
The feasibility of steady cardiac output deter-
mination during combined heart catheterization
is illustrated in figure 16. The fourth output (at
two and one-half minutes exercise) is during an
unsteady state. The last two outputs (Nos. 6 and
7) are during combined heart catheterization;
the first five outputs are during right heart cathe-
terization alone.
Discussion
Prior to the availability of left heart catheteri-
zation, no direct measure of the pressure differ-
ence between left atrium and left ventricle was
possible. Since this pressure gradient is the phy-
siologic hallmark of mitral stenosis and since the
interpretation of “pulmonary capillary pressure”
is a controversial subject10 and is at best sub-
ject to error, as indicated, the necessity for direct
measurement of this gradient becomes self evident.
The interrelationships between the mean systolic
or diastolic gradient, the cardiac output, and the
heart rate render determination of all three vari-
ables a necessity for physiologic evaluation of pa-
tients with mitral and/or aortic stenosis.
The clinical utility of combined heart catheter-
ization is well illustrated by the patient in case 2.
598
SAMET et al: VALVULAR HEART SURGERY
Volume XLIV
Number 6
Previous physiologic studies in rheumatic heart
disease1-2 have delineated the subject with mitral
stenosis in whom surgery is of little or no value.
Minimal or absent pulmonary hypertension at
rest and during exercise, and a low cardiac out-
put at rest with a limited increase on exercise
(the myocardial factor) characterize this type of
patient. After right heart catheterization alone,
therefore, surgery would not have been advised in
this patient. The finding of a large left atrial-
left ventricular gradient at rest points out the
potential error in this approach; the findings at
surgery confirmed the belief that a stenotic mitral
valve was present. The residual pulmonary hyper-
tension in case 1 one month after surgery could
per se raise doubts as to whether or not the mitral
valve was adequately opened at surgery. The
minimal left atrial-left ventricular gradient is
proof that the residual pulmonary hypertension is
due to pulmonary vascular lesions, in the absence
of left ventricular failure.
Three physiologic parameters are needed to
evaluate the size of the mitral valve. These in-
clude cardiac output, mean diastolic left atrial-
left ventricular gradient, and the heart rate. Only
combined heart catheterization affords a means of
determining these variables.
Summary
In view of the growing importance of surgery
for rheumatic heart disease and because of the
difficulties in adequate selection of cases on clini-
cal grounds alone, physiologic study of the type
discussed is needed: (a) to avoid unnecessary
surgery in some patients; (b) to permit critical
selection for surgical intervention in other sub-
jects; (c) to provide immediate information to
the surgeon in the operating room as to the ade-
quacy of the commissurotomy; and (d) to per-
mit long term clinical and physiologic evaluation
of the effect of the operative procedure upon the
clinical course of the disease process.
At least some of the instances of recurrent
mitral stenosis reported in the literature may well
be due to failure to open the valve properly at
the time of initial surgery.
Mitral commissurotomy was performed as indicated in these
patients by Drs. Robert S. Litwak, DeWitt C. Daughtry, Fran-
cis N. Cooke, and Myron I. Segal.
References
1. Ferrer, M. T., and others: Circulatory Effects of Mitral
Commissurotomy with Particular Reference to Selection of
Patients for Surgery, Circulation 12:7-29 (July) 1955.
2. Harvey, R. M., and others: Mechanical and Myocardial
Factors in Rheumatic Heart Disease with Mitral Stenosis,
Circulation 11:531-551 (April) 1955.
3. Facquet, J.; Lemoine, J. M.; Alhomme, P., and LeFevre.
J. : La mesure de la pression auriculaire gauche par voie
transbronchique, Arch. mal. coeur 45:741-745 (Aug.) 1952.
4. Radner, S. : Suprasternal Puncture of Left Atrium for
Flow Studies, Acta med. Scandinav. 148:57-60, 1954.
5. Allison, P. R., and Linden, R. J.: Bronchoscopic Measure-
ment of Left Auricular Pressure, Circulation 7:669-673
(May) 1953.
6. Bjork, V. O. ; Malmstrom, G., and Uggla, L. G. : Left
Auricular Pressure Measurements in Man, Ann. Surg.
138:718-725 (Nov.) 1953.
7. Wood, E. H • Sutterer, W. ; Swan, H. J. C., and Helm-
holz, H. F. Jr.: Technique and Special Instrumentation
Problems Associated with Catheterization of Left Side of
Heart, Proc. Staff Meet., Mayo Clin. 31:108-115 (Mar. 7)
1956.
8. Fisher, D. L. : Use of Pressure Recordings Obtained at
Transthoracic Left Heart Catheterization in Diagnosis of
Valvular Disease, J. Thoracic Surg. 30:379-396 (Oct.)
1 95 5 .
9. Braunwald, E., and others: Hemodynamics of Left Side of
Heart as Studied by Simultaneous Left Atrial, Left Ven-
tricular, and Aortic Pressures; Particular Reference to
Mitral Stenosis, Circulation 12:69-81 (July) 1955.
10. Burton, A. C. : Peripheral Circulation, Ann. Rev. Physiol.
15:213-246, 1953
5951 Alton Road (Dr. Samet).
November Issues of The Journal Wanted
A shortage in the supply of the November issue is preventing The Journal from filling urgent re-
quests not only from members of the Association but from libraries which bind each volume.
If you will part with your copy of the November issue for a good cause, please send it to The
Journal, P.O. Box 2411, 735 Riverside Ave., Jacksonville, postage collect.
J. Florida, M.A.
December, 1957
599
The Diagnosis and Management
Of Ectopic Pregnancy
Frank R. Smith, M.D.
AND
William H. Whiteside, M.D.
NEW YORK
It is apparent from the rather abundant litera-
ture on the subject of ectopic pregnancies that
many authors believe them to be increasing in
number. Kohl, Tricomi and Siegler1 stated that
the incidence of tubal pregnancies in 1951 was
twice as great as in 1942. There is, however,
some evidence that the increase is in proportion
to an increase in the number of births in the
individual clinics reporting. At New York Lying-
In Hospital2 there were 351 ectopic pregnancies
during the years 1932-1955, and 117 of these
occurred from 1951 to 1955. Yet in proportion to
pregnancies in this clinic for the same years, there
was little difference, as is shown in table 1.
From table 1 it would seem that the increase
is more apparent than factual. From Roosevelt
Hospital, which has no obstetric service for com-
parison, Crawford, Wichern and Cave3 reported
57 ectopic pregnancies in the 10 year period from
1940 to 1951. There have been 51 patients with
ectopic pregnancy during the five year period
from 1951 to 1955. This increase, while question-
able, seems apparent. The use of antibiotics as
therapy for salpingitis with resulting canalization
of the tubes has been suggested as the explana-
tion for this apparent increase, but this explana-
tion is based on the questionable assumption that
most ectopic pregnancies are preceded by chronic
salpingitis. At the University of Helsinki, 1,158
patients operated on for ectopic pregnancy showed
a 20 per cent rate increase from 1945 to 1953,
and 60 per cent had had previous antibiotic treat-
ment for genital infection.4
Table 1. — Ectopic Pregnancies at New York
Lying-In Hospital
Year
Number of
Ectopic
Pregnancies
Number of
Births
Per Cent of
Ectopic
Pregnancies
1932 - 1950
234
62,561
0.4
1951 - 1955
117
22,656
0.5
1932 - 1955
351
85,217
0.4
From the Gynecology Service of Roosevelt Hospital, New
York. Dr. Whiteside is the Resident in Gynecology at Roosevelt
Hospital.
Read before the Florida Obstetric and Gynecologic Society,
Ninth Annual Meeting, Miami Beach, May 13, 1956.
Prior to 1900, ectopic gestation was justly
considered a catastrophe.5 From 1900 until ade-
quate blood replacement was possible, the mor-
tality was estimated at 4 to 8 per cent. Kohl and
his associates,1 in an excellent article, reported
that in 454 consecutive cases of ectopic pregnancy
at King’s County Hospital in Brooklyn (1942-
1951) the diagnosis was correct in 89 per cent
with four deaths, or a mortality of 1.3 per cent.
Yet Rosenthal and Glass*5 stated that in Brook-
lyn, from 1937 to 1950, there were 64 maternal
deaths from early ectopic gestation. The diagnosis
was incorrect in 30 of the 64 cases, or 47 per cent.
In 18 other cases, although tubal pregnancy was
suspected, therapy was delayed sufficiently to
cause death.
When a patient of child-bearing age, who is in
shock with an acute condition of the abdomen
requiring surgical intervention, has a history of
sudden onset of abdominal pain, amenorrhea,
scanty periods, or excessive bleeding, and a
doughy pelvic mass is detected, the diagnosis of
ruptured ectopic gestation is relatively easy and
will be correct in 90 per cent of such cases.
Formerly, emphasis was placed on a history of a
previous ectopic pregnancy, of infertility, or of a
long time interval since the previous pregnancy.
Unfortunately, many patients do not present so
clear and classical a picture. Conditions that can
be easily confused with ectopic pregnancies in-
clude acute appendicitis, diverticulitis, ruptured
hemorrhagic ovarian cyst, torsion of the pedicle
of an ovarian cyst, acute salpingitis, endometriosis
and intestinal obstruction. During the years 1940
to 1951 at Roosevelt Hospital, Crawford and his
associates3 reported 57 ectopic pregnancies with
91 per cent accurate preoperative diagnoses and
one death due to congestive heart failure follow-
ing surgery. There was no death from hem-
orrhage. During the same years 52 other surgical
emergencies simulating ectopic pregnancy were
encountered. These are briefly commented upon
in tables 2 to 5.
600
SMITH AND WHITESIDE: ECTOPIC PREGNANCY
Volume XLIV
Number 6
Surgical Emergencies Simulating
Ectopic Pregnancy
As shown in table 2, ectopic pregnancy was
suspected in only four of the 52 cases. The pre-
dominance of a preoperative diagnosis of appen-
dicitis and right-sided lesions in this series sug-
gests that with left-sided ruptured cysts there was
recovery without operation and perhaps many of
the operations were unnecessary for cure of the
patient.
Table 2. — Ruptured Hemorrhagic Ovarian Cysts
at Roosevelt Hospital
52 surgical emergencies in 10 years — 1940-1951
Preoperative diagnosis of appendicitis in 40 cases
Right ovary site of rupture in 48 of 52 cases
Ectopic pregnancy suspected in only 4 cases
In the 18 cases of torsion of ovarian cysts
(table 3), six cysts were dermoids, nine were
simple cystomas, two were corpus luteum, and
one was parovarian. There were no pseudomucin-
ous cysts. The commonest symptom syndrome
was recurrent episodes of pain with nausea, but
all of the patients had sudden severe attacks be-
fore surgery.
Table 3. — Torsion of Ovarian Cvsts at Roosevelt
Hospital — 1940-1951
Total
18 cases
Correct preoperative diagnosis
8 cases
44.0%
Youngest patient
8 years
Oldest patient
80 years
Appendicitis suspected
6 cases
33.3%
In table 4 the therapy for acute salpingitis is
outlined. In some cases, even if ectopic pregnancy
is suspected, delay in operating is justified long
enough to complete tests for diagnosis.
Table 4. — Acute Salpingitis
If the diagnosis is definitely established, surgery is not
indicated
If there is evidence of progressive or ascending peritonitis,
prompt surgery is indicated
Drainage through a posterior colpotomy for abscess is
indicated
In certain situations laparotomy is indicated
Table 5 summarizes the cases of endometriosis
in which an acute condition of the abdomen re-
quiring surgery was present. Ectopic pregnancy
was considered, but the preoperative diagnosis
was intestinal obstruction.
Table 5. — Endometriosis with Acute or Subacute
Intestinal Obstruction
Obstruction Cases
Partial obstruction 5
Complete obstruction 2
Endometriosis involving terminal ileum 3
Lesions requiring intestinal resection 4
Analysis of Ectopic Pregnancy Series
With these facts in mind, we decided to ana-
lyze the 51 cases of ectopic pregnancy in which
the patient was operated upon at Roosevelt Hos-
pital from 1951 to 1955. Fully realizing the
futility of statistics in so small a series, we made
this study with the intention of determining his-
tory characteristics and patient behavior and
findings as well as methods of diagnosis, delays in
therapy and errors in diagnosis — not for com-
parison with statistics from other clinics.
Table 6 shows the age distribution, which
naturally falls entirely within the child-bearing
age limits.
Table 6. — Age of Patients Having Ectopic
Pregnancy at Roosevelt Hospital — 1951-1955
Age
Number
Under 20
2
20-29
26
30-39
20
40-50
3
Total
51
Thirty-nine of the 51 patients had previously
had at least one birth and one abortion (table 7).
Only two patients had not been pregnant previous
to this pregnancy, although 30 patients had
previously had at least one abortion. This an-
alysis somewhat reduces the impression of the
importance of a history of infertility when ectopic
gestation is suspected. Only two patients had
previously experienced an ectopic pregnancy, or
3.9 per cent. This figure is in keeping with the
3.0 per cent reported by Ware and Winston,7 but
less than the 16.0 per cent recurrence reported
by Bender,8 or the 6.3 per cent reported by Kohl
and his associates.1
Table 7. — Parity in Patients with Ectopic
Pregnancy at Roosevelt Hospital — 1951-1955
None
One
Two
Three
Four
More
than
four
Total
Births
24
16
3
7
0
1
51
Gravidity
2
13
15
11
7
3
51
Abortions
30
15
5
1
0
0
51
Abortions and
births
39
10
2
0
0
0
51
Note: Only two patients had had a previous ectopic pregnancy
(3.9 per cent).
Only eight of the 5 1 patients had had previous
operations, as shown in table 8, and this group
included two patients with previous ectopic preg-
nancies. Grant9 was of the opinion that 50 per
cent of ectopic pregnancies occur after tubal
operations.
J. Florida, M.A.
December, 1957
SMITH AND WHITESIDE: ECTOPIC PREGNANCY
601
Table 8. — Previous Operations in Eight of
Fifty-One Patients
Plastic operation on fallopian tubes
1
Pelvic inflammatory disease
1
Cyst, ovarian
1
Cvst, abdominal
1
“Tubal ligation” at 23 years; 2 children.
, 3 abortions 1
Appendectomy and partial salpingectomy
1
Ruptured ectopic pregnancy (previous)
2
Previous illnesses, listed in table 9, occurred
in 15 of the 51 patients. Only two had definite
inflammatory disease although in two others the
diagnosis was in doubt. In this series genital infec-
tion played a smaller part in the
occurrence of
ectopic pregnancy than is generally supposed.
Table 9. — Previous Illnesses
Past History Number of Patients
Pelvic inflammatory disease,
with penicillin
2
Pelvic inflammatory disease, without
antibiotics
1
Duodenal ulcer
1
Tuberculosis
1
Fibroid tumor
1
Intestinal parasites
l
Cysts of breast
1
Ovarian cyst (pelvic inflammatory
disease?)
2
Post polio
1
Illegal abortion
1
Bladder infection
1
Pyelonephritis
1
Infectious hepatitis
1
15 of 51 patients
Previous admissions to any hospital are tabu-
lated in table 10. Sixteen of the 51 patients were
included in this category. While only two pa-
tients had presented evidence of definite pelvic
inflammatory disease, the predominance of some
infection is worth noting.
Pain and some type of bleeding were the most
characteristic symptoms (table 11). Amenorrhea
was less frequent than bleeding or oligomenorrhea.
Table 11. — Symptoms
Symptoms Number of Patients
Pain
47
Bleeding
26
Amenorrhea
2
Oligomenorrhea
Pain alone
27
8
Bleeding alone
1
Amenorrhea alone
1
Oligomenorrhea alone
0
Pain and bleeding
13
Pain and amenorrhea
1
Pain and oligomenorrhea
15
Pain, oligomenorrhea and bleeding
10
Bleeding and oligomenorrhea
2
Total
51
It is shown in table 12 that 30 patients had
previous attacks of fainting or pain
before
the
attack that precipitated hospital admission,
10 patients fainted at the time of admission.
and
Table 12. — Patients With Syncope
Number of
Type
Patients
Previous attacks of pain before admission
19
Fainted first on admission
10
Previous fainting attacks
11
Nausea and vomiting with pain
13
Nausea and vomiting without pain
2
Diarrhea with pain
3
Diarrhea without pain
0
Drop in blood pressure before surgery
11
Table 13 summarizes the laboratory findings.
Pregnancy tests, when made, were of less value
than usually expected. The reaction was negative
in four of the 13 cases in which such tests were
Table 10. — Previous Admission to Any Hospital
Pelvic
Observation Inflammatory Threatened Other
Disease Abortion Reasons
r of
> 06) 1
One week
before
returned
atory for
operation
for
ectopic
pregnancy
4
1-13 days before
1-5 years, pelvic
inflammatory disease
1-7 years, gonococcal infection
1-2 years, tuberculosis
2
1-1 week
before dilatation and curettage,
negative colpocentesis
1-11 days before dilatation
and curettage for
incomplete abortion
9
1 - 10 years, tubal
ligation
2 - office cautery
22 days before unruptured
ectopic pregnancy and
ovarian cyst
1-7 years, carcinoid
appendix
1 - 3 years, right hydronephrosis
and pyelonephritis
1-6 admissions for
induced abortion
1 -4 years, ectopic pregnancy
1 - post polio
1 - hematosalpinx, question
of pathology
1 - hematosalpinx with
bilateral salpingitis
602
SMITH AND WHITESIDE: ECTOPIC PREGNANCY
Volume XL1V
Number 6
made. Roentgenograms of the abdomen with the
patient in the supine position were taken in only
six cases, but gave significant findings in five.
Sedimentation tests in 1 1 cases showed an eleva-
tion in three. The leukocyte count in 36 cases
was higher than 10,000 and less than 10,000 in
only 11 cases. In four cases a leukocyte count
was not made.
Table 13. — Laboratory Findings
Type of Test Number of Patients
Achheim-Zondek test
13 (9 positive, 4 negative)
Hemoglobin less than 10 Gm.
on admission
8
Hemoglobin fell after admission
4
Fall in blood pressure
before surgery
11
Deteriorated before surgery
12
Leukocyte count more
than 10,000
36
Leukocyte count less
than 10,000
11
Leukocyte count not made
4
Sedimentation rate
11
Significant roentgen findings
S of 6 patients
The preoperative diagnosis was accurately
made in 43 of the 51 cases (table 14). In the
other eight cases ectopic pregnancy was suspected
enough to result in celiotomy. The postoperative
diagnosis at the time of surgery could not be
certain in two cases until confirmed by micro-
scopic examination. The pathologic diagnosis was
not definitely established in four cases.
Table 14. — Diagnosis
<v "V
o
*3
Ectopic
Pregnane
Pelvic
nflammat
Disease
Cyst
‘-3
c
OJ
a
a
<
Incomple
Threaten:
Abortioi
Total
Referring
diagnosis
Admission
26
6
8
4
7
51
proved
ectopic
pregnancy
Operating room
37
2
6
4
2
51
preoperative
diagnosis
43
2
0
4
2
51
Postoperative
diagnosis
49
1
1
0
0
51
Note: Pathologic change not definitely confirmed in four pa-
tients.
The patients in shock were all operated on
immediately, but in those patients with less acute
symptoms the delay had no bearing on the length
of stay in the hospital after surgery was per-
formed, nor on the outcome (table 15). No pa-
tients died.
In 31 of the 51 cases no preoperative surgical
diagnostic measures were instituted (table 16).
It is thought that each of the tabulated measures
has its value in individual situations. Culdoscopy
and hysterography are mentioned only to be con-
demned. Colpocentesis probably has its place in
establishing the diagnosis, although in cases in
which it would be of value, the diagnosis and
necessary procedure are evident without it. The
distaste of one of us (F.R.S.) for “needle surgery”
has influenced somewhat the rare use of colpocen-
tesis. Colpotomy is of definite value, but only
if both tubes and ovaries can be exposed and
visualized. In cases of ruptured ectopic pregnancy,
the diagnosis is generally evident without it.
While we confess to having successfully com-
pleted the removal of an ectopic gestation via the
posterior colpotomy approach, it would seem to
be a smug performance of “surgical calisthenics”
and to belong to the distant past when an ab-
dominal scar was considered to be a stigma.
Table 16. — Procedures Before Celiotomy
Procedure Number of Patients
Dilatation and curettage only
15
Colpotomy only
2
Colpocentesis only
1
Dilatation and curettage and colpotomy
2
Culdoscopy
0
Hysterograms
0
At operation, coexisting pathologic conditions
were present in 1 1 cases, in five of which there
was chronic salpingitis. In two cases there was
acute pelvic inflammatory disease, in one a hydro-
salpinx and in the other inflammation resulting
from self-induced attempted abortion. There
were two cases in which a fibroid uterus was pres-
ent. An acute infection of the bladder was present
in one case.
A blood transfusion was administered in 29
cases; in 22, no blood was administered. The
average amount of blood given was 1,000 cc., and
Table 15. — Time Factors
More
Than
Total
Days
Admitted
At once 1 2 3 4 5
6
7
8
9
10
11
12
13
14 14
to surgery
23 8 7 3 2 2
1
1
1
0
0
0
1
0
1 1
51
Surgery to
discharge
Total hospital
1
1
10
7
6
8
4
1
7
1 5
51
stay
1
5
9
8
5
6
1
7 9
51
Note: Longest hospital stay was 32 days.
f. Florida, M.A.
December, 1957
SMITH AND WHITESIDE: ECTOPIC PREGNANCY
603
the maximum amount to any patient was 2,500 cc.
No autogenous transfusion was given.
In five cases there were postoperative compli-
cations. In two, paralytic ileus occurred; in one,
an incompatible blood transfusion was given; in
one, pulmonary edema occurred between the per-
formance of dilatation and curettage and celiot-
omy, with a question later of pneumonia with
wound infection; and in one, there was throm-
bophlebitis.
The status of the patient deteriorated in 14
cases during periods of observation, as evidenced
by sudden shock, increased pain and/or bleeding,
reduction of hemoglobin or hematocrit levels, and
increased size, definiteness or tenderness of the
abdominal mass. The deterioration was the in-
dication for operation and the end of the period of
observation. In these 14 cases, diagnosis when the
patient was admitted to the hospital was probable
pelvic inflammatory disease in four cases, incom-
plete abortion in four, threatened abortion in
three, and ovarian cyst in three. The Friedman
test gave negative results in four cases and was
not reported at the time of operation, although
the reaction was positive, in three other cases. In
four cases dilatation and curettage were incon-
clusive, and in two cases the patient was allowed
to go home to return six to eight days later with
the diagnosis of ruptured ectopic pregnancy quite
evident. In one of these cases colpocentesis gave
a negative result at the time of the dilatation and
curettage.
Comment
Our plan of management has been to operate
in cases of definitely diagnosed ectopic pregnancy,
with blood replacement when diagnosed. In cases
with questionable diagnosis, additional diag-
nostic measures should be utilized or considered.
Hemoglobin, erythrocyte count, leukocyte count
and hematocrit determinations are all important
tests for evaluation of the patient’s status as well
as helpful diagnostic aids. Roentgenograms with
the patient in the supine position have been found
to be of greater value than we had supposed. Col-
potomy has been favored over colpocentesis. Cul-
doscopy has not been used on patients with sus-
pected ectopic pregnancy. Perhaps it could be
used to advantage in certain situations (and is
used in our clinic in other situations) because none
of our four cases of unruptured ectopic pregnancy
were accurately diagnosed preoperatively. We
have preferred colpotomy with visualization of
the tubes or exploratory laparotomy. Additional
elective surgery has usually been deferred.
Summary and Conclusions
An analysis of 51 cases of ectopic pregnancy
has been made as to diagnosis, behavior and man-
agement.
The predominant symptoms are pain and
bleeding of some sort. The influence of previous
or coexisting genital infection on the incidence of
ectopic pregnancy cannot be denied. Primary
infertility seems to play a minor role.
There is no routine preoperative program of
procedures. Instead, cases are individualized and
necessary measures instituted.
In cases of questionable diagnosis, additional
tests should be utilized. The value of these tests
has been discussed.
Complications and time factors have been
stated.
There were no deaths in this series.
It is suspected that the increase in incidence of
ectopic pregnancies is apparent rather than fac-
tual.
If observation is elected in doubtful situations,
the observers must be constantly alert for signs of
deterioration of the patient’s status.
In a case of suspected ectopic gestation, per-
form a celiotomy with accurate and adequate
visibility if there is any doubt.
The management is celiotomy with blood re-
placement when ectopic pregnancy is diagnosed.
References
1. Kohl, S. G. ; Tricomi, V., and Siegler, A. M.: Ectopic
Pregnancy, New York State I. Meu. 06:850-85 5 (Ma.ch
15) 1956.
2. Statistical Office, New York Lying-In Hospital, 1956.
3. Crawford, D. B. Jr.; VVichern, W. A., and Cave, H. W. :
Acute Lower Abdominal Emergencies, Rev. Gastroenterol.
20:363-372 (June) 1953.
4. Extrauterine Pregnancy, T. A. M. A. 156:1347 (Dec. 4)
1954.
5. Meigs, C. I).: Woman, Her Diseases and Remedies, ed. 4,
ph In el^’-ia. BL chard & Lea. 1859.
6. Rosenthal, A. H. and Glass, M.: Ectopic Pregnancy as
Cause of Maternal Mortality in Brooklyn, New York J.
Med. 51:2493-2498 (Nov. 1) 1951.
7. Ware, II. II. Ir., and Winston, W. O.: Ectopic Pregnancy,
Obst & Gvnec. 4:29-34 (Tulv) 1954.
8. Bender, S. : Fertility after Tubal Pregnancy, Obst. & Gynaec.
Brit. Emp. 62:306 (April) 1955.
9. Grant, A.: Problems in Fertility and Sterility Due to Ectopic
Pregnancy: Study of 259 Cases, M. J. Australia 40:817-819
(Nov.) 1953.
55 East Seventy-Third Street (Dr. Smith).
604
Volume XLIV
Number 6
Carcinoma of the Esophagus
Study of Fifty -Five Cases at Duval
Me diva l Center in Past Eight Years
John R. Doster Jr., M.D.
John A. Dyal Jr., M.D.
JACKSONVILLE
The increasing incidence of carcinoma of the
esophagus in recent years has made it a disease
of increasing importance to everyone. There
have been 55 cases of carcinoma of the
esophagus diagnosed and treated in the Duval
Medical Center Tumor Clinic during the past
eight years. All of these were proved histologi-
cally, and have been followed to the present date
or to the date of the patient’s death. Although
this institution does not have records that rep-
resent the incidence of the disease prior to our
present series, official mortality records of the
United States Public Health Service1 reveal that
the disease is increasing in frequency. The re-
ported deaths from carcinoma of the esophagus
in the years 1934-1944 increased approximately
30 per cent. During this period there was not a
corresponding increase in carcinoma of the stom-
ach and duodenum. Carcinoma of the esophagus
now ranks ninth in frequency in the malignant
diseases of the white male.1
This malignant condition is primarily a dis-
ease of the aging and elderly person. In our
series 87 per cent of the patients were over 50
years of age; 67 per cent were in the sixth and
seventh decades. The over-all age range was 23
to 88 years. This incidence closely parallels that
in 794 cases collected by DeBakey and Ochsner.2
The reported incidence in their Charity Hospital
series was 85 per cent over 50 years and ap-
proximately 70 per cent in the sixth and seventh
decades.
Table 1. — Age Incidence
Age Group
Patients
Per Cent
2-29
1
2
30-39
2
4
40-49
4
8
50-59
19
34
60-69
18
33
70-79
8
13
80-89
3
6
From the Department of Surgery, Duval Medical Center,
Jacksonville.
The racial incidence of the disease in this
series was 41 Negro patients and 14 white pa-
tients. This figure parallels the racial ratio in
the hospital admissions at Duval Medical Center.
In other reported series there is little if any sig-
nificant racial difference."*
There were 41 males and 14 females in the
series, a ratio of 3:1. In the series reported by
Brown15 the ratio was 29:21, and in that of De-
Bakey and Ochsner2 the males outnumbered the
females 2:1.
Table 2. — Race and Sex Incidence
Race
Patients
Negro
41
White
14
Male
41
Female
14
Anatomically, this malignant lesion is located
primarily in the thoracic portion of the esophagus,
although it may occur in the cervical and abdomi-
nal segments. In our series 12, or 22 per cent,
occurred in the upper third of the esophagus; 25,
or 45 per cent, in the middle third and 15, or
27 per cent, in the lower third. This distribution
closely corresponds to that reported in other col-
lected series.2,3
Table 3. — Site of Lesion
Location
Upper third
Middle third
Lower third
Net in records
Patients
12
25
15
3
Per Cent
23
45
27
5
The figures in table 3 are of considerable
therapeutic and prognostic significance, since
lesions of the lower portion of the esophagus
lend themselves more satisfactorily to surgical
procedures and have a higher rate of resecta-
bility. Histologically, carcinoma of the esophagus
may be divided into two types: adenocarcinoma,
which is comparatively infrequent, and epider-
moid carcinoma, which predominates. No case in
which adenocarcinoma was continuous with gas-
tric mucosa is included in our series. In all, epi-
T. Florida, M.A.
December, 1957
DOSTER AND DYAL: CARCINOMA OF THE ESOPHAGUS
605
dermoid carcinoma occurred in 93 per cent of the
cases and adenocarcinoma in 7 per cent. This is
a lower incidence of adenocarcinoma than is re-
ported in other series.
The onset of symptoms is insidious. The
symptoms may mimic diseases of other systems
and may not seem important to the patient or
even to the physician first consulted.4 In our
series the predominately appearing initial symp-
tom was a mild dysphagia, which was disregarded
by the patient, who seemed only vaguely aware
of this symptom at onset. This neglected symp-
tom was noted early in the disease by 75 per
cent of the patients. In all cases it was discount-
ed by the patient and in some cases treated symp-
tomatically with belladonna alkaloids, which of-
ten produced temporary improvement. The ini-
tial delay on the part of the patient and even the
physician in some cases is certainly a large factor
responsible for the poor survival rates in carci-
noma of the esophagus.5
In table 4 one may note the surprisingly long
duration of symptoms directly related to the ma-
lignant disease. In 17 cases symptoms had been
present for more than six months.
Table 4. — Symptoms of Carcinoma of the
Esophagus
Symptom
Dysphagia
Pain
Pain in chest
Pain in abdomen
Vomiting
Hoarseness
Cent
Period
75
3-21 months
16
1-2 months
11
7
7
2 weeks
0.5
1 month
It is apparent that the average patient is in
a far advanced stage of the disease when he first
presents himself for diagnosis and therapy. In
this fact lies the key to the currently poor surviv-
al rate, and at the same time early diagnosis pre-
sents the greatest hope for improvement of the
discouraging cure rate.7 It is well established
that after this lesion is suspected, there is little
difficulty in making a positive diagnosis by use
of esophagography and esophagoscopy. These
studies will usually confirm or exclude the pres-
ence of carcinoma. Palmer,8 in presenting an
analysis of 14 failures to prove a histologic diag-
nosis in 100 patients, sketched the intramural
spread of carcinoma and clearly demonstrated
how the lesion could obstruct the lumen and still
remain inaccessible to the biopsy forceps. In our
series we were able to establish the diagnosis in
80 per cent of the cases. In seven cases the results
of the biopsy were negative on the first attempt
and in two of these were negative despite a sec-
ond biopsy.
The therapy of choice and the only hope for
cure in carcinoma of the esophagus is surgical
extirpation.2 Any other therapeutic measure is
purely palliative. Table 5 clearly demonstrates
Table 5. — Results of Therapy
Cases
Per Cent
Operated
19
33
Inoperable
27
50
Curative
5
31
Resectable
16
80
Nonresectable
4
20
Palliative
11
69
Not operated on for
9
16
reasons other than
inoperability
that although the results of treatment, both
operative and nonoperative, were extremely poor,
the only cures and better palliation were pro-
duced by surgical extirpation of the diseased
tissue. In our series the lesion was classified as
inoperable if there was distant metastasis, inva-
sion into the bronchus, or tracheobronchial fis-
tula. In 27 cases it was pronounced inoperable
by these criteria. Two of the patients refused
surgery. Induction of anesthesia was stopped be-
fore surgery began in one case because the patient
was doing so poorly. Reaction to cocaine during
the bronchoscopic examination caused fatal ter-
mination in one case. In five cases the patient was
not cleared by the medical department because
of the presence of other diseases.
In nineteen of the cases the lesion was
thought to be operable and was explored.
In three of these the surgical measures were
open and close procedures. In the other
16 the lesion was resected, and esophagogas-
trostomy was performed; in five of the 16 the
surgical procedure was believed to be curative.
Of the patients in these five cases, two are living
without recurrence, one four years after and one
five and one-half years after the initial procedure.
The one who is a four year survivor has been
followed closely and has severe esophagitis re-
quiring repeated dilation. The one who is a five
and one-half year survivor had a supraclavicular
node dissection nine months after the initial
procedure. This case was reported by Day9
elsewhere and needs no further comment here.
Of the other three who had curative procedures,
one survived 13 months and died following recur-
rence. The other two died in the immediate post-
operative period of complications following sur-
gery. Of the 11 who had palliative procedures,
eight died in the immediate postoperative period
606
DOSTER AND DYAD: CARCINOMA OF THE ESOPHAGUS
Volume XLIV
Number 6
of complications. The other three survived five
months, three months and one month, and all
had residual disease with extension of the malig-
nant process at death.
Table 6. — Causes of Death
Cause Patients
Hemorrhage and shock 4
Pulmonary edema and shock 3
Cardiac arrest 2
Rupture of diaphragm 1
In our series the average time lapse from on-
set of symptoms to diagnosis was 6.8 months; the
time lapse from diagnosis to death was 5.6
months. The longest survival periods were five
and one-half years and three and one-half years.
One patient had roentgen therapy and is living
21 months after diagnosis, and one patient had
only dilation and lived 20 months. Another pa-
tient received no specific therapy and lived 14
months; still another had roentgen therapy and
lived 13 months. These cases are too few, how-
ever, to warrant any conclusions and represent
our extremes. Raven0 reported that of patients
treated with roentgen rays 30.6 per cent were
dead within three months, and 55 per cent were
dead within six months. He had one patient,
however, who lived four years after receiving
roentgen therapy. Of the 11 patients treated
with roentgen therapy, one is still living 20
months after diagnosis, although she has an
esophagotracheal fistula, which has been demon-
strated by dye studies. Excluding the one living
21 months, the average survival time was four
and one-half months; and, if that one is included,
the survival time was six months (table 6). This
period is longer than that for the entire series,
including the ones who had curative surgery. Six
of these patients were improved on roentgen ex-
amination with barium swallow.
Three of the patients who were subjected to
gastrostomy for obstruction could take solid food
following roentgen therapy. In three of these
patients no improvement was noted. Two of the
patients survived too short a time to evaluate the
therapy. Fifteen patients underwent gastrostomy,
the Spivak, Witzel and Janeway technics being
employed. One patient on whom a jejunostomy
was performed was lost to follow-up. All patients
who were subjected to gastrostomy were able to
be discharged from the hospital. The average
time between gastrostomy and death was three
and one-half months. The indications used for
gastrostomy were inoperability, severe pain as-
sociated with obstruction and fistula between the
esophagus and tracheobronchial tree. In all pa-
tients who experienced severe pain, the pain on
swallowing was less after surgery. All the pa-
tients with obstruction complained of being un-
able to swallow saliva, but adjusted to this trou-
ble a few weeks after gastrostomy.
Merendino and Mark10 reported 10 per cent
fistula formation in 100 cases of carcinoma of
the esophagus. In four cases in our series fistu-
lous tracts developed between the esophagus and
the tracheobronchial tree; three communicated
with the trachea and one with the left bronchus.
All were proved by roentgen dye studies. One
patient lived two weeks, and one lived five weeks
after the fistula was demonstrated. In one case
the fistula has been present for six months, and
the patient is still living. She has had roentgen
therapy and also has a gastrostomy, through
which she takes all nourishment and fluids.
In three of our cases diverticula were demon-
strated on roentgen examination. It was the
roentgenologist’s impression that all were of the
pulsion type, and all were in the upper third of
the esophagus. In all there was obstruction, and
gastrostomy had been performed. One patient
lived 20 months, one lived eight months, and one
lived only two weeks. The duration of symptoms
before diagnosis was 12 months, 15 months and
six weeks in the three cases, respectively.
Summary and Conclusion
A clinical review of 55 cases of histologically
proved carcinoma of the esophagus is presented.
This malignant lesion occurs predominately
in elderly persons and is more frequent in the
male.
The carcinoma is located predominately in
the middle third and lower third of the esophagus.
This fact should tend toward a higher rate of
resectability, therefore a higher rate of cure.
Ninety-three per cent of the lesions in the
series were epidermoid carcinoma; 7 per cent
were adenocarcinoma.
The urgent need for earlier diagnosis is clear-
ly demonstrated. The insidious onset of the dis-
ease and neglect of ominous symptoms are re-
viewed.
The operative rate was 33 per cent and the
rate of resectability 80 per cent. The mortality
rate was 65 per cent for cases with resection, al-
though the majority of resections were thought to
be palliative procedures. The operative mortality
was inordinately higher for this group than for
those in series reviewed. It is concluded from
this report that in most of the cases the operative
J. Florida, M.A.
December, 1957
ACKERMAN AND DONALDSON: SYPHILIS IN POLK COUNTY
607
risk was poor and improvements in preoperative
evaluation and postoperative management made
in recent years would reduce this figure markedly.
The use of palliative roentgen therapy seems
to be of value in relieving obstruction and possi-
bly increasing longevity.
Of the 55 patients only two survived without
disease. These two were treated by adequate sur-
gical removal, and represent a four and five year
survival.
References
1. Dorn, H. F. : Illness from Cancer in United States, Pub.
Health Rep. 59:33 (Jan. 14) 1944; 65 (Jan. 21) 1944, and
97 (Jan. 28) 1944.
2. DeBakey, M. E., and Ochsner, A.: Carcinoma of Esopha-
gus, Postgrad. Med. 3:192-198 (March) 1948.
3. Brown, M. Meredith: Carcinoma of the Oesophagus, Re-
view of Fifty Cases, Brit. M. J. 1:1462-1464 (June 26)
1954.
4. Puestow, C. B.: Cancer of the Esophagus, Postgrad. Med.
16:97-103 (Aug.) 1954.
5. Coleman, F. P., and Brawner, D. L. : Carcinoma of Cer-
vical Esophagus, Arch. Surg. 62:102-111 (Jan.) 1951.
6. Raven, R. W. : Carcinoma of Oesophagus, A Clinicopatho-
logical Study, Brit. J. Surg. 36:70-73 (July) 1948.
7. Merendino, K. A., and Mark, V. H.: Analysis of 100 Cases
of Squamous Cell Carcinoma of Esophagus, with Special
Reference to Its Theoretical Curability, Surg., Gynec. &
Obst. 94:110-114 (Jan.) 1952.
8. Palmer E. I).: Difficulties in Diagnosis of Esophagoscopic
Biopsy, Am. J. Digest. Dis. 22:65-67 (March) 1955.
9. Day, S. M.: Extensive Surgery and Repeated Surgery for
Malignant Disease, J. Florida M. A. 41:455-464 (Dec.)
1954.
10. Merendino, K. A., and Mark, V. H.: Analysis of 100
Cases of Squamous Cell Carcinoma of the Esophagus, with
Special Reference to Delay Periods and Delay Factors in
Diagnosis and Therapy, Contrasting State and City and
County Institutions, Cancer 5 :5 2-61 (Jan.) 1952.
1645 River Bluff Road (Dr. Doster).
2000 Jefferson Street (Dr. Dyal).
Syphilis in Polk County
Report of 1955 Blood Testing Survey
J. H. Ackerman, M.D.*
JACKSONVILLE
AND
James A. Donaldson, M.D.**
WINTER HAVEN
During the past years the Florida State Board
of Health in cooperation with local County Health
Departments has been conducting intensive selec-
tive mass blood testing surveys in those areas of
the state where it is believed there is an appre-
ciable amount of undetected syphilis. Polk Coun-
ty, as a highly populated industrial and agricul-
tural county with a population of approximately
31,000 Negroes, was thought to be such an area.
No previous intensive survey had been conducted
in the county. Many of the agricultural and in-
dustrial employees had not been tested in routine
programs of the Health Department. The deci-
sion was made, therefore, with the approval of
the Polk County Medical Association, to conduct
an intensive serologic survey among suspected
high incidence groups. Such groups included low
income Negroes, migrant agricultural workers
and low income white workers.
Survey Program
The blood samples were drawn in predomi-
nantly Negro and low income white areas, to in-
^Director, Venereal Disease Control Division, Florida State
Board of Health.
#*Senior Assistant Surgeon (R), United States Public
Health Service, assigned to Polk County Health Department.
Read before the Florida Health Officers’ Society, Eleventh
Annual Meeting, Miami Beach, May 13, 1956.
elude as many persons as possible in these sus-
pected high incidence groups. In each community
one station was located in a white business dis-
trict to help direct public attention to the pro-
gram. In advance of the survey the project super-
visor and a health department physician met with
prominent persons in the Negro communities and
a few white officials. These meetings were held
in each of the five main communities in the coun-
ty. At this time the reasons for the survey and
the methods of conducting the survey were dis-
cussed. A motion picture on syphilis was shown,
and any questions about the disease or the survey
were answered. Medical questions were answered
by the physician from the health department. In
addition to the publicity obtained by the com-
munity meetings, posters were placed throughout
the area indicating the dates of the survey, and
radio and newspaper announcements gave the
times and places for each blood testing station.
Each testing station was staffed by a nurse
and a clerk. A sound truck traveled through the
testing areas prior to and during testing hours.
The truck used records and announcements to
attract the attention of the residents in the area,
and informed them of the station location. The
testing stations were designed to be simple and
608
ACKERMAN AND DONALDSON: SYPHILIS IN POLK COUNTY
Volume XLIV
Number 6
easily portable. They consisted simply of a fold-
ing table, two chairs, and signs and posters advis-
ing the public to have a blood test. Stations were
located near business establishments where people
would normally tend to congregate and where
lighting conditions were favorable for work at
night. Testing hours were from 4 to 8 p.m.. Tues-
day through Friday, and 10 a.m. to 4 p.m. on
Saturday.
Blood samples were drawn with the Sheppard-
Keidel vacuum tube. This was chosen because it
is a self-contained sterile unit, eliminating the
necessity of presterilization and repeat steriliza-
tion of syringes and needles.
Serologic testing was performed by the branch
laboratory of the State Board of Health in
Tampa. All specimens were tested by the VDRL
qualitative method, and if positive, by the VDRL
quantitative test.
All patients with positive or weakly positive
reactions to serologic tests, with the exception of
those already being followed by the Polk County
Health Department, were asked to report to one
of the seven Health Department offices through-
out the county. Except for 18 patients who were
examined by their personal physician, all patients
were examined in one of the Health Department
offices. Reports from the private physicians who
examined these 18 patients are included in this
report.
Suspects examined in the clinic of the Polk
County Health Department were given a physical
examination, and a complete history referable to
syphilis was taken. Records of previous exami-
nations, serologic tests for syphilis, and treatment
were available on a number of suspects. These
records were obtained from the Polk County
Health Department, other Health Departments,
hospitals, and private physicians. Information
from the history, physical examination, and pre-
vious records was correlated to arrive at as ac-
curate a diagnosis as possible. In those cases with
the history and physical examination giving nega-
tive evidence, further serologic tests were made.
In some cases monthly serologic tests were per-
formed for six months. In those cases in which a
biologic false positive reaction was considered,
treponema pallidum immobilization (TPI) tests
were made. While there are many causes for
acute and chronic biologic false positive serologic
reactions, few if any nontreponemal diseases cause
a positive TPI test. In this survey, a false posi-
tive serologic reaction was diagnosed in 48
suspects.
Results of Survey
Between Sept. 8, 1955, and Oct. 16, 1955,
6.273 blood specimens were drawn and tested. Of
these, 387 gave a positive and 153 a weakly posi-
tive reaction, a positivity rate of 8.6 per cent.
Of the suspects 533 were Negroes and seven were
white. A total of 515 persons was evaluated, or
95.4 per cent of the suspects. Table 1 gives the
disposition of the suspects. Table 2 gives the
diagnoses of those suspects found to be infected.
Ten had early latent and 343 late latent syphilis,
13 cardiovascular syphilis, 66 neurosyphilis, one
late cutaneous syphilis, and 38 congenital syphilis.
Table 1. — Disposition of Suspects
Disposition
Number
Not located
19
Uncooperative
6
Infected
467
Not infected
48
Total
540
Table 2. — Diagnoses of
Infected Suspects
Stage of Infection
Number
Early latent
10
Late latent
343
Cardiovascular
11
Neurosyphilis
64
Late cutaneous
1
Congenital
38
Total
467
Of those patients who were infected, 152 had
had no previous treatment, 153 had never had
adequate treatment, and only 162 had been ade-
quately treated. Table 3 gives the diagnoses and
treatment status of those suspects found to be in-
fected. It is worthy of note that 12 patients with
congenital syphilis had never been treated. These
patients had never been examined for congenital
syphilis even though in many cases the mother
had been treated for syphilis after the patient’s
birth or siblings had been treated for congenital
syphilis.
Table 3. — Diagnoses and Treatment Status of
infected Suspects
Stage of
Infection
No
Previous
Treatment
Previous
Inadequate
Treatment
Previous
Adequate
Treatment
Early latent
9
0
1
Late latent
99
123
121
Cardiovascular
5
2
4
Neurosyphilis
26
22
16
Late cutaneous
1
0
0
Congenital
12
6
20
Total
152
153
162
An attempt
was made
to make spinal fluid
examinations on all patients who had been pre-
viously inadequately treated before beginning a
T Ft on ■’a, M ' .
December, 1957
ACKERMAN AND DONALDSON: SYPHILIS IN POLK COUNTY
609
course of treatment. Spinal fluid examinations
were performed on 89 patients. Table 4 shows
the results of these examinations. In 79 the reac-
tions were negative, in six they were positive but
inactive, and in four they were positive and ac-
tive. Old clinic or Rapid Treatment Center rec-
ords provided an additional 77 spinal fluid ex-
aminations. Of these, in 62 the reactions were
negative, in 12 they were positive but inactive,
and in three they were positive and active. An
additional 43 patients said they had had spinal
fluid examination in the past and were told they
were “all right,” but no records were obtainable.
All patients being treated for the first time and
all patients with clinical neurosyphilis will have
spinal fluid examinations one year after treatment.
Table 4. — Results of Spinal Fluid Examinations
Examination Result
Number
Negative
79
Positive, inactive
6
Positive, active
4
Total
89
It is evident that the survey detected pre-
dominantly late latent syphilis. In 73.4 per cent
of the suspects found to be infected, late latent
syphilis was present. No primary or secondary
syphilis was found. Sex contacts of all patients
with early latent syphilis were examined, and one
case of secondary syphilis was found. Other con-
tacts were out of the county, and reports have
not as yet been received regarding their diagnoses.
The principal value in a survey of this type
is the detection of previously unknown and inad-
equately treated syphilitic persons, and bringing
or returning them to treatment. In this survey,
305 syphilitic patients were brought or returned
to treatment. In addition, the survey was believed
to be of educational value in acquainting the
physicians and lay persons with the prevalence of
syphilis in the county.
Summary
Of 6,273 serologic tests for syphilis, 540 (8.6
per cent) gave positive or weakly positive results.
Of the suspects, 515 (95.4 per cent) were
evaluated, and 467 (90.7 per cent) of those
evaluated were presumed to be infected with
syphilis as a result of the correlation of the his-
tory, physical findings and laboratory studies.
Of the 467 presumably having syphilis, 305
(65.3 per cent) had either received no previous
treatment or had been inadequately treated.
Of the 515 suspects evaluated, in. 48 (9.3 per
cent) a false positive serologic reaction was diag-
osed, largely by means of clinical findings giving
negative evidence and a negative reaction to the
Treponema pallidum immobilization test.
Referenced
Ledbetter. R. K. Jr.: Biologic False Positive STS Reactions,
Possible Causes, a paper delivered before the International
Symposium on Venereal Diseases and the Treponematoses,
Washington, D. C., May 30-June 1, 1956.
1217 Pearl Street (Dr. Ackerman).
Polk County Health Center (Dr. Donaldson).
I
610
Volume XLIV
Number 6
Yirological Findings on Polio and
Polio-Like Diseases — 1956
M. M. Sigel, Ph.D., G. Schlaepfer, B.A.,
L. Moewus, M.S., and A. Branch, B.S.
MIAMI
The Virus Diagnostic Laboratory was opened
officially in November 1955. The purpose of the
laboratory is to aid physicians in the differential
diagnosis of viral and rickettsial infections. An-
other function of the laboratory is to furnish
information to the health officers about the oc-
currence of previously recognized as well as here-
tofore unrecognized infections in their respective
communities and areas. A third function of the
laboratory is the furtherance of training at the
undergraduate and graduate levels. During the
past 18 months, the laboratory services have been
utilized by physicians in Dade, Broward and
Monroe counties, as well as by hospitals and
other agencies in several countries of the Carib-
bean.
One of the contributions made during this
period of time was the provision of information
in the area of differentiation between the many
causes of polio-like diseases. The breakdown of
the findings for 1956 is shown in tables 1 to 4.
Virus isolation was performed in strain HeLa
cells (derived from human carcinoma of the
cervix) and in monkey kidney cells grown in
tissue culture. Preliminary identification of the
isolated agents was based on the nature of the
cytopathogenic changes. Final typing was ac-
complished by the neutralization test in tissue cul-
ture tubes. The tests on patients’ serums included
neutralization tests, a few complement fixation
tests with polio antigens and, whenever indi-
cated, complement fixation tests with lymphocytic
choriomeningitis, eastern equine encephalitis, St.
Louis encephalitis, mumps, Coxsackie B and
adenovirus antigens.
Table 1 is based on results obtained from
specimens provided by patients who had not re-
ce.vecl vaccine. The most important feature of
this table is the finding that whereas 21 out of 27
(80 per cent) paralytic patients yielded the clas-
sical types of poliovirus only a relatively small
From the Virus Diagnostic Laboratory of the Variety Chil-
dren’s Hospital and the University of Miami School of Medi-
cine.
number of nonparalytic patients yielded these
viruses (8 per cent). APC (adeno) viruses and
ECHO* viruses were recovered each from one
patient. The causal relationship between these
viruses and diseases is not fully understood and
is currently the subject of research. In the
majority of nonparalytic patients no etiologic
agent was demonstrated either by isolation tech-
nics or by antibody studies. This finding indicat-
es that a large portion of nonparalytic patients
may be infected with agents whose nature is yet
unknown and may conceivably include new
types of poliovirus.
In tables 3 and 4 are shown the results of
laboratory tests in patients who received one, two
and three injections of poliovaccine. The num-
bers are too small to allow a definite conclusion
regarding the effectiveness of the vaccine. All
that can be said at this time is that seven paraly-
tic cases occurred among patients who had pre-
viously received one or two injections. Five of
these yielded poliovirus in their stool, and there
was only one paralytic mild illness, in a patient
who had received all three injections. This pa-
tient yielded no virus, and it is possible that his
illness was not due to poliovirus.
Table 4 illustrates that not infrequently
mumps virus may cause a clinical picture resem-
bling nonparalytic poliomyelitis.
The findings here reported represent the be-
ginning of the operation of the Virus Diagnostic
Laboratory. It is hoped that continued efforts
in this undertaking will help to explain and clarify
such questions as the etiology of some of the
polio-like diseases, the importance of poliovirus in
the occurrences of aseptic meningitis and the ef-
fectiveness of vaccine against polio. As more and
more people become immunized, the medical pro-
fession may witness the occurrence of many ill-
nesses which, while resembling polio, especially
the nonparalytic variety, may actually be caused
by numerous other agents. The Virus Diagnostic
Laboratory could therefore become increasingly
*Enteric Cytopathogenic Human Orphan Viruses.
f. Florida, M.A.
December, 1957
SIGEL et al: VIROLOGICAL FINDINGS
611
Table 1. — Patients Who Had Not Received Vaccine
Virus Isolation Findings
Form of
Disease
Total Number
Number Tested
Polio
Type I
Polio
Type II
Polio Other Negative
Type III Viruses
Per Cent
Positive for
Poliovirus
Fatal
1 1
1
Bulbar
3 3
2
1
66
Bulbospinal
2 1
1
Paralytic
36 27*
12
8
- 1
6
80
Nonparalytic
41 36
2
1
1 adeno**
31
8
1 ECHOt
Miscellaneous 13 11
11
0
Total
96 79
14
10
2
2
SI
33
* Two additional patients were tested;
the results suggested the presence of
poliovirus, but were inconclusive.
** Formerly designated adenoidal pharyngeal conjunctival
virus.
t ECHO, enteric cytopathogenic human
orphan virus.
Table 2.
— Patients Who Had
Not Received Vaccine
Serologic Findings on Patients From Whom Virus Was Not Isolated
Tests with Polio Antigens*
Tests with Neurotropic
Virus
CF Battery**
Form of
Number Polio
Polio
Polio
Polio
Number
Negative
Disease
Tested Type I
Type II Type III
UTt
Negative Tested
Bulbospinal
2 2
0
0
0
0 0
Paralytic
6 1
1
2
2 0
Nonparalytic
19 0
0
13
6 29
29
* With few i
exceptions, this was the neutralization test.
** Includes:
LCM, EEE, St. Louis encephalitis, mumps, Coxsackie B and adenovirus antigens.
t UT. infection at undetermined time, not necessarily recently.
Table 3. -
— Patients Who Had Received Polio Vaccine
Virus Isolation Findings
Form of
Total Number
Polio
Polio
Polio Other
Disease
Number Tested
Type I
Type II Type III Viruses
Negative
One
Paralytic 3
2
1
1
Injection
Nonparalytic 5
3
3
Miscellaneous 2
1
1
Two
Bulbospinal 1
1
1
Injections
Paralytic 3
3
1
2
Nonparalytic 10
8
8
Miscellaneous 1
1
1
Three
Paralytic 1
1
1
Injections
Nonparalytic 4
3
3
Table 4. — Patients Who Had Received Polio Vaccine
Serologic Findings on Patients From Whom Virus Was Not Isolated
Tested with Polio
Antigens
Neurotropic Virus CF Battery
Form of Number Polio Polio
Polio
Polio
Number
Disease Tested Type I Type II
Type III
UT
Negative
Tested
Positive Negative
One
Paralytic
0
0
Injection
Nonparalytic
3
1
2
5
S
Miscellaneous
0
2
1 (mumps) 1
Two
Paralytic
0
0
Injections
Nonparalytic
5
3
2
9
1 (mumps) 8
Miscellaneous
1
1
Three
Paralvtic
1
1
1
1
Injections
Nonparalytic
0
4
3 (all mumps) 1
612
SIGEL et al: VIROLOGICAL FINDINGS
Volume XLIV
Number 6
helpful in aiding the physician to arrive at a dif-
ferential diagnosis.
As an additional service the Laboratory is
currently accepting, at physicians' request, serum
from normal persons wishing to know whether
they possess antibodies to polio and mumps
Mail or Deliver Specimens to VIRUS DIAGNOSTIC LABORATORY
Variety Children’s Hospital
6125 S. W. 31st Street
Miami, Florida
MOhawk 1-5391
viruses. For the convenience of physicians we
are reproducing instructions for submission of
specimens.
We wish to thank Dr. T. E. Cato, Dade County Health
Officer, Dr. G. Erickson, Dade County epidemiologist, and the
many physicians who submitted specimens to the laboratory for
their excellent cooperation and help.
Instructions for the Collection of Specimens for Virus and Rickettsial Diagnosis
The Virus Diagnostic Laboratory is prepared to aid in the diagnosis of the following diseases:
Viral meningitis
Encephalitis
Poliomyelitis
Mumps
Herpes simplex
Herpangina
Pleurodynia
Influenza
Q Fever
Psittacosis
Lymphogranuloma venereum
Smallpox
Vaccinia
Pharyngoconjunctival fever
Measles
In addition, the laboratory may on occasion accept specimens on a research basis for studies on dis-
eases of unknown etiology. Routine tests are also performed for typhus, Rocky Mountain spotted
fever and rickettsial pox.
All specimens must be accompanied by a history either in the nature of a carbon copy of the
hospital history or in the form of a special history sheet obtainable from the laboratory.
With few exceptions, laboratory diagnosis may be secured from an examination of paired serum
specimens, one to be taken in the acute phase of illness and the other two weeks later. Such serums
may be sent by first class mail — in regular mailing tubes — provided they are not contaminated.
Under some circumstances, such as when a diagnosis of rickettsial diseases, psittacosis or lym-
phogranuloma venereum is suspected and antibiotic therapy has been administered, it may be neces-
sary to obtain a later specimen inasmuch as antibodies to the etiologic agents of these diseases may
be suppressed for a time by the therapy.
All serum specimens must be sterile and submitted in sterile tubes sealed with sterile stoppers.
Adhesive tape should be wound around the stoppers.
The exceptions in which serum specimens are inadequate are: poliomyelitis, pharyngoconjunc-
tival fever, pleurodynia, herpangina, herpes simplex, measles, smallpox and vaccinia. For these it
is necessary to have specimens as indicated:
Poliomyelitis — stool! and paired serum specimens
Pharyngoconjunctival fever — throat washing* — paired serum specimens
Pleurodynia— throat washing! and/or stool! and paired serum specimens
Herpes simplex — material from lesion* and paired serum specimens
Herpangina — throat washing! and/or stool! and paired serum specimens
Smallpox and vaccinia — material! from the lesion and paired serum specimens
Measles — throat washing* and stool* and paired serum specimens.
Although serum specimens are adequate for diagnosis for most of the other types of illnesses, it
may sometimes be appropriate and occasionally necessary to send specimens for virus isolation in the
following diseases:
Conjunctivitis — eye wash* and paired serum specimens
Influenza — throat washing* and paired serum specimens; in both instances, the washing may be
obtained with sterile broth, sterile milk or sterile water.
Viral meningitis — spinal fluid,* stool* and paired serum specimens.
Single serum specimens are of considerably less value than paired serum specimens. If and when
it is not possible to obtain an early acute phase serum, a single specimen of convalescent serum will
be accepted for testing.
J. Florida, M.A.
December, 1957
ABSTRACTS
613
Information about special problems including “viral” myocarditis, cytomegalic inclusion disease,
unclassified diseases, or other viral problems may be secured by contacting Dr. M. Michael Sigel,
University of Miami School of Medicine, Highland 3-4633, extension 32, or Virus Diagnostic Lab-
oratory, Variety Children’s Hospital, MOhawk 1-5391, extension 40.
* Should be sent either by messenger or by first class mail in frozen condition,
t May be sent by first class mail without freezing if dry ice is not available.
All specimens * t for virus isolation must be sent to the laboratory as soon after taking as possible. A delay will decrease
the likelihood of virus isolation. Freezing of serum specimens for routine work is not necessary. They may be sent by first
class mail.
For immunity studies 3 cc. of serum is required. For diagnostic tests 5 cc. is needed.
ABSTRACTS
A Cytochemical and Cytomorphological
Orientation of Intraepithelial Carcinoma of
the Cervix Uteri. By Alvan G. Foraker, M.D.
Acta Union Internationale Contre le Cancer
12:74-79, 1956.
In this study, as measures in orienting intra-
epithelial carcinoma with respect to frank invasive
carcinoma and to non-neoplastic cervical lesions,
dehydrogenase localization, measurement of nu-
clear size and photometric estimation of hyper-
chromatism were investigated. Through these pro-
cedures additional information was sought con-
cerning the currently doubtful relationship of
intraepithelial carcinoma to invasive cervical car-
cinoma. The materials and methods are described
and the results set forth in tables. It is con-
cluded that with the methods used in studying
different properties of squamous epithelium, each
relating in some manner to cell growth, intra-
epithelial carcinoma conforms closely to invasive
carcinoma as regards dehydrogenase activity,
mean nuclear size, nuclear-cytoplasmic ratio and
hyperchromatism.
Renal Revascularization by Splenic Ar-
tery Implantation. An Experimental Study.
By H. Clinton Davis, M.D., and Irwin S. Morse,
M.D. A. M. A. Arch. Surg. 75:13-16 (July)
iot 7.
This study was undertaken to determine the
adequacy of the Vineberg principle of arterial
implantation for collateral circulation on the kid-
ney, inasmuch as this organ is more easily studied
than either the heart or the liver. The ease with
which the blood supply of the kidney can be con-
trolled, and function studies performed, makes
the kidney the organ of choice in evaluating the
effectiveness of arterial implantations for collateral
circulation. The technic employed and the results
obtained are described.
Observations on five dogs in which the splenic
artery was implanted into the left renal cortex
showed some splenorenal collateral circulation,
which was most effective in a kidney which had
been rendered partially ischemic by ligation of a
branch of the left renal artery. Volume flow
studies, attempted in the six month waiting
period, suggested that the amount of collateral
flow was small in the nonischemic kidney.
Determination of Bacterial Sensitivity,
an Office Procedure. By L. P. Carmichael.
Postgrad. Med. 20:26-28 (Oct.) 1956.
Increasing bacterial resistance is resulting
from the widespread use and abuse of antibiotics.
This fact, coupled with patient sensitivity to an-
tibiotics and the number of chemotherapeutic
agents now available, has made the determination
of correct agents to use in infection a matter of
prime importance. Culture of the offending or-
ganism in determining its sensitivity to antibiot-
ics, once an involved laboratory procedure, can
now be done simply and quickly in any physician’s
office, this author reports. He describes a simple
but effective incubator, constructed from a wooden
box, and the additional equipment required for
carrying out this test as an office procedure. Little
time or material is invested in this method, and
the cost to the patient is no more than that of
the usual laboratory procedure. A case is reported
which illustrates the usefulness of this method.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 241, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
614
Volume XLIV
Number 6
A pRAyeR £OR physicians
^Jlmighty and ever creating god, from whom we come and to whom
WE RETURN, WE BOW IN AWE BEFORE THE MYSTERY OF LIFE WHOSE SOURCE AND
SECRETS ARE IN THY KEEPING. THANK THEE FOR ALL THOSE THY SERVANTS WHO
ARE WORKERS TOGETHER WITH THEE IN SAVING AND STRENGTHENING THE LIFE
WHICH THOU HAST GIVEN UNTO US. AT THIS SEASON OF THE GREAT PHYSICIAN'S BIRTH
WE PRAISE THEE FOR THE NOBLE PROFESSION WHICH HAS CARRIED THE MINISTRY
OF HEALING ACROSS ALL BOUNDARIES OF RACE AND NATION AND CREED.
VIA PRAY O GOD, THAT THOU WILT GUIDE WITH THINE INFINITE WISDOM THOSE TO WHOSE
CARE WE ENTRUST OUR MINDS AND BODIES IN THE CRISES OF LIFE. JlLUMINE THE
INSIGHTS TO DISCOVER CAUSES AND MAKE DECISIONS, WHEN LIFE HANGS IN
THE BALANCE. GIVE POISE TO MEET THE UNEXPECTED AND PATIENCE TO
ENDURE THE TEDIOUS. ^NDOW OUR DOCTORS, WE BESEECH THEE, WITH THAT
ABOUNDING HEALTH OF MIND WHICH IMPARTS COURAGE TO THOSE WHO SUFFER AND
QUICKENS HOPE IN HEARTS THAT ARE FAINT. BE THOU THE GOOD SHEPHERD.
TO THE HEALERS WHO ARE CALLED SO OFTEN TO WALK THROUGH THE VALLEY OF
THE SHADOW OF DEATH THAT THEY MAY LESSEN FEAR AND STRENGTHEN FAITH.
(2)ur father, WE ARE PROFOUNDLY GRATEFUL FOR THE HIGH STANDARDS WHICH HAVE
ENNOBLED THE HEALING PROFESSION, AND WE PRAY THAT ALL WHO PURSUE IT MAY
FIND INNER SATISFACTION FROM ITS LOFTY SPIRIT OF SERVICE. [^EEP ALIVE
THE QUESTING EAGERNESS OF SCIENCE THAT CURES MAY BE FOUND FOR THE DREAD
DISEASES WHICH STILL BAFFLE US. CONTINUE AND DEEPEN THE DESIRE TO
SHARE THE SECRETS OF THE HEALING ART WITH ALL PEOPLES AND NATIONS THAT
THE FORCES WHICH HELP MAY OVERCOME THE FORCES WHICH HURT AND
THE CHRISTMAS PROMISE OF PEACE MAY COME TO EARTH. AMEN.
WRITTEN ESPECIALLY
FOR WHAT'S NEW
REPRINTED BY
PERMISSION OF
ABBOTT LABORATORIES
RALPH W. SOCKMAN
Ralph W. Sockman, D.D., Ph.D., is minister oj Christ Church,
New York, a prominent churchman, lecturer and author. He is a
former president of Federation of Churches and Church Peace Union.
Books by Doctor Sockman include “ Higher Happiness,"
iiNrnu) tn RpUpup” nnd liThp Whn/p Armnr ni find ”
I Florida. M.
December, 1957
615
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF
SHALER RICHARDSON, M.D., Editor
Editorial Consultant
Mrs. Edith B. Hill
Managing Editor
Ernest R. Gibson
Assistant Managing Editor
Thomas R. Jarvis
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
Committee on Publication
Shaler Richardson, M.D., Chairman. .. .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D -..Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
The Voice of Reason
Frank G. Slaughter, M.D.
“That man no other man shall own,
Who to himself belongs alone.”
So wrote Paracelsus nearly four hundred years
ago. Yet the truth he managed to compress into
two short lines of verse was never more important
than it is today. Living in a state of tension and
uncertainty, physical, economic and political, the
minds of men and their actions are constantly
swayed by conflicting urges and fears. The Rus-
sians toss a metal sphere called ‘‘sputnik” into
space and a wave of hysteria sweeps over the
world, the din of many voices presaging doom.
So it was when we ourselves exploded the first
atomic bomb over Hiroshima and the first mush-
room cloud of a hydrogen blast rose above a
Pacific atoll. So, too, did the croakers of doom
foretell the destruction of mankind when the
crossbow first came into use many centuries ago
and when gunpowder sounded the doom of knights
in armor. The truth is that weapons for mass de-
struction have been in men’s hands since the first
tlirt arrowhead was discovered and put into use.
When the chips were down, so to speak, reason
always prevailed over hysteria and it will un-
doubtedly do so again, but the world is obviously
in for some troubled times unless the voices of
reason speak louder than they have yet done.
‘‘Just as the lily produces invisible perfume,”
Paracelsus also wrote, “so does the invisible body
(the soul or mind) send forth its healing influ-
ence.” He was speaking of physicians and how
they should exert the steadying influence of their
own sanity and certainty of purpose upon people
under stress. Our modern mass media of com-
munication serve to make one man’s fears those of
a hundred million people, if he has their ears
and eyes through newspapers, television, and
radio. The sound of voices on the air preaching
doom today is literally as it was in biblical times
on the tower of Babel when God did “there con-
found their language, that they may not under-
stand one another’s speech.”
Were it possible to give a gift at Christmas
to all the world, the most appropriate one might
well be a brief period of aural nonfunction during
which men would not be swayed by the voices
616
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 6
of doom inciting them to hysteria. Instead, they
could listen then to the voice of reason within
themselves. Failing that gift, however, hysteria
should be treated by those best qualified to rec-
ognize and treat it, the physicians of the world.
Come upon an accident shortly after it has hap-
pened and you find a scene of feverish confusion.
Yet moments after a doctor arrives, reason is
restored, not so much by what he does but be-
cause those confused have confidence in his ability
to handle the emergency.
Hysterical symptoms can wreck the body so
that, even when the cause is removed, permanent
damage results. And this is no less true of the
mistakes men make in the excitement of fear.
Permanent damage can easily be done under the
stress of intense emotion to our institutions, our
government, even our religion, for we are all too
easily drawn away from the teachings of Him
whose birth we celebrate at this season. “Be not
afraid of them that kill the body,” said Jesus
shortly before he went up to Jerusalem to be
crucified. To kill a man’s body is a single act,
affecting him alone. But to kill a man’s soul by
depriving him of the power to reason logically
because of fear can bring the same fate to many
who listen and are swayed by him.
Individually and collectively, the voice of the
medical profession is more respected than any
other. But if we are to be heard, we must break
out of our own snug nest of conformity, comfort
and financial well-being. We must risk offend-
ing others by standing for order even when mob
emotions erupt. Then more than ever, the calm
voice of reason. needs to be heard, as the voice of
Jesus was heard nearly two thousand years ago,
with the comforting message to those troubled by
their own insignificance: “Fear not; you are of
more value than many sparrows.”
Editor’s Note: The Journal is honored to have for the fifth
consecutive year a guest editorial befitting the Christmas
Season from the pen of Dr. Frank G. Slaughter, of Jacksonville,
Florida’s distinguished physician-author.
Whole Truths to Combat Misconceptions
The medical profession has progressed to the
status of an art as well as a science. The medical
man has manifested his importance in markedly
increasing the longevity of life in preventive as
well as curative medicine, and, until the last dec-
ade, has acquired a position of esteem, admira-
tion and respect throughout the world.
The socialistic trend, however, during the last
25 years has somewhat altered this position. The
opinion people have formed of the medical pro-
fession is partly the result of incomplete informa-
tion as well as lack of information. Modern liv-
ing no longer permits the intimate family and
doctor relationship that existed in the “horse and
buggy days.”
The men and women of medicine adhere to
great principles tested throughout long years,
and today our tenets give us a bulwark of strength
that has not failed. There are elements who
would destroy the position occupied by Doctors
of Medicine in those sectors remaining as a free
world and whose efforts constitute a real threat.
Popular opinion of the doctor has many facets,
some justified, others unjustified. Our faults re-
main ours to correct, and this responsibility is an
obligation of the medical profession.
One of our paramount duties and an obliga-
tion is to make an all-out effort to correct mis-
understanding and misinformation fostered by
half-truths presented through the press, whether
in magazine articles or newspaper features. “As
the Devil can quote Scriptures so can the Philos-
opher quote Science.” Any corrective method used
should manifest itself with supreme dignity and
honesty.
Would it not be wise for the Florida Medical
Association, as well as each component medical
group, to have a special bureau which would
provide a definite program of information to be
disseminated by timely newspaper articles as well
as individual speakers who appear before church
groups, P.T.A. organizations, civic clubs, and
other organizations? Much good can be accom-
plished by the presentation to the public of whole
truths combating misconceptions of “wonder
drugs,” clarifying the title “Doctor” and its
numerous connotations, explaining the care of the
indigent as a service contributed by the profes-
sion, and providing a better understanding of
demands made of men and women of the medical
profession to meet ever higher standards. These
are a few examples.
J. Florida, M.A.
December, 1957
EDITORIALS AND COMMENTARIES
617
One of the best public relations approaches is
for the doctor to take an active part in civic as
well as political affairs. The inner sanctum of his
office provides a focal point for each individual
doctor to establish his own sphere of influence and
make his personal contribution to the education
of all.
Distinguished Florida Physician
Sponsored for Highest National Office
Plans to present the name of Dr. Louis M.
Orr of Orlando to the House of Delegates of the
American Medical Association for consideration
as President-Elect at the annual meeting of that
association in San Francisco in June 1958 are of
particular interest to every member of the Florida
Medical Association. The letter announcing these
plans, signed by Dr. Homer L. Pearson Jr., of
Miami, the chairman of the Judicial Council of
the American Medical Association, Dr. Reuben
B. Chrisman Jr., of Coral Gables, and Dr. Francis
T. Holland, of Tallahassee, Florida delegates to
that body, and Dr. William C. Roberts, of Pana-
ma City, president of the Florida Medical Associ-
ation, is published in this issue of The Journal
It has been sent to all of the delegates and officers
of the American Medical Association.
Born in Cummings, Ga., on Sept. 27, 1899,
Dr. Orr received his academic and professional
training in his native state. He was awarded the
degree of Bachelor of Science in 1921 and the
degree of Doctor of Medicine in 1924 by Emory
University. There followed an internship at Peter
Bent Brigham Hospital in Boston and a year’s
residency at Lakeside Hospital in Cleveland. He
then entered the private practice of medicine in
Orlando, and has continued to practice there since
1926. He limits his practice to urology.
Dr. Orr has through the years rendered faith-
ful service to medicine both in Florida and in the
nation. Since 1927 he has been active in the
Florida Medical Association. In 1933, he became
an Associate Editor of The Journal and has con-
tinued to serve in that capacity for a quarter of a
century. In 1935 he was Councilor for his district.
He was a member of the Committee on Venereal
Disease Control in 1941, and chairman of the
Committee of Review, Florida Medical Service
( orporation in 1947. He served on the Advisory
Board to the Executive Committee of the Florida
Society of Medical Technologists in 1948 and on
the Committee on Scientific Assembly and Spe-
cialty Group Problem in 1952. Since 1948, he has
been a member of the Association’s House of
Delegates and for seven of the 10 years of this
service he has served as chairman of the Creden-
tials Committee. In 1954-55, he was a member of
the Board of Governors. He is a prolific writer
and has contributed many valuable scientific
papers to The Journal as well as to national med-
ical publications.
Also since 1948, Dr. Orr has represented the
Florida Medical Association in the House of
Delegates of the American Medical Association
and in 1955 was elected its vice speaker. In addi-
tion, he has served the parent organization as
chairman of the Federal Medical Services Com-
mittee and as a member of its Council on Medical
Service. In 1953, he was chosen president-elect
and in 1954 became president of the Conference
of Presidents and Other Officers of State Medical
Associations.
Dr. Orr is a member of the following medical
societies: American Medical Association, Ameri-
can Association of Genito-Urinary Surgeons,
American Urological Association, Southeastern
Section of the American Urological Association,
Southern Medical Association, Southeastern Sur-
gical Congress, American College of Surgeons,
Diplomate of the American Board of Urology,
Association of American Physicians and Surgeons,
and the International Society of Urology.
During World War II, Dr. Orr served as a
colonel in the Medical Corps. From 1942 to 1945,
he was the executive officer of the 15th Hospital
Center in the European Theatre of Operations.
Among the many local activities with which
Dr. Orr has been prominently identified through
the years is the Civic Music Association of Or-
lando, of which he was president from 1939 to
1952. He has for some years also served as a trus-
tee of Rollins College in nearby Winter Park.
Announcing Dr. Orr's Candidacy
Dear Dr. :
For several years an increasing number of delegates
and other prominent members of the American Medical
Association have urged that Louis Orr be presented to
the House of Delegates for consideration as President-
Elect. This we plan to do at the San Francisco meet-
ing in June of 19S8.
Since you know Louis’ qualifications and capabilities,
we respectfully request that you give your personal con-
sideration to his continuing service to American Medicine.
Very cordially yours,
Homer L. Pearson Jr., M.I). Reuben B. Chrisman Jr., M I).
Francis T. Holland, M.D. William C. Roberts, M.D.,
FMA, President
618
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 6
Laying of Cornerstone
University Teaching Hospital
The cornerstone of the new Teaching Hospital
of the University of Florida was laid on Oct. 26,
1957, in a simple ceremony presided over by Dr.
J. Wayne Reitz, President of the University, as
the second unit of the J. Hillis Miller Health Cen-
ter now nears completion. In formally placing the
mortar in the edifice for the cornerstone. Dr. Reitz
used the trowel that was used in laying the corner-
stone of the Medical Sciences Building, first unit
of the Center, which was dedicated last year. As-
sisting Dr. Reitz in the ceremony were Mrs. J.
Hillis Miller, widow of the late president of the
University for whom the Center is named, Dean
George T. Harrell Jr., of the College of Medicine,
Dean Dorothy Smith of the College of Nursing,
and Dr. Russell S. Poor, Provost of the Center.
Dr. Reitz presented the Medical Advisory
Committee of Florida physicians who contributed
Dr. J. Wayne Reitz, President of the University of
Florida, places mortar in the cornerstone while Dr.
George T. Harrell Jr., Dean of the College of Medi-
cine, observes.
Members of the Medical Advisory Committee of Florida physicians attending the ceremonies are shown
left to right: Drs. William C. Thomas Sr., Gainesville; Chas. J. Collins, Orlando; Eugene G. Peek Sr., Ocala;
David R. Murphey Jr., Tampa; William M. Rowlett, Tampa; Donald W. Smith, Miami, and Turner Z. Cason,
Jacksonville. Attending but not shown are Drs. Clyde O. Anderson, St. Petersburg, and Edward Jelks, Jack-
sonville.
J. Florida, M.A.
December, 1957
EDITORIALS AND COMMENTARIES
619
to the planning of the Center. The members of
this committee who were in attendance were Dr.
Clyde O. Anderson of St. Petersburg, Dr. Turner
Z. Cason of Jacksonville, Dr. Charles J. Collins of
Orlando, Dr. Edward Jelks of Jacksonville, Dr.
David R. Murphey Jr. of Tampa, Dr. Eugene G.
Peek Sr. of Ocala, Dr. William M. Rowlett of
Tampa, Dr. Donald W. Smith of Miami, and Dr.
William C. Thomas Sr. of Gainesville.
The building is scheduled for completion in
time for use next September. The acceptance of
in-patients in the fall of 1958 will coincide with
the third year teaching schedule for the first
classes of the College of Medicine and College of
Nursing, enabling the students in these classes to
begin their clinical training at that time.
The 400 bed Teaching Hospital will house
outpatient clinics, a rehabilitation unit, a psy-
chiatric floor and an ambulatory wing, which is
a new concept in patient care. These facilities are
in addition to those set aside for general hospital
care of acutely ill patients. According to Dean
Harrell, patients will be admitted by referral
from the local family physician. He will decide
whether the patient needs the specialized services
of the Health Center or can be better cared for
locally and he will remain in charge of the pa-
tient’s care all year round.
Midwinter Seminar
Ophthalmology and Otolaryngology
Miami Beach, Jan. 27 - Feb. 1, 1958
The University of Florida Midwinter Seminar
in Ophthalmology and Otolaryngology will be held
in Miami Beach again this season. This twelfth
annual meeting will convene on January 27 and
continue through February 1. The Americana
Hotel, the newest hotel on the ocean front, has
been chosen for the meeting place. All of its
facilities, including the beach and swimming pool,
will be available to all registrants of the Seminar
and their families. The schedule has been ar-
ranged to allow plenty of time to enjoy the excep-
tional vacation facilities of Miami Beach. The
hours for all meetings are 8:30 a.m. to 1:30 p.m.
On January 27, 28 and 29, the lectures on
Ophthalmology will be presented. The lecturers
will be Dr. Frank D. Costenbader of Washington,
D. C., Dr. John H. Dunnington of New York
City, Dr. Peter C. Kronfeld of Chicago, Dr. W.
Howard Morrison of Omaha, and Dr. C. L.
Schepens of Boston.
The lectures on Otolaryngology are scheduled
for January 30 and 31 and February 1. The lec-
turers will be Dr. Aram Glorig of Los Angeles,
Dr. Jerome Hilger of St. Paul, Dr. Alexander S.
McMillan of Boston, Dr. Samuel Martin of
Gainesville, and Dr. James Maxwell of Ann
Arbor, Mich.
On Wednesday, January 29, at 6:30 p.m., all
registrants and their wives will be entertained at
a cocktail party at the Americana. At 8 p.m. that
evening, there will be an informal dinner for all
registrants and their wives, with dancing and an
nitstanding floor show.
Florida Diabetes Association
Annual Meeting Held
New trends in the treatment of diabetes were
discussed at the Florida Diabetes Association’s
fifth annual meeting held at the University of
Florida College of Medicine in Gainesville late in
October. The three day program capsuled the
most current advances with lectures and demon-
strations for more than 60 Florida physicians.
Dr. William R. Jordan, Associate Professor of
Clinical Medicine, Medical College of Virginia,
lectured on the diagnosis and prognosis in diabetes
as well as diabetes in children, the diabetic foot
and the renal threshold and bladder residual as
they affect the treatment of diabetes. Also serving
on the faculty, Dr. Roger H. Unger, Instructor
in Clinical Medicine, Southwestern Medical School
of the University of Texas, spoke on the manage-
ment of diabetes with oral drugs, the current status
of insulin therapy as well as insulin action and
metabolism, and the intravenous tolbutamide
response test, which is a new diagnostic test for
mild diabetes mellitus.
From The Upjohn Company’s Department of
Clinical Investigation, Dr. Cornelius J. O’Dono-
van reviewed the history of tolbutamide and dis-
cussed the mechanism of action and clinical exper-
ience with the drug. He stressed the fact that the
new drug cannot be considered a substitute for
insulin, but its most important contribution is in
regulating mild cases of adult type diabetes for
routine maintenance.
Other speakers for the session included Dr.
Sanford A. Mullen of Jacksonville, who spoke on
methods of determining blood and urine sugar
and their clinical interpretation, and Dr. Sidney
Davidson of Lake Worth, whose subject was “The
Unknown Diabetic in Your Practice.” Dr. Will-
620
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 6
iam C. Thomas Jr., Assistant Professor of Medi-
cine and Director of the Division of Postgraduate
Education of the University of Florida College
of Medicine, discussed disorders accompanied by
severe and often unrecognized hypoglycemia.
Moderating panel discussions were Dr. Glenn
O. Summerlin of Gainesville, President of the
Alachua County Medical Society, Dr. George H.
Garmany of Tallahassee, incoming president of
the Florida Diabetes Association, and Dr. Joseph
J. Lowenthal of Jacksonville, President-Elect. Dr.
Garmany succeeds Dr. Edward R. Smith of Jack-
sonville as president. Dr. Grover C. Collins of
Palatka was named secretary-treasurer.
The meeting was held in cooperation with the
Florida State Board of Health, the Florida Medi-
cal Association and the Division of Postgraduate
Education of the University of Florida College
of Medicine.
The New Orleans Graduate
Medical Assembly
The twenty-first annual meeting of The New
Orleans Graduate Medical Assembly will be held
March 3, 4, 5 and 6, 1958, with headquarters at
the Roosevelt Hotel.
Eighteen outstanding guest speakers will par-
ticipate, and their presentations will be of inter-
est to both specialists and general practitioners.
The program will include 54 informative discus-
sions on many topics of current medical interest,
in addition to clinicopathologic conferences, sym-
posiums, medical motion pictures, round table
luncheons and technical exhibits.
The Assembly has been officially approved for
Category I by the Commission on Education of
the American Academy of General Practice.
Thirty hours of formal credit will be allowed for
attendance at this meeting.
Following the meeting in New Orleans, ar-
rangements have been made for a postclinical
tour to Mexico City, Cuernavaca, Taxco and
Acapulco, leaving from New Orleans on Friday,
March 7, and returning on Tuesday, March 18.
Details of the New Orleans meeting and the
postclinical tour are available at the office of the
Assembly, Room 103, 1430 Tulane Avenue, New
Orleans 12.
The list of guest speakers for the Assembly
and their specialties may be found on Page 626 of
this issue of The Journal.
“Jacksonville Blood Bank, Inc.”
A Review
The Jacksonville Blood Bank is now complet-
ing its fourteenth year of service to the commu-
nity. Through war and peace an enviable record
of progress has been enjoyed. In 1941, the state
was asked, through the Civil Defense program, to
establish five regional blood banks in Florida in
order to obtain adequate supplies of blood and
plasma in anticipation of military and civilian
needs. The story of the bank established in Jack-
sonville is related in a recently published booklet
entitled “Jacksonville Blood Bank, Inc.”
The Jacksonville Blood Bank was launched
under Civil Defense by a corporation set up for
this purpose. The Board of Directors was com-
prised of subscribers to the charter, which was
approved on March 17, 1942. Officers included
Dr. Robert B. Mclver, President, Dr. Lucien Y.
Dyrenforth, Vice President, Mr. Warren L. Jones,
Secretary, and Mr. Francis P. Fleming, Treas-
urer. A basic program set up for the Jacksonville
Blood Bank and the other blood banks in Florida
featured: (1) a governing board of laymen and
professional groups, (2) nonprofit operation, (3)
maintenance of financial solvency, (4) availability
of an adequate supply of blood, (5) cooperation
of and supervision by the medical profession with
approval of the county medical society, (6) ade-
quate provision for outlying communities, (7) a
donor registry for emergencies to be established
in outlying hospitals, (8) the technical procedures
to be performed by trained blood bank tech-
nicians, and (9) the technical work to be under
the direct supervision of a certified clinical path-
ologist.
The formal opening of the Jacksonville Blood
Bank was held in October 1942, in a remodeled
building at 2208 Otto Street, strategically located
near three of Jacksonville’s busy hospitals. Hun-
dreds of blood donation were from groups of
civic and religious organizations, and individual
donors. The technical staff of three was assisted
by volunteers from the Civil Defense Unit, and
the Jacksonville Junior League, Inc. Whole blood
and plasma were dispensed to individuals accord-
ing to the adopted plan. Reserve plasma, proc-
essed by the Blood Bank, and a stock of dried
plasma, received from the National Office of Civil
Defense, were held in the event of disaster.
In 1944, termination of the emergency cre-
ated by World War II and discontinance of the
Civil Defense program necessitated reorganization
J. Florida, M.A
December, 195'
EDITORIALS AND COMMENTARIES
621
The modern structure, housing the Jacksonville Blood Bank, was dedicated in October 1949. The staff has
increased from three persons in 1942 to 36 at the present time, and the volume of work has increased tenfold.
Dr. John B. Ross is the full time Medical Director.
of the Blood Bank. A new policy, based on in-
vestigation and statistics of other blood banks,
was made to meet postwar problems. Growing
steadily, the Blood Bank service was expanded to
meet the need of the adjacent communities. A
donor reserve program, through civic and military
organizations, was initiated. Mobile blood units
were organized, and an agreement was made with
the American Red Cross to participate in the
Armed Forces Blood Procurement Program.
A charter member of the Florida Association
of Blood Banks, the Jacksonville Blood Bank now
had the formal approval of the National Institutes
of Health. On Oct. 16, 1949, a carefully planned
dream was realized — the dedication of the mod-
ern new building at 535 West Tenth Street.
After a decade of progress, a full time Medi-
cal Director, Dr. John B. Ross, was appointed.
The personnel had increased from three to 36 staff
members, and during the 10 year span, the Blood
Bank had enjoyed a tenfold increase in volume of
work. An improved community service featured:
frozen plasma; blood for treatment of patients
with platelet deficiency; emergency group O blood
in all hospitals; arrangements to fractionate plas-
ma into albumin, gamma globulin and fibrinogen;
anti-A, anti-B, anti-Rh and Coombs’ serums pre-
pared by the Blood Bank for its own use, and
mumps immune serum for patients. Other im-
portant programs included participation in the
Blood Bank clearing house, similar to monetary
clearing houses, for the exchange of blood and
credits throughout the United States.
In 1954, the establishment of a Radioactive
Isotope Department and a Tissue (Bone and
Blood Vessel) Bank was a reality. This nonprofit
laboratory was organized to serve the general pub-
lic through private physicians.
The Watchword of the Jacksonville Blood
Bank is Progress, and the goal is ever to extend
the usefulness of human blood and blood prod-
ucts.
Dr. Mclver deserves major credit for his un-
tiring efforts since its organization to make this
institution outstanding. Mrs. Edith B. Hill, edi-
torial consultant, is likewise to be commended
for her service in the preparation of the brochure.
Called Meeting of House of Delegates
Florida Medical Association
December 8
Dr. William C. Roberts, President of the Flor-
ida Medical Association, has called a meeting of
the House of Delegates for 9 a.m., Sunday, Dec.
8, 1957, at the George Washington Hotel in Jack-
sonville to specifically consider Medicare. Dele-
gates seated at the 1957 Annual Meeting are eli-
gible to be registered and to vote.
622
Volume XLIV
Number 6
OTHERS ARE SAVING
Is Your Pride an Asset or Liability?
Have you ever asked yourself what makes one
do unreasonable, unfair, unnatural or unjust ac-
tions or reactions? It’s sometimes difficult to ex-
plain or understand why the mass of protoplasm
takes on a certain type of behavior. But when
one speaks of behavior and the response of an
adult to a situation, and the attempts to explain
the factors that bring about the response, one must
go back into items that constitute character, per-
sonality, heredity, environment and its influences.
It’s all a very complex conglomerate making a
contribution to what we would call a response to
a specific situation.
In this treatise I am not concerned with all
the factors that control an adult’s human being,
but rather with us as individual physicians, and
our inability to cope with these influences. One
knows the decision or deed is unfair, unjust or
what not and yet one is unable to throw off the
powerful force that makes him commit or decide
unfairly or unjustly. To be specific it has been
said that some will follow a patient to death, too
proud to ask for consultation. This factor in the
make-up of an adult individual is commonly re-
ferred to as pride.
It intrigues me to watch this element work in
the daily routine of people, one who is proud may-
be satisfied, confident, secure, dignified, vain,
at times arrogant, conceited, august, elated, carry
high ambitions, high notions, or display egotism.
The pride of some adults seems never to be satis-
fied. It’s a potent mechanism that can make one
desire, acquire, dominate, persecute, discriminate
or commit common unlawful civil, social, moral
or physical acts. Yet in the world of material
accomplishments or acquirements it drives one to
produce and achieve and possibly advance in
terms of other standards. To be proud is neces-
sary in today’s competitive society, and it will
continue to be a powerful characteristic of people
for unforeseeable generations.
To understand one’s pride and how it operates
is a great achievement on the part of man, very
few are capable of harnessing this great dynamo
and keeping it under reasonable control. You and
I are well aware of those with too much pride,
and those with too little. Now in between these
two extremes the mass of the population falls. As
you watch the people in general too many are
victims of their own pride, many are victims of
the absence of pride.
In discussing the effect of pride one must
necessarily discuss humility. Humility is the de-
sirable counterpart of pride and is necessary in
the proper proportion in an integrated individual.
For this discussion only, an integrated individual
is one who has the proper balance between pride
and humility and exercises reasonable control over
both. To be humble is to be shy, modest, timid,
conciliatory, respectful and understanding, par-
ticularly in our profession.
You, no doubt, are wondering what all this
has to do with medicine. If you recall the title
of this paper — “Is your pride an asset or liabil-
ity?” you will begin to see some application.
When one acquires an M.D. degree he or she is
rightfully a proud one, and justifiably so. Then
after having worked in medicine a few years the
W3ar and tear of the work and the changing pub-
lic attitude causes your pride to give way some-
what to humility. One becomes more considerate,
tolerant, understanding, conciliatory and just
plain more reasonable in dealing with people and
their problems. Then still more years in medicine
and public service tends to dull one’s pride and
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CHEMOTHERAPY PLUS FLORA CONTROL
Floraquin
Destroys Vaginal Parasites
Protects Vaginal Mucosa
Vaginal discharge is one of the most com-
mon and most troublesome complaints met
in practice. Trichomoniasis and mondial
vaginitis, by far the most common causes
of leukorrhea, are often the most difficult to
control. Unless the normal acid secretions
are restored and the protective Doderlein
bacilli return, the infection usually persists.
Through the direct chemotherapeutic ac-
tion of its Diodoquin® (diiodohydroxyquin,
U.S.P.) content, Floraquin effectively elimi-
nates both trichomonal and mondial infec-
tions. Floraquin also contains boric acid and
dextrose to restore the physiologic acid pH
and provide nutriment which favor* re-
growth of the normal flora.
Method of Use
The following therapeutic procedure is
suggested: One or two tablets are inserted
by the patient each night and each morning;
treatment is continued for four to eight
weeks.
Intravaginal A pplicator for Improved
Treatment of Vaginitis
This smooth, unbreakable, plastic device is
designed for simplified vaginal insertion of
Floraquin tablets by the patient. It places
tablets in the fornices and thus assures coat-
ing of the entire vaginal mucosa as the tab-
lets disintegrate.
A Floraquin applicator is supplied with
each box of 50 tablets. G. D. Searle & Co.,
Chicago 80, Illinois. Research in the Service
of Medicine.
s
a new era
in sulfa therapy
New authoritative studies prove that Kynex dosage can be reduced even
further than that recommended earlier.1 Now, clinical evidence has established
that a single (0.5 Gm.) tablet maintains therapeutic blood levels extending
beyond 24 hours. Still more proof that Kynex stands alone in sulfa per-
formance—
• Lowest Oral Dose In Sulfa History— 0.5 Gm. ( 1 tablet) daily in the usual
patient for maintenance of therapeutic blood levels
• Higher Solubility— effective blood concentrations within an hour or two
• Effective Antibacterial Range— exceptional effectiveness in urinary tract
infections
• Convenience— the low dose of 0.5 Gm. (1 tablet) per day offers optimum
convenience and acceptance to patients
new dosage. The recommended adult dose is 1 Gm. (2 tablets or 4 teaspoon-
fuls of syrup) the first day, followed by 0.5 Gm. ( 1 tablet or 2 teaspoonfuls of
syrup) every day thereafter, or 1 Gm. every other day for mild to moderate
infections. In severe infections where prompt, high blood levels are indicated,
the initial dose should be 2 Gm. followed by 0.5 Gm. every 24 hours. Dosage
in children, according to weight; i.e., a 40 lb. child should receive Va of the
adult dosage. It is recommended that these dosages not be exceeded.
tablets: Each tablet contains 0.5 Gm. ( IV2 grains) of sulfamethoxypyri-
dazine. Bottles of 24 and 100 tablets.
syrup: Each teaspoonful (5 cc.) of caramel-flavored syrup contains 250 mg.
of sulfamethoxypyridazine. Bottle of 4 fl. oz.
I. Nichols, R. L. and Finland, M.: J. Clin. Med. 49:410, 1957.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
•Reg. U. S. Pat. Off.
626
Volume XLIV
Number 6
sharpen one’s humility. As you watch yourself
working with people and their problems you will
see this change in your attitude.
Your pride then acts as an asset to cause you
to do the right thing in most situations and gives
you drive and determination to acquire and ac-
complish, and aids you to keep your moral and
ethical standards high. Yet in other situations
your same pride causes you to do unjust, un-
ethical and improper acts, deeds and procedures
which seem at times to be outside the realm of
common sense. When you find yourself in such
an unhealthy situation it is time to bring into play
the element of humility to control the powerful
force which has gotten out of hand. Sit down
alone, think about your problem unemotionally.
You see, therefore, your pride can be a liability,
it can make you do something wrong.
In the practice of medicine one daily attempts
to control the influence of pride and humility.
To do this requires much conscious effort and
control over factors in your daily life such as —
economics, medical ethics, religion, politics, pro-
fessional rapport, etc. Some individuals never
learn to control these influences and yet some
control them unconsciously, and still others han-
dle each problem on its own merits attempting to
do what is commonly referred to as the right thing
with a conscious evaluation.
And so you see your pride can be an asset or
a liability. You should use your pride in the
practice of medicine judiciously and balance it
against humility in the proper situation so that
you will realize for yourself and your family the
fullest self-satisfaction possible from your chosen
life’s work. The application of good common
sense in conjunction with the basic principle of
Christianity will guarantee you that your pride
will be an asset and not a liability.
Walter J. Glenn
“The President’s Page”
— The Record, Broward
County Medical Association
September 1957
DEATHS
Deaths — Members
Adams, Texas A., Daytona Beach October 3, 19S7
Cronkite, Alfred E., Fort Lauderdale October 27, 19S7
Deaths — Other Doctors
MacLean, J. Arthur Jr., Miami September 22, 1957
Myers, Edmund, St. Petersburg September 4, 1957
~y4nnotincincj The Twenty-First Annual Meeting
of
THE NEW ORLEANS GRADUATE MEDICAL ASSEMBLY
Conference Headquarters — Roosevelt Hotel
March 3, 4, 5, 6, I 958
GUEST SPEAKERS
Carleton B. Chapman, M.D., Dallas, Tex.
Cardiology
Herbert Rattner, M.D., Chicago, 111.
Dermatology
Charles A. Flood, M.D., New York, N. Y.
Gastroenterology
Robert A. Davison, M.D., Memphis, Tenn.
General Practice
Lawrence M. Randall, M.D., Rochester, Minn.
Gynecology
Bayard T. Horton. M.D., Rochester, Minn.
Internal Medicine
Perrin H. Long, M.D., Brooklyn, N. Y.
Internal Medicine
George N. Raines, Capt., MC, USN, Washington, D. C.
Neuropsychiatry
Robert H. Barter, M.D., Washington, D. C.
Obstetrics
Ralph O. Rychener, M.D., Memphis, Tenn.
Ophthalmology
C. Leslie Mitchell, M.D., Detroit, Mich.
Orthopedic Surgery
Frank D. Lathrop, M.D., Boston, Mass.
Otolaryngology
Arthur H. Wells, M.D., Duluth, Minn.
Pathology
James Marvin Baty, M.D., Boston, Mass.
Pediatrics
Harold O. Peterson, M.D., Minneapolis, Minn.
Radiology
Jere W. Lord, Jr., M.D., New York, N. Y.
Surgery
Claude E. Welch, M.D., Boston, Mass.
Surgery
Ormond S. Culp, M.D., Rochester, Minn.
Urology
LECTURES, SYMPOSIA, CLINICOPATHOLOGIC CONFERENCES. ROUND-TABLE LUNCHEONS,
MEDICAL MOTION PICTURES AND TECHNICAL EXHIBITS.
(All-inclusive registration fee — $20.00)
THE POSTCLINICAL TOUR TO MEXICO CITY, CUERNAVACA,
TAXCO AND ACAPULCO
Leaving March 7 from New Orleans and returning March 18, 1958
For information concerning the Assembly meeting and the tour
write, Secretary, Room 103, 1430 Tulane Avenue, New Orleans 12, La.
J. Florida, M.A.
December, 1957
627
TETRACYCLINE
OPHTHALMIC OIL
SUSPENSION 1%
bland soothing drops
• floods tissues quickly, evenly
o compatible with ocular tissues and fluids
o eliminates cross contamination
unsurpassed in antibiotic efficacy
• Therapeutic: the true broad-spectrum action
of Achromycin, promptly effective in a wide
variety of common eye infections
o easily self-administered
supplied:
4 cc. plastic squeeze, dropper bottle containing
Achromycin Tetracycline HC1 (1%) 10.0 mg.,
per cc. suspended in sesame oil.
• Prophylactic: following removal of foreign
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• Stable, no refrigeration needed: retains full
potency for 2 years
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
'Reg. U. S. Pat. Off.
628
Volume XLIV
Number 6
“ the value of analgesic and tranquilizing agents
should be clearly recognized in the management of [angina] . . ”1
new for angina
*ENTAEftrTH*»ITOL BAAMO Of
TETAANlTftATC HVOAOKYZlM
In pain. Anxious. Fearful. On the road to cardiac in-
validism. These are the pathways of angina patients.
For fear and pain are inextricably linked in the
angina syndrome.
For angina patients — perhaps the next one who
enters your office— won’t you consider new cartrax?
This doubly effective therapy combines petn (pen-
taerythritol tetranitrate) for lasting vasodilation and
atarax for peace of mind. Thus cartrax relieves
not only the anginal pain but reduces the concomi-
tant anxiety.
Dosage and supplied: begin with 1 to 2 yellow tab-
lets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. This may be increased for maximal effect by
switching to pink tablets (20 mg. petn plus 10 mg.
atarax). In bottles of 100.
cartrax should be taken before meals, on a contin-
uous dosage schedule. Use with caution in glaucoma.
1. Russek, H. I.: J. Am. Geriat. Soc. 4:877 (Sept.) 1956.
‘Trademark
J. Florida, M.A
December, 1957
629
<- READ THIS
630
Volume XLIV
Number 6
STATE NEWS ITEMS
Dr. Leon S. Eisenman of Hialeah has been
elected president of the Dade County Academy of
General Practice. Elected to serve with Dr.
Eisenman are Dr. Jack Keefe III of Miami, vice
president, and Dr. Bernard Yesner of Coral Ga-
bles, secretary and treasurer. Drs. Milton S.
Goldman of Miami Beach and Vincent P. Corso
of Miami have been chosen as members of the
board of directors.
Dr. Ralph S. Sappenfield of Miami has been
elected president of the American Society of
Anesthesiologists.
Dr. Julius C. Davis of Quincy, who served as
President of the Florida Medical Association in
1930, has returned to his practice at Quincy after
having been away most of the past summer.
Dr. Douglas R. Murphy of Sarasota was
among the group of physicians from Florida who
attended the recent meeting of the American Col-
lege of Surgeons held at Atlantic City.
Mediclinics third annual postgraduate refresher
course will be held in Fort Lauderdale, March
2-12, 1958. The American Academy of General
Practice has certified the course for 32 hours of
formal postgraduate study in Category 1. The
tuition fee for the course is $50 payable in ad-
vance to Mediclinics of Minnesota, 601 Medical
Arts Bldg., Minneapolis 2, Minn.
A special meeting of the Florida Society of
Plastic and Reconstructive Surgeons was held the
latter part of September at Orlando. Attending
were Drs. George W. Robertson III, president,
Leo H. Wilson Jr., Clifford C. Snyder, David R.
Millard Jr. and Thomas J. Zaydon of Miami ;Drs.
Grover Austin and John Hamilton of St. Peters-
burg; Drs. Thomas Cullen and William M. Doug-
las of Tampa; Dr. Bernard L.N. Morgan, secre-
tary, of Jacksonville, and Dr. Joseph E. O’Malley
of Orlando.
Dr. Victor M. Arean has been appointed As-
sociate Professor of Pathology at the University
of Florida College of Medicine at Gainesville.
A native of Havana, Cuba, Dr. Arean was for-
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
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December, 1957
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symptomatic
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ACHh
TETRAC YCL I NE-ANT IHI STAM INE-ANALGESIC COMPOUND
Achrocidin is indicated for prompt
control of undifferentiated upper res-
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nephritic, or rheumatic signs; during
respiratory epidemics; when bacterial
complications are observed or expected
from the patient’s history.
Early potent therapy is provided
against such threatening complications
as sinusitis, adenitis, otitis, pneumon-
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Included in this versatile formula are
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Adult dosage for achrocidin Tablets
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Available on prescription only
Tablets
Each tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Syrup
Each teaspoonful (5 cc.) contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyrilamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
*Trademark
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
632
Volume XLIV
Number 6
TJCtUfmacttce
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f
merly Associate Professor of Pathology at the
University of Puerto Rico Medical School. He
previously served on the faculties of the Ochsner
Foundation Hospital at New Orleans and the Har-
vard Medical School.
Ur. William White Stead has been appointed
Professor of Medicine at the University of Florida
College of Medicine. Dr. Stead was formerly As-
sociate Professor of Medicine at the University
of Minnesota Medical School, a post he has held
since 1949.
Dr. Melvin Simonson announces the opening
of an office at 765 N.E. 125th St., North Miami,
for the practice of neurology and psychiatry.
Dr. Edgar Watson of Lakeland has been elec-
ted president of the Polk County Unit of the
American Cancer Society.
Dr. M. Jay Flipse of Miami served as co-
chairman of a scientific session of the interim ses-
sion of the American College of Chest Physicians
held at Philadelphia, December 2-3.
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY BOOK PRINTING
PUBLICATIONS BROCHURES
Convention
PRESS ^ ^
218 West Church St.
Jacksonville, Florida
The Marion County Medical Society, through
Dr. Richard C. Cumming of Ocala, has presented
the first Dr. Stewart Thompson Memorial Award
to Mr. Santford Russell Wilson of Miami, a stu-
dent at the University of Florida College of Med-
icine at Gainesville. The award was given for
high scholarship.
Dr. John E. Deitrick, Dean of the Cornell
University Medical College, New York, was prin-
cipal speaker at the first convocation of the Uni-
versity of Florida Colleges of Medicine and Nurs-
ing held the later part of September. Dr. Deitrick
was a member of the executive committee of the
original Medical Center Study and participated in
the planning of the J. Hillis Miller Health Center
at Gainesville.
Dr. Gretchen V. Squires of Pensacola has re-
cently been elected to the position of Governor
of the College of American Pathologists.
The Fifth International Congress on Diseases
of the Chest, sponsored by the American College
of Chest Physicians, will be held Sept. 7-11, 1958
in Tokyo, Japan. It will be presented under the
J. Florida, M.A.
December, 1957
633
patronage of the government of Japan and the
Japan Science Council. Information on the meet-
ing may be obtained from Mr. Murray Kornfeld,
Executive Director, American College of Chest
Physicians, 112 East Chestnut St., Chicago 11,
111.
The Fifty-Ninth Annual Meeting of the Amer-
ican Roentgen Ray Society will be held at the
Shoreham Hotel in Washington, D. C., September
27-October 3, 1958.
Dr. William N. Chambers of Jacksonville has
been elected president of the recently organized
Duval County Psychiatric Association. Dr. Mar-
lin C. Moore has been chosen vice president and
Dr. Merton L. Ekwall secretary-treasurer. Drs.
Moore and Ekwall are also from Jacksonville.
Dr. Terry Bird of Sanford was principal
speaker at a recent meeting of the Sanford-Semi-
nole Junior Chamber of Commerce held at San-
ford in the Yacht Club.
Dr. Paul T. Cope of St. Petersburg represented
the United States Committee as an observer at the
Eleventh General Assembly of the World Medical
Association held September 29 through October
5 at Istanbul, Turkey.
Dr. J. Basil Hall of Tavares addressed a re-
cent meeting of the Lake County Tuberculosis
and Health Association held at Tavares.
Dr. Leo Batell of Tampa has been chosen
president of the Tampa Art Institute, an organ-
ization of 320 members which sponsors exhibi-
tions and conducts a program of audio-visual
films, lectures and demonstrations.
Dr. Redden L. Miller of Graceville was hon-
ored by that city October 20 when an entire
day was set aside for tributes to him. The event
was initiated by the men’s groups of the First
Baptist Church and the First Methodist Church.
A dinner was served at noon. Invited guests were
members of the Jackson-Calhoun County Medical
Society.
Dr. Myron L. Habegger of Rockledge, presi-
dent of the Brevard County Medical Society, ad-
dressed members of the Woman’s Auxiliary to
the Society at its regular monthly meeting held
the middle of October.
DOCTOR
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The many thousands of path
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;hty-seven patients with various
•tions of the skin were treated over
•riod of six weeks with [Signe-
in] . Excellent or good results were
eved in sixty-seven, including
■n of twenty-two patients refrac-
to other antibiotics.”
I is, H. H. ; Fruitless, G. M., and
schel, E. J.: Rocky Mountain M. J.
jf06 (Aug.) 1957.
ults of treatment with oleando-
; n-tetracycline of 50 infections
-tly respiratory] due to resistant
inisms and 40 infections [respira-
skin, urinary infections] due to
tive organisms are very encour-
jg. In some of these patients,
jnemycin] was lifesaving, and in
s surgery was made unnecessary,
confirms other reports.”
run, H.: Antibiotic Med. & Clin,
rapy 4:174 (March) 1957.
li on case reports documented by
bendent investigators in 26 coun-
i abroad, the clinical response
tned with Signemycin in 1404 pa-
i with a wide variety of infections
uccessful in 1329 patients; in 13
5 only was it necessary to discon-
,1 therapy because of side effects.
>.rt on 1404 Cases Treated with
jemycin: Medical Department,
Pfizer International. Available on
request.
In 50 nonselected patients, Signemy-
cin “...appears to be effective in the
treatment of most general surgical in-
fections, including virulent staphylo-
coccus aureus infections. In some cases
these infections had been clinically
resistant to other antibiotics. The drug
is apparently well tolerated.”
Levi, W. M., and Kredel, F. E. : J.
South Carolina M. A. 53:178 (May)
1957.
Of 50 patients with various infectious
processes, 26 had not responded to
previous antibiotic therapy. With Sig-
nemycin “Ninety-six per cent of the
mixed infections were clinically con-
trolled. . . . and in none of the cases
was there any reason to discontinue
the drug.”
Winton, S. S., and Chesrow, E.: Anti-
biotics Annual 1956-1957, New York,
Medical Encyclopedia, Inc., 1957,
p. 55.
Signemycin in 79 patients with severe
soft tissue infections: “The average
response of these cases was excellent
and inflammatory symptoms subsided
with almost uniform rapidity The
magnitude and incidence of surgical
intervention was reduced Side re-
actions were minimal. . .
LaCaille, R. A., and Prigot, A.: Anti-
biotics Annual 1956-1957, New York,
Medical Encyclopedia, Inc., 1957,
p. 67.
Five groups of patients (total 211)
with acne were treated with one of five
antibiotic agents, including Signemy-
cin (55 cases). “The results were
evaluated taking into consideration the
usual response to such conservative
conventional therapy and the rapidity
of response.” In 8 weeks, Signemycin
rapidly attained and maintained the
highest percentage of efficacy of anti-
biotic agents tried.
Frank, L., and Stritzler, C. : Antibiotic
Med. & Clin. Therapy 4:419 (July)
1957.
In the treatment of 78 patients with
tropical infections, some complicated
by multiple bacterial contamination or
present for years, Signemycin was
found to be “. . . an exceptionally effec-
tive agent,” requiring smaller doses
and less extended periods of therapy
than with the tetracyclines alone, and
“caused no notable toxic reactions.”
Loughlin, E. H., and Mullin, W. G.:
Antibiotics Annual 1956-1957, New
York, Medical Encyclopedia, Inc.,
1957, p. 63.
le iomycin tetracycline
fTrademark
be sure to write the
V on your Rx
I'
638
in very special cases
a very superior brandy.,
specify
EtlMttlSSY
COGNAC BRANDY
84 Proof Schieffelin & Co.. New York
Volume XUV
Number 6
MAGNETIC REMOVAL OE
FOREIGN ROD! ES
Gy
MURDOCK EQUEN, M.D., F.A.C.S.
Founder and Chief of Staff
of Ponce de Leon Infirmary
Atlanta, Georgia
The Use of the Alnico Magnet in the Recovery of
Foreign Bodies from the Air Passages, the Esopha-
gus, Stomach and Duodenum
Written in an informal, conversational style and
abundantly illustrated with roentgenograms, this
book can be read with interest by many groups, es-
pecially bronchoscopists, pediatricians, general prac-
titioners, gastroenterologists, otolaryngologists,
roentgenologists and chest surgeons.
• Describes and illustrates the various modifications
the author has made in the original Alnico magnet
and the auxiliary apparatus, often of his own design,
that he has used
• Describes the author’s technics
• Discusses roentgenologic diagnosis, including
some original pointers
• Points out disadvantages, contraindications and
precautions
104 pages 119 illustrations
Published 1957 Sent on approval, $4,50
CHARLES C. THOMAS • PUBLISHER
301-327 East Lawrence Avenue
Springfield, Illinois
CLASSIFIED
Advertising rates for this column are S5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: A General Practitioner, an Ophthal-
mologist, an Otolaryngologist to associate with group
in Brevard County. Florida license necessary. Write
age, training, medical experience and references. Write
Box 368, Rockledge, Fla.
HOSPITAL FOR SALE: 30 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
FOR SALE: Fifty milligrams of radium element
in five platinum needles, ten milligrams each. Price
$750. Write or call W. T. Simpson, M.D., Winter
Haven, Fla.
WANTED: Physician with Florida license. In-
terest in Physical Medicine and Geriatrics. State
nullifications in writing. The Miami- Battle Creek,
Miami Springs. Fla.
WANTED: Physician desires temporary position
beginning January while awaiting residency. Have
two years surgical training. Any type practice con-
sidered. Florida license. Married. Age 28. Write
69-244, P. O. Box 2411, Jacksonville, Fla.
WANTED: General Practitioner to join three
man group in clinic practice in Miami. Florida li-
cense necessary. Adequate salary first, followed by
partnership. Give details first letter. Write 69-241,
P. O. Box 2411, Jacksonville, Fla.
FOR RENT: Completely equipped office lower
Florida east coast. Large reception room, consultation
room, two treatment rooms, laboratory, X-ray, dark
room and ample parking area. Air conditioned. Write
Mrs. Edwin B. Davis, 235 Phipps Plaza, Palm Beach,
Fla.
OBSTETRICIAN-GYNECOLOGIST: Desires as-
sociation with Ob-Gyn man or clinic. Florida license.
Board eligible. Age 32. University trained. Family.
Write 69-247, P. O. Box 2411, Jacksonville, Fla.
WANTED: Association with Pediatrician or Gen-
eral Practitioner with large pediatric and obstetric
practice. Florida license. Age 35. Family. Training
in Pediatrics and General Practice. Write proposal.
69-248, P. O. Box 2411, Jacksonville, Fla.
WANTED: General Practitioner to associate with
group in South Florida. No Ob or Surgery required
Give full particulars of training, experience and refer-
ences. Write 69-249, P. O. Box 2411, Jacksonville,
Fla.
GENERAL SURGEON: Desires association. Flor-
ida license. FACS-FICS. Married. Write 69-250,
P. O. Box 2411, Jacksonville, Fla.
FOR SALE: “Simpli-Scribe” portable Model Cam-
bridge Electrocardiograph in excellent condition.
Price $450. L. E. Geeslin, M.D., 1022 Park St., Jack-
sonville, Fla. I
~ MODERN'ImEdTcAL OFFICE FOR- RENT: Air
conditioned office in Clearwater. Ideal location near
hospital. Write Mrs. A. Wilbur, P. O. Box 335, Nep-
tune Beach, Fla.
AVAILABLE IMMEDIATELY: Experienced Gen-
eral Practitioner. Will consider locum tenens, institu-
tion or practice with minimum guarantee. At present
in private practice ; will consider relocation site.
White 69-251, P. O. Bex 2411, Jacksonville, Fla.
J. Florida, M.A.
December, 1957
639
For the common cold . . .
symptom by symptom
and prevention of sequelae
To check symptoms, to curb bacterial complications,
prescribe PEN*VEE*Cfdiw for its multiple benefits.
It exerts antibacterial, analgesic, antipyretic,
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mood-stimulating actions.
THE ONLY PREPARATION FOR SYMPTOMATIC RELIEF
OF THE COMMON COLD TO CONTAIN PENICILLIN V!
Supplied: Capsules, bottles of 36. Each capsule contains 62.5
mg. (100,000 units) of penicillin V, 194 mg. of salicylamide,
6.25 mg. of promethazine hydrochloride, 130 mg. of phenacetin,
and 3 mg. of mephentermine sulfate.
Pe n • Ve e • Cidin
Penicillin V with Salicylamide, Promethazine Hydrochloride, Phenacetin, and Mephentermine Sulfate
Philadelphia 1, Pa.
640
Volume XLlV
Number 6
COMPONENT SOCIETY NOTES
Brevard
The October meeting of the Brevard County
Medical Society was held in Conjunction with
the “Crossroad Cancer Seminar” under auspices
of the Florida State Board of Health. Dr. Myron
L. Habegger, president of the Society, presided
and introduced Dr. John Turner who in turn in-
troduced the principal speaker, Dr. Colvin T.
Klopp of George Washington University School of
Medicine, Washington, D.C.
The underlying theme of Dr. Klopp’s address
was: “The treatment of cancer which usually has
been believed to be one in which the surgeon or
the radiotherapist hopes to totally exterminate
a given growth with the idea that this represents
a permanent cure needs a reevaluation.” He
brought out that cancer patients required regular
periodic follow-ups, preferably by the physician
who had treated the cancer apparently with suc-
cess or formation of new or recurrent neoplasms.
Dr. Klopp cited statistics tending to show that
the cancer patient had a much greater chance of
developing a similar malignancy in the same area
or elsewhere or even a much different type of
tumor than the non-cancer patient, and that in
many respects treatment of cancer had to be con-
sidered palliative even though so-called five year
cures were obtained.
Broward
Dr. Julian A. Rickies, of Miami, was princi-
pal speaker for the October meeting of the Bro-
ward County Medical Association. Meeting with
the Association were members of the Broward
County Dental Society.
On the program with Dr. Rickies was Dr. Wil-
liam Schiff, of Coral Gables. Dr. Rickies, chair-
man of the Dade Civil Defense Medical Council, |
and Dr. Schiff, chairman of the Dade Civil De-
fense Medical Aid Station Group, discussed the
treatment of mass casualties resulting from nuclear
bomb explosions.
Public forums on medical subjects are to be j
held jointly by the Association, the Fort Lauder-
dale Daily News, and the Recreation Department
of the City of Fort Lauderdale. The Public Re-
lations Committee has formulated plans for three
forums, the first of which will be held the first
NEW YORK 18, N Y
IPHERAL
of CouCjiv
ANTITUSSIVE . DECONGESTANT • A N T I H I ST A M I N fC
Eacltlmpcmlul (4cc.) uh&um :
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December, 1957
641
1. TRAPPED - This highly mo-
tile, viable sperm becomes non-repro-
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IMMOLIN Cream-Jel.
2. WEAKENED - Devitalized,
and no longer motile, the sperm
swerves from line of travel and is
pulled aside by spreading matrix.
3. KILLED — Motion, whiplash
stop as sperm succumbs to matrix.
“freezes,” weakens and kills
even the most viable sperm
The unique sperm-trapping matrix formed with explo-
sive speed when semen meets IMMOLIN® Vaginal
Cream-Jel accounts for the outstanding effectiveness
of this new contraceptive for use without diaphragm.
These unusual pictures, taken at high speed and mag-
nification, show the IMMOLIN matrix in action — how
a single sperm “freezes,” weakens and dies — within the
distance it normally travels in one-quarter of a second.
DEPENDABLE WITHOUT D I APH R AG M— With this
new contraceptive technique, a pregnancy rate of 2.01
per 100 woman-years of exposure is reported.* “This
extremely low pregnancy rate indicates that IMMOLIN
Cream-Jel used without an occlusive device is an effi-
cient and dependable contraceptive.”
*Goldstein, L. Z.: Obst. & Gynec. 70:1 33 (Aug.) 1957.
JULIUS SCHMID, INC.
423 West 55th Street, New York 19, N. Y.
IMMOLIN is a registered trade-mark of Julius Schmid, Inc.
A. BURIED — The dead sperm is trapped
deep in the impenetrable IMMOLIN matrix.
642
Volume XLIV
Number 6
week of December. The Fort Lauderdale Daily
News conducted a poll to determine the most
popular subjects and the forum topics were se-
lected as a result of the poll.
Dr. Ernest B. Howard, Vice President of the
American Medical Association, was featured
speaker for the Association’s November meeting.
He discussed “Sociomedical Economics of Medi-
cine.” Invited guests were members of the Wo-
man’s Auxiliary to the Broward County Medical
Association.
Dr. William C. Roberts, President of the
Florida Medical Association, also attended the
November meeting.
Dade
Dr. William C. Roberts, of Panama City, Pres-
ident of the Florida Medical Association was
featured speaker for the November meeting of the
Dade County Medical Association. He discussed
some of the activities of the state association.
The executive office building of the Dade
County Medical Association was dedicated on
November 3 when members of the Association
acted as hosts to the public. Tours through the
building, brief dedicatory ceremonies and refresh-
ments served by the Woman’s Auxiliary made up
the day’s activities which began at 3 p.m.
Duval
Dr. Manson Meads, Associate Dean of Bow-
man Gray School of Medicine of Wake Forest
College, Winston-Salem, N. C., was principal
speaker for the November meeting of the Duval
County Medical Society. The title of his address
was “Cause of Failure of Antibiotic Therapy.”
Invited guests were members of neighboring coun-
ty medical societies.
Hillsborough-Pinellas
The annual combined meeting of the Hills-
borough County Medical Association and the
Pinellas County Medical Society was held Novem-
ber 5. Invited guests were members of the Wo-
man’s Auxiliaries of the two societies. Principal
speaker on the program was Mr. William C. Cra-
mer, a member of the U.S. House of Representa-
tives.
Orange
Dr. Robert E. Zellner, of Orlando, was prin-
cipal speaker for the November meeting of the
Orange County Medical Society. The subject for
discussion was the Code of Cooperation with the
Bar Association. For the October meeting, Dr.
Frank J. Pyle, of Orlando, discussed “The Doctor
and Investments.”
Active relief
in
cough
both allergic and infectious
HYDRYLUN
COMPOUND
• allays bronchial spasm • liquefies tenacious secretions • suppresses allergic manifestations
The ingredients of Hydryllin Compound are proportioned to provide high therapeutic response.
Each 4 cc. (one teaspoonful) contains:
Aminophyllin 32.0 mg. Chloroform 8.0 mg.
Diphenhydramine 8.0 mg. Sugar 2.8 Gm,
Ammonium chloride 30.0 mg. Alcohol 5% (v/v)
G. D. Searle & Co., Chicago 80, Illinois.
s
Research in the Service of Medicine
WALLACE LABORATORIES. New Brunswick, N. J.
“care of
the man
rather than merely
his stomach”8
Mil path
Miltown® O anticholinergic
two-level control of
gastrointestinal dysfunction
at the central level The tranquilizer Miltown® reduces anxiety and tension.1- 3- 6- 7
Unlike the barbiturates, it does not impair mental or physical efficiency.5-7
at the peripheral level The anticholinergic tridihexethyl iodide reduces
hypermotility and hypersecretion.
Unlike the belladonna alkaloids, it rarely produces dry mouth or blurred vision.2 '1
indications: peptic ulcer, spastic and irritable colon, esophageal
spasm, G. I. symptoms of anxiety states.
each Milpa th tablet contains:
Miltown.® ( meprobamate WALLACE) 400 mg.
(2-met by l-2-//-propy 1-1. 3-propanediol dicarbamate)
Tridihexethyl iodide . . . 25 mg.
(3-diet by lamino-l-cyolohexyl-l-pheny 1-1 -propanol-ethiodide)
dosage: 1 tablet t.i.d. at mealtime
and 2 tablets at bedtime.
available: bottles of 50 scored tablets.
references: l Altsehul, A. and Billow. B.: The clinical use of meprobamate. (Miltown®). New York J Med. ; 77: 2361.
July 15, 1957. 2. Atwater, J. S : The use of anticholinergic agents in peptic ulcer therapy J M. A. Georgia -,5:121. Oct. 1956.
3. Borrus. J (' : Study of effect of Miltown (2-mcthy!-2-/i-propyl-l. 3-propanediol dicarbamate) on psychiatric states.
J. A. M. A. /77:1590. April 30. 1955. 1 Gayer. 1).: Prolonged anticholinergic therapy of duodenal ulcer. Am J Digest. Pis.
7:301. July 1956. 5. Marquis. I). Cl.. Kelly. E. L. , Miller. J. <: . Gerard. R. W. and Rapoport. A : Experimental studies of
behavioral effects of. meprobamate on normal subjects. Ann. New York Acad. Sc. 0*7:701. May 9. 1957. 6. Phillips, R. E.:
Use of meprobamate (Miltown®) for the treatment of emotional disorders. Am. Pract. «K; Digest Treat. 7:1573. Oct. 1956.
7. Selling. L. S.: A clinical study of Miltown®. a new tranquilizing agent. J Clin. & Exper. Psychopath. 17: 7. March 1956.
H. Wolf. s. and Wolff, H. G.: Human Gastric Function, Oxford University Press. New York, 1947.
Volume XLIV
644 Number 6
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
[ W 1 HOSPITAL, PHYSICIANS and LABORATORY SUPPLIES l EQUIPMENT
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Each Magenta Soft
Methyltestosterone 2 mg.
Ethinyl Estradiol 0.01 mg.
Ferrous Sulfate 50 mg.
Rutin 10 mg.
Ascorbic Acid 30 mg.
B-12 1 meg.
Molybdenum 0.5 mg.
Cobalt 0.1 mg.
Copper 0.2 mg.
Vitamin A 5,000 I.U.
Vitamin D 400 I.U.
Vitamin E 1 I.U.
Cal. Pantothenate .3 mg.
Write for Latest Technical
‘REFERENCE: J.A.M.A. 163:
Capsule contains:
Thiamine Hcl. 2 mg
Riboflavin 2 mg
Pyridoxine Hcl 0.3 mg
Niacinamide 20 mg
Manganese I mg
Magnesium 5 mg
Iodine . 0. 15 mg
Potassium 2 mg
Zinc I mg
Choline Bitartrate . 40 mg
Methionine 20 mg
Inositol 20 mg
Bulletins.
359, 1957 (February 2)
S. J. TUTAG & COMPANY [TTOSj DETROIT 34, MICHIGAN
J. Florida, M.A.
December, 1957
645
TUI
PRELUDIN
(brand of phenmetrazine hydrochloride)
developed specifically
for appetite suppression
Chemically different from the amphetamines,
Preludin provides potent appetite suppression with little
or no central stimulation.
rarely causes loss of sleep'— may be given late enough
in the day to curtail after-dinner "nibbling," yet not hinder sleep.
avoids nervous tension and "jitters"3 — simultaneous
sedation is not required.3
"...in clinical use the side-effects of nervousness,
hyperexcitability, euphoria, and insomnia are much less than
with the amphetamine compounds and rarely cause difficulty."*
References: (1) Gelvin, E. R; McGavack, T. H., and Kenigsberg, S.: Am. J. Digest.
Dis. 1:155, 1956. (2) Holt, J. O. S., Jr.: Dallas M. J. 42:497, 1956.
(3) Natenshon, A. I.: Am. Pract. & Digest Treat. 7:1456, 1956. (4) Council on
Pharmacy and Chemistry, New and Nonofficial Remedies: J.A.M.A.
163:356 (Feb. 2) 1957.
PRELUDIN® (brand of phenmetrazine hydrochloride). Scored, square, pink
tablets of 25 mg. Under license from C. H. Boehringer Sohn, Ingelheim.
Ardsley, New York
• 7057
646
Volume XLIV
Number 6
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Adams, Leslie R., Jacksonville
Boothby, Richard J., Jacksonville
Braden, Frederick R., Pensacola
Brandon, James R., West Palm Beach
Doane, Joseph C., West Palm Beach
Fanizzi, William J., Fort Lauderdale
Gouchnour, Thomas FL. Jacksonville
Kilgo, Frank D., Macclenny
Lees, Irving B., West Palm Beach
McCall, John B. Jr., Jacksonville
Madison, William M. Jr., Jacksonville
Martorell, Richard A., Tampa
Meriwether, Richard B., Clearwater
Nadeau, Natalie A., Fort Lauderdale
Nadeau, Oscar E., Fort Lauderdale
O’Brien, F. Kevin. Riviera Beach
Price, Robert N., Pensacola
Ptomey, William R., Century
Quehl, Thomas M. L., St. Petersburg
Ryan, Albert O. Jr., Hollywood
Spivey, Lee M., West Palm Beach
Warren, Donald E., West Palm Beach
Whitehurst, William L., Jacksonville
Young, Cabell Jr., West Palm Beach
OBITUARIES
Gordon Fuller Henry
Dr. Gordon Fuller Henry of West Palm Beach
died on April 25, 1957. He was 71 years of age.
A Tennessean by birth, Dr. Henry was born
in Nashville on Dec. 17, 1885. The son of Dr.
George Pomeroy Henry, a prominent surgeon of
that city, he represented the third generation of
medical men in his family. He received his medi-
cal education at Tulane University School of
Medicine, where he was awarded the degree of
Doctor of Medicine in 1910.
Dr. Henry entered the general practice of
medicine in Fort Myers and practiced there for
10 years. He then left to specialize in ophthal-
mology and otolaryngology at the University of
Chicago School of Medicine. Upon his return
1 3 Florida in 1920, he located in West Palm
Beach, where he practiced his specialty for 37
years. Locally, he was a member of the General
(Continued on Page (48)
when anxiety and tension "erupts” in the G. I. tract...
IN GASTRIC ULCER
PATH I BAM ATE
Meprobamate with PATHILOhU Lederle
Combines Meprobamate (400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of gastric ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATH HON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
'Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
J. Florida, M.A.
December, 1957
647
PHENAPHEW
V
,'~ASIATIC%'
~v
« • ' . *
« , i i i •
\ > \ ‘ 1 : ; '/ *
PWS
Phenaphen Plus is the physician-requested
combination of Phenaphen, plus an anti-
histaminic and a nasal decongestant.
Available on prescription only.
each coated tablet contains: Phenaphen
Phenacetln (3 gr.) 194.0 mg.
Acetylsallcytic Acid (214 gr.) . 162.0 mg.
Phenobarbital (14 gr.) .... 16.2 mg.
Hyoscyamine Sulfate .... 0.031 mg.
plus
Prophenpyrldamlne Maleate . . 12.5 mg.
Phenylephrine Hydrochloride . 10.0 mg.
J
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATHIBAMATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate loginess, hangover or
habituation . . .with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexefhyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
648
Volume XLIV
Number 6
(Continued from Page 646)
and Consulting Staff of the Good Samaritan
Hospital.
A member of the Palm Beach County Medical
Society, Dr. Henry was also a member of the
Florida Medical Association, in which he held
life membership. In addition, he was affiliated
with the American Medical Association and his
specialty societies.
Dr. Henry’s wife was the former Ester Corrine
Lynn of Madisonville, Ky., who preceded him in
death by several years. Surviving are two chil-
dren, Gordon F. Henry Jr., and Jean Henry Char-
lotte, both of West Palm Beach.
Charlotte Kusta Wilkins
Dr. Charlotte Kusta Wilkins of North Miami
died on Nov. 4, 1956 as a result of a coronary
occlusion. She was 56 years of age.
Born in Cleveland, Ohio, on Feb. 9, 1890,
Dr. Wilkins was educated in her native state.
She received the degree of Doctor of Medicine
from Ohio State University College of Medicine
in 1925 and served an internship at the Woman’s
Hospital in Cleveland. Later she served on the
staff and was a member of the board of trustees
of that hospital.
For 25 years, Dr. Wilkins was associated with
the Maternal Health Association in Cleveland.
She served as president of the Cleveland chap-
ter of the American Medical Women’s Associa-
tion, and later headed the Miami chapter of that
group.
In 1949, Dr. Wilkins was licensed to practice
in Florida and located in Miami. Her practice
was largely limited to office gynecology, and she
devoted some time to assisting the Dade County
Health Department with its school health pro-
gram and in its clinic.
Dr. Wilkins was a member of the Dade Coun-
ty Medical Association and since 1950 had held
membership in the Florida Medical Association.
Thomas Robbin Griffin
Dr. Thomas Robbin Griffin of St. Petersburg
died on July 20, 1957, at his summer home in
Danville, Ky., where interment took place. He
was 78 years of age.
Dr. Griffin was born at Somerset, Ky., on
May 5, 1880. He received his medical training
at the Medical College of Ohio in Cincinnati,
Gnderson Surgical Supply Co.
Established 1916
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December, 1957
649
simple, well-tolerated routine for "sluggish” older patients
one tablet t.i.d.
DECHOLIN
‘therapeutic bile’
Establishes free drainage of biliary system— effectively combats bile stasis and
improves intestinal function.
Corrects constipation without catharsis— copious, free-flowing bile overcomes tendency
to hard, dry stools and provides the natural stimulant to peristalsis.
Relieves certain G.I. complaints — improved biliary and intestinal function enhance
medical regimens in hepatobiliary disorders.
Decholin Tablets: (dehydrocholic acid, Ames) 3% gr.
AMES COMPANY, INC • ELKHART, INDIANA • Ames Company of Canada, Ltd., Toronto
650
Volume XLIV
Number 6
where he was graduated in 1900. For some years
prior to locating in St. Petersburg in 1920, he
practiced medicine in Somerset and in Danville.
During World War I, he served as an Army
surgeon in the Pacific theater and was a member
of the American Legion.
For 30 years prior to his retirement in 1950,
Dr. Griffin was a leading surgeon and obstetrician
in St. Petersburg. He was chief surgeon and phy-
sician for the Florida Power Corporation, and for
three decades served as chief local surgeon for
the Seaboard Airline Railroad. An original staff
member of St. Anthony’s Hospital in 1931, he
later served as chief of staff there. He was also
a staff member at Mound Park Hospital. In
1936, he was elected chief of staff at the Crippled
Children’s Hospital. He performed the first sur-
gery at this Legion hospital and was among its
organizers.
Dr. Griffin was a member of the Pinellas
County Medical Society and since 1926 had been
a member of the Florida Medical Association. He
also held membership in the American Medical
Association and in his specialty organizations.
Survivors include the widow. Mrs. Alvina
Griffin, of St. Petersburg; one son, Bernard Grif-
fin, of Danville; two daughters, Gertrude and
Martha, and several grandchildren.
Clarence Harold Edmunds
Dr. Clarence Harold Edmunds of Miami died
suddenly on Aug. 26, 1957. He was 68 years of
age.
Born in Arthur, Ontario, in April 1889, Dr.
Edmunds was educated in the public schools of
Western Ontario and received his academic train-
ing at the University of Toronto. In 1913, he was
awarded the degree of Doctor of Medicine by the
University of Western Ontario Faculty of Medi-
cine.
For nine years Dr. Edmunds practiced medi-
cine in Ceylon, Saskatchewan, where he also
owned and operated the only drug store. In 1921,
he left Ceylon to attend a series of clinics at the
Mayo Clinic in Rochester, Minn., and upon his
return to Canada he located in Saskatoon in
March 1922. His life and practice in Canada and
his contributions to its growth are recorded in
the Story of Saskatchewan and Its People by
John Hawkes.
After additional studies in Chicago and a
short stay in Orlando, Dr. Edmunds located in
Miami in 1941. He rapidly built up an excellent
practice and maintained it vigorously until the
day of his death.
(Continued on Page 654)
when anxiety and tension "erupts” in the G. I. tract...
IN ILEITIS
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of ileitis — without fear of barbiturate loginess, hangover or
habituation . . .with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
J. Florida, M.A.
December, 1957
651
optimal dosages for atakax.
based on thousands of case histories:
mg. ((j.i.d.)
for these 2 S adult indications:
TENSION SENILE ANXIETY MENOPAUSAL SYNDROME ANXIETY PREMENSTRUAL TENSION
PHOBIA HYPOCHONDRIASIS TICS FUNCTIONAL C. I. DISORDERS PRE-OPERATIVE ANXIETY
HYSTERIA PRENATAL ANXIETY • AND ADJUNCTIVELY IN CEREBRAL ARTERIOSCLEROSIS
PEPTIC ULCER HYPERTENSION COLITIS NEUROSES DYSPNEA INSOMNIA
PRURITIS ASTHMA ALCOHOLISM DERMATITIS PARKINSONISM PSORIASIS
perhaps the safest ataraxic known
pe^ce OF MIND ATARAX
Supplied: In tiny 10 mg. (orange) and 25 mg. (green) (srano or hydroxyzine)
tablets. Also now available In 100 mg.
tablets. Bottles of 100. ATARAX Syrup, 10 mg.
pertsp., in pint bottles. Prescription only.
Tablets-Syrup
I
for these ILO
ANXIETY TICS
TEMPER TANTRUMS
NEW YORK 17, NEW YORK
In daily practice: always have it handy
• to calm the acutely disturbed or hysterical patient
• to rehabilitate the alcoholic
In hospitals: use it routinely
• to make overwrought patients manageable
without loss of alertness
• to allay anxiety and control vomiting
before and after surgery and childbirth
Supplied: 10 cc. multiple-dose vials. The adult dosage is
25 mg. to 50 mg. (1-2 cc.) intramuscularly, 3 to 4 times daily,
at 4 hour intervals. The moderated dosage level for children
under 12, when given intramuscularly, has not yet been
established, and the oral dosage should be used.
I l/ew Chemotherapy
ARALEN
iMj
RHEUMATOID
ARTHRITIS
Extensive studies of rheumatoid arthritis and related
collagen diseases— in this country and abroad-
have shown the antimalarial Aralen phosphate to be highly effective
and well tolerated in a large percentage of patients.
Clinical Results with Aralen
in Rheumatoid Arthritis
_
ANALGESICS AND STEROIDS:
Requirements usually reduced
eliminated
Author
No. of
Cases
Major
Improvement
Minor
Improvement
No Effect
Hoydwl
28
22
5
1
Rinehart2
25
12
4
9
Freedman2
50
43
3
4
Bagnall4
108
77
12
19
Bruckner2
36
32
o
4
Cohen and Calkint*
22
17
3
2
Scherbel et al7
25
9
8
8
,
JOINT EFFECTS:
Total
294
212 (72%)
35 (12%)
47(16%)
• Success dependent upon persistent treatment
• Often of benefit where other agents have failed
Remissions on therapy well maintained
Remission of 3 to 12 months possible even if
treatment is interrupted
• Tachyphylaxis not evident
GENERAL EFFECTS:
Patient feels better
Patient looks better
Exercise tolerance increases
Walking speed and hand grip improves
LABORATORY EFFECTS:
_ 'C' O T>
-P^Tl ~T^„rT,e
Pain and tenderness relieved
Mobility increases
Swellings diminish or disappear
Muscle strength improves
Rheumatic nodules may disappear
Even severe or advanced deformitj
may improve
Active inflammatory process usual
subsides
Joint effusion may diminish
DOSAGE:
Aralen is cumulative in action and
requires four to twelve weeks of
administration before therapeutic efl
become apparent.
Latest information indicates that an initial c
dose of 250 mg. of Aralen phosphate is prefe
to the higher doses sometimes recommended
However, if side effects appear, withdraw
Aralen for several days until they
subside. Reinstate treatment with 125 mg.
daily and, if well tolerated, increase to 250 n
The usual maintenance dose is 250 mg. daily
Rheumatoid arthritis, acute or chronic
-with or without adjunctive therapy.
Arthritis associated with lupus
erythematosus or psoriasis
HOW SUPPLIED:
Woiaj Chemotherapy
THEORY OF ACTION:
Aralen appears to suppress or
induce remission of rheumatoid
inflammatory processes by inhibiting
adenosinetriphosphatase.
Aralen phosphate: 250 mg. tablets in bottles of 100 and 1000.
125 mg. tablets in bottles of 100.
usually well tolerated. Toxic effects are
/ mild and to date have been transitory in
, disappearing completely either on con-
ation of therapy or on reduction in
s (e.g. nausea,
ominal cramps,
tions of intoler-
(due to inter-
s also relat:
eruptions (e.g. lichenoid,
:), although generally mild,
le use of an optimum dosage
tin reaction persists on a reduced
or recurs after reinstitution of
gradually increasing doses, discon-
ill the lesion again disappears and
treatment with Plaquenil®
iiloroquine) .
ry vertigo, headache,
disturbances, such as
•nal change, and
stances <
;ht loss as the
tic condition improved
:casional instances of
) of the hair have been
Caution:
Aralen is known to concentrate in the liver and,
although hepatic damage has never been reported,
the drug should be used with caution in the pres-
ence of liver disease. In the presence of severe
gastrointestinal, neurological, or blood disorders,
the drug should be used with caution or not at all.
If such disorders occur during the course of ther-
apy, the drug should be discontinued. Concomit
use of gold or phenylbutazone with Ara
be avoided because of the tendency of the
to produce drug dermatitis.
Clinical Comments:
Of fifty patients receiving Aralen therapy, “43
have become really well ; that is, they have no stiff-
ness, and any pain that occurs can reasonably be
attributed to use of joints affected by secondary
degenerative changes. They have no evidence of
joint inflammation, but may have a raised erythro-
cyte sedimentation rate. They have little or no need
for analgesics.”
iional instance of leukopenia,
erential count, has been reported
I , it has not proved troublesome
i always been reve
diminution of the dose,
lr while full i
“One hundred and twenty-five private patients
have been carefully followed clinically and haema-
tologically while receiving well over 200 patient-
years of chloroquine [Aralen] therapy. The results
are considered good in 70%, one-half of these cases
being in remission. Improved work performance,
sedimentation rate, and hemoglobin levels para-
lleled the major objective gain in this 70%. 90% of
them remained on chloroquine [Aralen] therapy,
half for more than two years. Classical peripheral
rheumatoid arthritis, spondylitis, arthritis of
juvenile onset, and rheumatoid disease with
psoriasis, all appeared to respond about equally
well.
“It is suggested that chloroquine comes closer to
the ideal for long-term, safe, control of rheumatoid
disease than any other agent now available.”
Bagnall *
“Out of the 36 rheumatoid arthritis cases we
treated . . . favorable results were obtained in 32
cases. Bruckner ct at.*
1. Haydu, G.G.
Rheumatoid arthritis therapy: a rationale and the use of
Am. J. M. Sc. 226:71, Jan.. 1963.
Chloroquine therapy in rheumatoid arthritis, Northweat Med.
>6.
Chloroquine and rheumatoid arthritis, a short-term controlled trial.
of
read at
June 23-28, 1967
zweig. S.: Treatment of
nthetic antimalarials. read at the
Toronto, Canada, June
Evan: A controlled study of
International Congress
23-28, 1957.
e in rheumatoid disease, a four year study
International Congress on Rheumatic Diseases
istional Congr
ne as an antirheumatic
654
Volume XLIV
Number 6
( Continued from Page 650)
In Canada, Dr. Edmunds was a member of
the Canadian Medical Association, the Saskatche-
wan Medical Society and the Saskatoon Academy
of Medicine. Since coming to Florida, he had
been a member of the Dade County Medical
Association and the Florida Medical Association.
He also held membership in the American Medi-
cal Association.
Surviving are the widow, Mrs. Bernadette
Edmunds, of Miami; a daughter, Mrs. Lynette
Bernbaum, of Chicago; and a granddaughter.
Lucien Evans Myers
Dr. Lucien Evans Myers of Winter Park
died on July 11, 1957, at the Veterans Hospital
in Gulfport, Miss., after an illness of several
years. He was 54 years of age. Interment took
place in the national cemetery at Gulfport.
Dr. Myers was born in Mobile, Ala., on
March 7, 1903. He was a graduate pharmacist
and taught chemistry at Clemson College and
biochemistry at the University of Tennessee Col-
lege of Medicine before entering medical school.
He was awarded the degree of Doctor of Medicine
by the Tulane University School of Medicine in
1932. He interned at Bassett Hospital in
Cooperstown, N. Y., and later engaged in post-
graduate work in gastroenterology at the Lahey
Clinic.
For some years Dr. Myers practiced in Cherry
Valley, N. Y. In 1942, he came to Florida and
located in Winter Park. He practiced his spe-
cialty of internal medicine there until he entered
military service in World War II. He served as
a lieutenant commander in the Navy and had
combat service in the Pacific theater. After he
was released from military duty, he returned to
Florida, practicing for a time in Orlando before
returning to Winter Park.
Dr. Myers was a member of the Orange Coun-
ty Medical Society and of the Florida Medical
Association. He also held membership in the
American Medical Association.
Survivors include the widow, Mrs. Helen Col- I
ley Myers, of Winter Park; his mother, Mrs.
Mary Elizabeth Myers, of New Orleans, La.;
three brothers, Horace Myers, of Memphis, I
Tenn., Kenneth Myers, of Kansas City, Mo., and
E. B. Byers, of St. Louis, Mo.; and three sisters, I
Mrs. James Gillis, of New Orleans, Mrs. Russell
Woods, of Timmonsville, S. C., and Mrs. Earl
Cesalu, of Anita, La.
when anxiety and tension "erupts” in the G. I. tract . . .
in spastic
and irritable colon
PATHIBAMATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate [400 mg.) the most widely prescribed tranquilizer. . . helps control the
“emotional overlay” of sDastic and irritable colon — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON [25 mg-) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t. i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
f Florida, M.A.
December, 1957
655
In Ireland, too, Pentothal is used almost constantly
With Pentothal Sodium, there is no prolonged induction period.
Recovery is smooth, rapid, because there is little drug to be detoxified.
And Pentothal is economical because the total dosage to achieve
the desired levels of anesthesia is small. More than 2800 published
reports, over 23 years of use ... make it an “agent of choice p p , ,
wherever modem intravenous anesthesia is practiced. LluuOU
TOT HAL Sodium
(Thiopental Sodium for Injection, Abbott)
MKtl
ANEW
why Otmetaneis the best reason yet for you to re-exami
the antihistamine you’re now using » Milligram for miliigi
DIMETANE potency is unexcelled. DIMETANE has a therapeutic index unrivaled bj
other antihistamine— a relative safety unexceeded
by any other antihistamine, dimetane, even in very
low dosage, has been effective when other antihis-
tamines have failed. Drowsiness, other side effects
have been at the very minimum.
» unexcelled antihistaminic action
From the nrp liminarv nimotanp Fxtentah<; studies of three invest iaators. Further clinical investigations will be reported as
Diagnosis
No. of
Patients
Response
Side Effects
Excellent
Good
Fair
Negative
Allergic
rhinitis and vaso*
motor rhinitis
30
14
9
5
2
Slight Drow
Urticaria and
angioneurotic
edema
3
1
I
t
Dizzy (1)
Allergic
dermatitis
2
I
1
-
Slight Drow
Bronchial asthma
1
1
Pruritus
1
1
Total
37
15
13
7
2
Drowsiness
Dizzy (1)
lanket of allergic protection, covering 10-12
irs — with just one Dimetane Extentab » dimetane
entabs protect patient for 10-12 hours on one tablet.
Periods of stress can be easily han-
dled with supplementary dimetane
Tablets or Elixir to obtain maxi-
mum coverage.
10 11 12
A. H. ROBINS CO., INC.
Dosage:
Adults— One or two J*-mg. tabs,
or two to four teaspoonfuls
Elixir, three or four times daily.
One Extentab q.S-12 h.
or twice daily.
Children over 6— One tab.
or two teaspoonfuls Elixir t.i.d.
Or q.i.d., or one Extentab q.l2h.
Children 3-6— % tab.
or one teaspoonful Elixir t.i.d.
Richmond, Virginia | Ethical Pharmaceuticals
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or V2 teaspoonful
contains:
Pentylenetetrazol .. 100 mg.
Nicot-inic Acid 50 mg.
1. Levy, s., JAMA., 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J., 15:596. 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
T. Florida, M.A.
December, 1957
659
Achrostatin V combines Achromycin! V . . .
the new rapid-acting oral form of
Achromycin! Tetracycline . . . noted for its
outstanding effectiveness against more than
50 different infections . . . and Nystatin . . . the
antifungal specific. Achrostatin V provides
particularly effective therapy for those
patients who are prone to mondial overgrowth
during a protracted course
of antibiotic treatment.
supplied:
Achrostatin V Capsules
contain 250 mg. tetracycline
HC1 equivalent (phosphate-
buffered) and 250,000
units Nystatin.
dosage :
Basic oral dosage (6-7 mg.
per lb. body weight per day)
in the average adult is
4 capsules of Achrostatin V
per day, equivalent to
1 Gm. of Achromycin V.
^Trademark
(Reg. U. S. Pat. Off.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. N. Y.
660
Volume XI.IV
Number 6
both-
orally for
dependable prophyLj
sublingually for
fast relief
'ECEMBER, 1957
. Florida, M.A.
661
RANOL
HMATIC —
serful instead of fearful
uprel-Franol tablets bring
de-clock relief plus emergency
ainst sudden attack. Anxiety
hen patients know they’ll get
i 60 seconds — relief that Con-
or four hours or more.
HC1 (10 mg. for adults, 5 mg.
Iren) , the most potent broncho-
known, makes up the outer
In a sudden attack, the patient
tablet under his tongue. Relief
l 60 seconds. A unique feature
davor-timer.” As the Isuprel is
d a lemon flavor appears. When
pears — about five minutes later
atient swallows the tablet.
xcelled combination for pro-
ironchodilatation makes up the
Franol core : benzylephedrine
l mg.), Luminal® (8 mg.) and
lline (130 mg.) . Swallowed, the
orks for four hours or more.
Franol tablets are . . effec-
controlling over 80% of
; with mild to moderate
of asthma.”1
J. L., and DeRisio,
hey Clin. Bull. 10:45,
1956.
LABORATORIES
New York 18, N. Y.
k
%0 /M
<2d&Lc/b f
ISUPREL-FRANOL
tablets (Isuprel HC1 10 mg.)
for adults;
ISUPREL-FRANOL
Mild tablets (Isuprel HC1
5 mg.) for children;
One tablet every three or
four hours taken orally for
continuous control of bron-
chospasm in chronic asthma.
One tablet taken sublingual-
ly for sudden attack. “Fla-
vor-timer” signals when
patient should swallow.
Bottles of 100 tablets.
“ Flavor-timer ” signals patients
when to swallow tablets
ISUPREL
Immediate effect sublingually —
for emergency use
LEMON “FLAVOR-TIMER”
Disappearance of flavor is the
signal to swallow
( Theophylline
FRANOL 1 Luminal
I Benzylephedrine
Sustained action - reduces fre-
quency and intensity of attacks
'RAND OF ISOPROTERENOL), FRANOL AND LUMINAL (BRAND OF PH E NO B A R B I T A L ) , .RADEMARKS REG. U. S. PAT. OFF.
662
Volume XLIV
Number 6
Relax the best way
... pause for Coke
Make your pause at work
truly refreshing. Have a frosty bottle
of pure, delicious Coca-Cola
. . . and be yourself again.
oral progestational agent
with
unexcelled potency
and
unsurpassed efficacy
With NORLUTIN you can now pre-
scribe truly effective oral progesta-
tional therapy. Small oral doses of this
new and distinctive progestogen pro-
duce the biologic effects of injected
progesterone.
THfftMOQtMIC BMICT
MARCH APRIL MAY JUNE
i i » 4 s • 7 • t ii tt it ir ii it n it » i) H ft it tr m l l « 4 j 4 r a * io u n t> i« is u u it it io n n it 14 it it tr is it io it i i s « i t r a t io n it is it is it it
^Whcn NORLUTIN was administered to
patients with uniphasic temperature
curves and menstrual irregularities
a rise in basal temperature occurred.*
major advance in female hormone therapy
for certain disorders
of menstruation and pregnancy
indications for norlutin; conditions
involving deficiency of progestogen, such as
primary and secondary amenorrhea, men-
strual irregularity, functional uterine bleed-
ing, endocrine infertility, habitual abortion,
threatened abortion, premenstrual tension,
and dysmenorrhea.
packaging: 5-mg. scored tablets (C. T. No.
882), bottles of 30.
PARKE, DAVIS & COMPANY*
DETROIT 32,
•Greenblatt, R. B.: ]. Clin. Endocrinol. 16:869, 1956.
MICHIGAN
S0I92
* V-
Azotrex is the only
urinary anti-infective
agent combining:
(l)the broad-spectrum
antibiotic efficiency of
Tetrex — the original
tetracycline phosphate
complex which pro-
vides faster and higher
blood levels;
(2) the chemothera-
peutic effectiveness of
su If a methizole — out-
standing for solubility,
absorption and safety;
(3) the pain-relieving
action of phenylazo-
diamino-pyridine HCI
— long recognized as a
2 urinary analgesic.
This unique formulation
assures faster and more
certain control of urinary
tract infections, by provid-
ing comprehensive effec-
tiveness against whatever
sensitive organisms may
be involved. Indicated in
the treatment of cystitis,
urethritis, pyelitis, pyelo-
nephritis, ureteritis and
prostatitis due to bacterial
infection. Also before and
after genitourinary surgery
and instrumentation, and
for prophylaxis.
In each AZOTREX Capsule:
Tetrex (tetracycline phos-
phate complex) 125 mg.
Sulfamethizole 250 mg.
Phenylazo-diamino-
pyridine HCI 50 mg.
Min. adult dose: 1 cap. q.i.d.
666
Volume XLIV
Number 6
/l
l
ivine in geriatrics
} 1 2 and convalescence ?
/ ;
Convalescents, regardless of their years, share many of the tonic and recuperative
needs of the aged, and wine is probably more widely recommended in the care
of these patient groups than in any other.
Many generations of physicians have warmly advocated not only dry table wines
but also sweet dessert wines of many varieties for their nutritional value
in elderly and convalescent patients.
Now modern research supplies the raison d'etre by clearly showing that wine not only
supplies quick fuel but also serves to stimulate the desire for food where appetite is poor.
WINE AIDS DIGESTION —Wi ne has been found to increase salivary flow,1 stimulate
gastric secretion-’ and facilitate the gastrocolic reflex.3
WINE FOR GENTLE, SAFE SEDATION — Described as the safest of all sedatives, wine can
often dispel the anxieties, fears and emotional pressures of old age and prolonged
illness. The relaxation of gastric tension produced by moderate amounts of wine
may be a significant factor in the prevention of dyspepsia. The systemic sedative4 5
and vasodilative’’ actions of wine can be of great aid in cardiovascular disease.
For a few cents a day your patients can have wines produced from the world’s
finest grape varieties grown in an ideal climate and handled with consummate skill.
Research information on wine is available on request. Just write for your copy
of “Uses of Wine in Medical Practice.” Wine Advisory Board, 717 Market Street,
San Francisco 3, California.
1. Winsor, A. t., and Sfrongin, E. !.: J. Exper. Psychol. 16 589 (1933).
2. Ogden, E., and Southard, Jr., F. D.: Fed. Proceedings 5.77 (1946).
3. Adler, H. F.; Beazell, J. M.; Atkinson, A. J., and Ivy, A. C.: Quart. J. Studies on Ale. 7.638 (1941).
4. Salter, W. T.: Geriatrics 7.317 (1952).
5. Wright, I. S., Arteriosclerosis, in Steiglifz, E. J.: Geriatric Medicine, Philadelphia, W. B. Sounders Co. (1949).
J. Fiorida, M.A.
December, 1957
667
DR. M»I£I./\T
assure her
a more serene, a happier pregnancy
. . . without nausea
give her i
MAREDOX
i®
brand
Cyclizine Hydrochloride and Pyridoxine Hydrochloride
because
‘Maredox’ gives the expectant mother new-found
relief from morning sickness.
relieves nausea and vomiting
and
counteracts pyridoxine deficiency
pregnancy
One tablet a day, taken either on rising or at night,
is all that most women require.
Each tablet of ‘Maredox’ contains:
‘Marezine’® brand Cyclizine Hydrochloride.
Pyridoxine Hydrochloride
50 mg.
50 mg.
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
668
Volume XLIV
Number 6
EVERY WOMAN
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
"PREMARIN"
widely used
natural, oral
estrogen
AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
5646
WOMAN’S AUXILIARY
TO THE
FLORIDA MEDICAL ASSOCIATION
OFFICERS
Mrs. 1’erry D. Melvin, President Miami
Mrs. Lee Rogers Jr., President-Elect Rockledge
Mrs. William D. Rogers. 1st Vice Pres. .. .Chattahoochee
Mrs. Leffie M. Carlton Jr., 2nd Vice Pres Tampa
Mrs. Edward W. Ludwig, 3rd Vice Pres Jacksonville
Mrs. James M. Weaver, 4th Vice Pres.. .Fort Lauderdale
Mrs. Wendell J. Newcomb, Recording Sec’y ... .Pensacola
Mrs. Willard L. Fitzgerald, Treasurer Miami
Report of Fall Conference
Of Presidents and Presidents-Elect
The Fall Conference in Chicago for Presidents
and Presidents-Elect had four Florida members
representing our fair state. Mrs. Richard F.
Stover, Miami, Third Vice President of the Wo-
man’s Auxiliary to the American Medical Associa-
tion and Regional Membership Chairman for the
Southern States, had all us at work helping her
be hospitable to other Southern Presidents and
Presidents-Elect. All were so genuinely friendly
and nice, it was a pleasure to be associated with
them.
Mrs. Samuel S. Lombardo of Jacksonville,
Southern Regional Chairman of the Safety Com-
mittee of the Woman’s Auxiliary to the American
Medical Association, conferred at length with the
national chairman. Mrs. John Wagner of Pennsyl-
vania, Peggy’s home state, and other members of
this new and important committee.
Safety, by special request of the A.M.A., is
to be one of our “priority projects” this year. So
be prepared when you shop for that new car to
having your wife insist on safety devices such as
shock absorbing padding on the dash and visors, '
recessed knobs and seat belts or harnesses. It
seems accident prevention is such a slow process
that the immediate requirement is to protect your-
self. your wife and children. When the three
daughters of your next door neighbor are killed
in an automobile accident, leaving six motherless
children, and the daughter of one of your oldest
friends is killed only fifty miles from home as she
began her honeymoon, you cannot help but stop
and consider what you can do to prevent such
tragedies. One thing everybody can do is demand
safety devices as standard equipment in their new
cars thereby making the automobile manufac-
turers conscious of their shortcomings in this
respect.
Today’s Health is to be another Auxiliary
"priority project” for the year and the appoint-
ment of Mr. James Liston, formerly with Better
Homes and Gardens, as full time editor was an-
J. Florida, M.A.
December, 1957
669
nounced. The magazine will be changed con-
siderably this coming year and will provide better
reading for the anxious patient waiting in your
reception room. We have been asked this year
by the A. M.A. to emphasize “Reception Room
Readership,” one reason being that advertising
revenue is based on circulation and a copy in
your reception room will reach at least fifty times
the number of persons as the copy in your home.
It is estimated that 331 million persons will visit
doctors’ offices this coming year and if each one
learned only one medical fact from the copy of
Today’s Health there, think of all the needless
explaining that would be saved. Some doctors
give a subscription to every new mother when
her bill is fully paid, and they estimate from five
to ten phone calls are saved by each one.
Also persons in a doctor’s reception room are
vitally interested in health and will be receptive to
authentic and factual health information. Our
"Operation Christmas” is under way, so alert your
secretary to be ready when she is called by an
Auxiliary member for your new or renewal sub-
scription. Escambia County Auxiliary won this
national contest last year for their membership
group and we would like to do as well or better
this year. You can do your Christmas shopping
in the easy way by giving a subscription to To-
day’s Health — to your dentist, who discounts your
bills if he charges you at all; to your barber, for
being so kind to those thinning locks, and to your
office nurse, so she will leave your copy in the
reception room. Better yet, let your wife get all
the subscriptions and save yourself the worry.
Mrs. Perry D. Melvin
Eighty-Fourth Annual Mooting'
Florida Modioal Association
Hotol Americana, Miami Beach
May 10-14, 1058
I
I Allen j Invalid Home !
I I
MILLEDGEVILLE, GA.
i Established 1 8lJ0
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
i Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
+ +
SUN RAY PARK
SANITARIUM IN MIAMI
HEALTH RESORT
Medical Hospital American Plan
Hotel for Patients and their families.
REST, CONVALESCENCE, ACUTE and
CHRONIC MEDICAL CASES. Elderly
People and Invalids. FREE Booklet!
Acres Tropical Grounds, Delicious Meals,
Res. Physician, Grad. Nurses, Dietitian.
125 S.W. 30TH COURT, MIAMI, FLORIDA™"^
MEMBER, AMERICAN HOSPITAL ASSOCIATION agement.
MEMBER, FLORIDA HOSPITAL ASSOCIATION
670
Volume XLIV
Number 6
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
J. Florida, M.A.
December, 1957
671
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association ot
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D. ALBERT F. BRAWNER, M.D.
Medical Director Assistant Director
P. O. Box 218 Phone HEmlock 5-4486
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St DON SAVAGE P. O. Box 10368
Telephone 61-4191 Owner and Manager Tampa 9, Florida
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
Out-Patient Clinic and Offices
James A. Becton, M.D. James K. Ward, M.D'
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala. Phone WOrth 1-115
672
Volume XLIV
Number 6
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond. Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
v Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
T. Florida, M.A.
December, 1957
INDEX TO ADVERTISERS
673
Abbott Laboratories 580, 581, 646a, 655, 3rd Cover
Allen’s Invalid Home 669
Ames Co., Inc 649
Anclote Manor ... 674
Anderson Surgical Supply Co. 648
Appalachian Hall 670
Ayerst Laboratories 668
Ballast Point Manor 671
Brawner’s Sanitarium 671
Brayten Pharmaceutical Co. 575
Bristol Laboratories 578a, 634, 635, 664, 665
Burroughs Wellcome & Co. 654a, 667
Carlton Corp 630
Convention Press 632
Coca-Cola Co 662
Desitin Chemical Co. 574
Drug Specialties, Inc. 658
Duvall Home 622
Geigy Pharmaceuticals 645
Highland Hospital, Inc. 670
Hill Crest Sanitarium .. 672
Knox Gelatine Co 582, 583
Lakeside Laboratories 573
Lederle Laboratories 624, 625, 627, 631, 646,
647, 650, 654, 659
Eli Lilly & Co 586
Medical Protective Co 632
Medical Supply Co 644
• Merck Sharp & Dohme 577
• Miami Medical Center 675
• New Orleans Graduate Medical Assembly 626
• Parke-Davis & Co. Second Cover, 571, 663
• Pfizer Laboratories 636, 637
• Quincy X-Ray & Radium Labs 622
• Rich Company, Inc 584
• A. H. Robins & Co. 647, 656, 657
• Roerig & Co. . 628, 629, 651
• St. Albans Sanitarium 673
• Schering Corp. 585
• Schieffelin & Co. 638
• Julius Schmid 641
• G. D. Searle Company 623, 642
• Smith, Kline & French Labs. Back Cover
• E. R. Squibb & Sons 579
• Sun Ray Park Health Resort 669
• Surgical Supply Co 633
• Charles C. Thomas, Publisher 638
• Tucker Hospital, Inc ., 672
• S. J. Tutag 644
• Wallace Laboratories 642a, 643
• Westbrook Sanatorium 674
• Wine Advisory Board 666
• Winthrop Laboratories, Inc 576, 578, 640, 652,
653, 660, 661
• Wyeth Laboratories 639
SAINT ALBANS
A PRIVATt PSYCHIATRIC HOSPlTAt
RADFORD, VIRGINIA
STAFF
James P. King, M.D.
Director
Affiliated Clinics:
James K. Morrow, M.D.
Thomas E. Painter, M.D.
Clara K. Dickinson, M.D.
Bluefield Mental Health Center
Bluefield, W. Va.
David M. Wayne, M.D.
Daniel D. Chiles, M.D.
James L. Chitwood, M.D.
Medical Consultant
Harlan Mental Health Center
Harlan, Ky.
C. H. Crudden, M.D.
Beckley Mental Health Center
Beckley, W. Va.
W. E. Wilkinson, M.D.
674
Volume XLIV
Number 6
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
9 Modern Treatment Facilities
9 Psychotherapy Emphasized
• Large Trained Staff
9 Individual Attention
9 Capacity Limited
9 Occupational and Hobby Therapy
9 Healthful Outdoor Recreation
9 Supervised Sports
9 Religious Services
9 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL Dl RECTOR — WAITER H. WELLBORN, Jr., M D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants in Psychiatry
SAMUEL G. WARSON. M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
%'cstbroo/\ Sana
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff PAUL v- ANDERSON, M.D., President
REX B LAN KINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request - P. 0. Box 1514 - Phone 5-3245
DA, M.A.
ek, 1957
SCHEDULE OF MEETINGS
675
ORGANIZATION
PRESIDENT
SECRETARY
ANNUAL MEETING
Medical Association
Medical Districts
>rthwest
>rtheast
uthvvest
utheast
Specialty Societies
ly of General Practice
Society
esiologists, Soc. of
’hys., Am. Coll., Fla. Chap.
and Syph., Assn of
Officers’ Society
ial and Railway Surgeons
1 Medicine
d Gynec. Society
.1. & Otol., Soc. of
edic Society
jgists, Society of
ic Society
& Reconstructive Surgery
ogic Society
itric Society
igical Society
ns, Am. Coll., Fla. Chapter
ical Society
Science Exam. Board
d Banks, Association
Cross of Florida, Inc
Shield of Florida, Inc
er Council
etes Assn
al Society, State
t Association
lital Association
ical Examining Board
ical Postgraduate Course
e Anesthetists, Fla. Assn
es Association, State
maceutical Assoc., State
ic Health Association
leau Society
:rculosis & Health Assn
lan’s Auxiliary
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Robert J. Needles, St. Petersburg
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Reiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Mrs. Bertha King, Tampa
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando ....
Mr. R. Q. Richards, Ft. Myers
Clarence L. Brumback, W. P. B
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Miami Beach, May 1958
yy yy yy yy
yy yy yy yy
y » y> yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
Clearwater, Nov. 30-Dec. 1, ’57
Jan. 58
Miami Beach, May 1958
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
Miami Beach, May 11, ’58
Miami Beach, May 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
yy yy yy yy
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
Jacksonville, May 18-21, ’58
Miami Beach, May 10-14, ’58
an Medical Association
A. Clinical Session
rn Medical Association
aa Medical Association
a, Medical Assn, of
hospital Conference
astern Allergy Assn
astern, Am. Urological Assn,
astern Surgical Congress ...
-oast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Ray McKenzie, Balti., Md.
Grady O. Segrest, Mobile
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala. ...
San Francisco, June 23-27, ’58
Philadelphia, Dec. 3-6, ’57
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Hollywood, Jan. 12-16, ’58
MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin. Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Member American Hospital Association
676
Volume XLIV
Number 6
FLORIDA MEDICAL ASSOCIATION
Officers and
OFFICERS
WILLIAM C. ROBERTS, M.D., President ..Panama City
JERE W. ANNIS, M.D., Pres. -Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . .Jacksonville
SHALER RICHARDSON, M.D., Editor. .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR.. M.D.. AL-58 Ocala
GEORGE S. PALMER, M.D... A-58 Tallahassee
CLYDE O. ANDERSON, M.D. C-59 St. Petersburg
REUBEN B. CHRISMAN JR., M.D.. D-60. .Coral Gables
MEREDITH MALLORY, M.D... B-61 Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D...PP-59 St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) . Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
t. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS. M.D Fort Lauderdale
JAMES I.. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL-58 Brooksville
First — ALPHF.US T. KENNEDY, M.D. 1-58 Pensacola
Second— T. BF.RT FLETCHER JR., M.D 2-59 Tallahassee
Third — LEO M. WACHTEL, M.D 3-58 Jacksonville
Fourth — DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHFR. M.D. 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D 6-58 Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
FOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm Orlando
THOMAS II. BATES, M.D. “A” Lake Cits
FRANK I.. FORT, M.D "IT Jacksonville
ALVIN L. MILLS, M.D. “C” St. Petersburg
JOHN D. MILTON, M.D “D” Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
LEO E. REILLY, M.D. AL-58 Panama City
ROBERT B. MOVER, M.l). B 58 Jacksonville
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
DONALD W. SMITH, M.D D-60 Miami
Committees
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D A-58 - Tallahassee , «
JOHN J. CHELEDEN, M.D. B-58 Daytona Beach 1
JOHN M. BUTCHER, M.D C-58 Sarasota l
PAUL G. SHELL, M.D D-58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D A-59 PensacolaM
HENRY L. HARRELL, M.D. B 59 Ocala
JAMES R. BOULWARE JR., M.D C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 IV. Palm Beach I
MERRITT R. CLEMENTS, M.D. A 60 Tallahassee I
ROBERT E. ZELLNER, M.D B-60 Orlando II
WHITMAN C. McCONNELL, M.D C-60 St. Petersburg!
RALPH S. SAPPENFIELD, M.D D-60 Miami I
HAROLD E. WAGER, M.D A-61 Panama City I
CHARLES F. McCRORY, M.D B-61 Jacksonville
JOHN S. STEWART, M.D. C-61 Fort Myer s «
DONALD F. MARION, M.D D 61 .Miami I
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm AL-58... Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
BARCLEY' D. RHEA, M.D. A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm. D-58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama City
WILLIAM S. JOHNSON, M.D C-59 Lakeland
GEORGE S. PALMER, M.D A-60 Tallahassee
J. K. DAVID JR., M.D B-61 Jacksonville
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm AL-58 Orlando
WILLIAM W. TRICE JR„ M.D C-58 Tampa
JOHN V. HANDWERKER JR., M.D D-59 Miami
WALTER C. PAYNE JR., M.D A-60 Pensacola
W. DEAN STEWARD, M.D B-61 Orlando
CONSERVATION OE VISION
CARL S. McLEMORE, M.D., Chm AL-58 ._. Orlando
HUGH E. PARSONS, M.D C-58 Tampa
CHARLES C. GRACE, M.D B-59 St. Augustine
ALAN E. BELL, M.D. A-60 Pensacola
LAURIE R. TEASDALE, M.D D-61 W. Palm Beach
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D St. Petersburg
IOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D Orlando
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 - W. Palm Beach
GEORGE H. GARMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY', M.D. (Ex Officio) Jacksonville
MATERNAL W' ELF ARE
E. FRANK McCALL, M.D., Chm. B 60 Jacksonville
WILLIAM C. FONTAINE, M.D. AL-58 Panama Cits
I. I.LOYD MASSEY M.D. A-58 Quincy
RICHARD F. STOVER, M.D D-59 Miami
S. L. WATSON, M.D C.61 Lakeland
677
D
Florida, M.A.
ECEMBER, 1957
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm. AL.58 Orlando
DEWITT C. DAUGHTRY, M.D. D 58 Miami
S. CARNES HARVARD, M.D. C-59 llrooksville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm B 60 _ Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D I) 58 Miami
RICHARD REESER JR., M.D. C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
PAUL J. COUGHLIN, M.D. AL-58 Tallahassee
WILLIAM C. MERIWETHER, M.D. C-59 Plant Cits
WALTER E. MURPHRF.E, M.D. 1! 60 Gainesville
RAYMOND B. SQUIRES, M.D. A-61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D B-58 Gainesville
JAMES N. PATTERSON, M.D C-61 Tampa
EDWARD W. CULLIPHER, M.D D-59 Miami
HOMER F. MARSH, Ph.D Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm. B-59 Jacksonville
LEO M. WACHTEL, M.D AI.-58 Jacksonville
C. FRANK CHUNN, M.D. C-58 Tampa
WILLIAM D. CAWTHON, M.D. A-60 DeFuniak Springs
V. MARKLIN JOHNSON, M.D. D 61 W. Palm Beach
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm A-60 Chattahoochee
NELSON H. KRAEFT, M.D AL-58 Tallahassee
WILLIAM L. MUSSER, M.D B-58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D. I) 61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. B-61 Jacksonville
HENRY 1. LANGSTON, M.D AL-58 Apalachicola
JOHN G. CHESNEY, M.D D-58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D. A-60 Wewahitchka
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
C. W. SHACKELFORD, M.D., Chm A 61 Panama City
FRANK V. CHAPPELL, M.D. AL 58 Tampa
A. BUIST LITTERER, M.D D-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.l) I! 60 Jacksonville
WOMAN'S AUXILIARY ADVISORY
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D. AL-58 Pensacola
J. LLOYD MASSEY, M.D. A- 5 8 Quincy
W. TRACY HAVERI II I I), M.D. I) 59 Miami
MASON TRUPP, M.D C-60 Tampa
NECROLOGY
J. BASIL HALL, M.D., Chm AL-58
WALTER W. SACKF.TT JR., M.D D-58
LEO M. WACHTEL, M.D. B-59
ALVIN L. STEBBINS, M.D A 60
RAYMOND H. CENTER, M.D. C-61
NURSING
THOMAS C. KENASTON, M.D., Chm B-59 Cocoa
CARL M. HERBERT, M.D AL-58 Gainesville
HERBERT L. BRYANS, M.D. A-58 Pensacola
VORVAL M. MARR SR., M.D C-60 St. Petersburg
JAMES R. SORY, M.D D 61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B-59 Jacksonville
OHN J. BENTON, M.D. AL-58 Panama City
JEORGE S. PALMER, M.D A-58 Tallahassee
DWARD W. CULLIPHER, M.D D 60 Miami
RANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
’ASCAL G. BATSON JR., M.D., Chm A 60 Pensacola
VILLIAM J. HUTCHISON, M.D. AL-58 Tallahassee
HAS. I.. FARRINGTON, M.D. C 58 St. Petersburg
THOMAS N. RYON, M.D. D-59 Miami
(AYMOND R. KILLINGER, M.D. B-61 Jacksonville
• pedal Assignment
I-. Industrial Health
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
JOHN H. TERRY, M.D AL-58 Jacksonville
WILEY M. SAMS, M.D. ..D-58 Miami
G. DEKLE TAYLOR, M.D B-59 Jacksonville
CHARLES McC. GRAY, M.D C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN J1L, M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 _ . Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 _. Pensacola
ORION O. FEASTER, M.D., 1936 . Maple Valiev, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 - Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
lOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 ...Tampa
ROBERT B. McIVER, M.D.. 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
Tavares
Miami
Jacksonville
Pensacola
Clearwater
678
Volume XLIV
Number 6
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H * >* ??
To cut daytime lethargy
(and keep rauwolfia potency)
in treatment
of hypertension:
Additional clinical evidence1 supports
the view that Harmonyl offers full
rauwolfia potency coupled with much
less lethargy. In a new comparative
study Harmonyl was given at the
same dosage as reserpine and other
rauwolfia alkaloids. Only one
Harmonyl patient in 20 showed
lethargy, while 11 patients in 20
showed lethargy with
reserpine; 10 in 20 with
the alseroxylon fraction.
QMott
for your hypertensives
who must stay on the job
Harmonyl
while the drug works effectively . . .
so does the patient
•Trademark for Deserpidine, Abbott
1. Winsor, Travis: Comparative Effects of Various
Rauwolfia Alkaloids in Hypertension, submit-
ted for publication.
NC tl YORK ACADCV.Y OF 2
fACD J C I NE
2 C ! C 3RD 3 T
NEW YORK N Y 2 ~j , r-F
w
when anxiety must he relieved
‘Compazine’ controls anxiety and. tension
— rapidly and with minimal side effects.
Most patients on ‘Compazine’ are not
lethargic or logy. They carry out their
normal activities unhampered by
drowsiness and depressing effect.
Compazine
the tranquilizer remarkable for its freedom
available: from drowsiness and depressing effect
Tablets, Ampuls, Suppositories,
Syrup and Spansule® Smith, Kline & French Laboratories, Philadelphia
sustained release capsules
*T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
JANUARY, 1958
Vol. XLIV
FOR PERSISTENT INFECTIONS
CHLOROMYCETIN
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
Acquired resistance seldom imposes restrictions on
antimicrobial therapy when CHLOROMYCETIN (chlor-
amphenicol, Parke-Davis) is selected to combat gram-
negative pathogens involving enteric and adjacent
structures of the urinary tract. The acknowledged effec-
tiveness with which CHLOROMYCETIN suppresses highly
invasive staphylococci1'9 extends to persistently patho-
genic coliforms.6-10'15 Experience with mixed groups of
Proteus species, for example, “...shows chloramphenicol
to be the drug of choice against these bacilli...”15
CHLOROMYCETIN is a potent therapeutic agent and, because
certain blood dyscrasias have been associated with its administra-
tion, it should not be used indiscriminately or for minor infections.
Furthermore, as with certain other drugs, adequate blood studies
should be made when the patient requires prolonged or intermit-
tent therapy.
REFERENCES:
(1) Petersdorf, R. G.; Bennett, I. L., Jr., & Rose, M. C.: Bull. Johns Hopkins
Hosp. 100:1, 1957. (2) Yow, E. M.: GP 15:102, 1957. (3) Altemeier, W. A.,
in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957, New
York, Medical Encyclopedia, Inc., 1957, p. 629. (4) Kempe, C. H.: California
Med. 84:242, 1956. (5) Spink, W. W.: Ann. New York Acad. Sc. 65:175,
1956. (6) Rantz, L. A., & Rantz, H. H.: Arch. Int. Med. 97:694, 1956.
(7) Wise, R. I.; Cranny, C., & Spink, W. W.: Am. J. Med. 20:176, 1956.
(8) Smith, R. T.; Platou, E. S., & Good, R. A.: Pediatrics 17:549, 1956.
(9) Royer, A.: Scientific Exhibit, 89th Ann. Conv. Canad. M. A., Quebec City,
Quebec, June 11-15, 1956. (10) Bennett, I. L., Jr.: West Virginia M. J. 53:55,
1957. (11) Altemeier, W. A.: Postgrad. Med. 20:319, 1956. (12) Felix, N. S.:
Pediat. Clin. North America 3:317, 1956. (13) Metzger, W. I., & Jenkins,
C. J.,Jr. : Pediatrics 18:929, 1956. (14) Woolington, S. S.; Adler, S.J..& Bower,
A. G., in Welch, H., and Marti-Ibanez, E, ed.: Antibiotics Annual 1956-1957,
New Y’ork, Medical Encyclopedia, Inc., 1957, p. 365. (15) Waisbren, B. A.,
& Strelitzer, C. L.: Arch. Int. Med. 99:744, 1957.
P
PARKE, DAVIS & COMPANY DETROIT 32, MICHIGAN
t *
50168
COMPARATIVE SENSITIVITY OF MIXED PROTEUS SPECIES TO CHLOROMYCETIN
AND SIX OTHER WIDELY USED ANTIBIOTIC AGENTS*
90
80
CHLOROMYCETIN 78%
70
60
50
This graph is adapted from Waisbren and Strelitzer.15 It represents in vitro data obtained with clinical material isolated between the years
1951 and 1956. Inhibitory concentrations, ranging from 3 to 25 meg. per ml., were selected on the basis of usual clinical sensitivity.
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
VOLUME xliv. No. 7 ♦ January, J95S
CONTENT S
Scien tific A rticl es
Diuresis and Antidiuresis, Thomas Findley, M.D. 695
Diffuse Interstitial Pulmonary Fibrosis:
The Hamman-Rich Syndrome, Augustus E. Anderson Jr.,
M.D., and G. Leonard Emmel, M.D. 702
Preliminary Report on Treatment of Mongoloids, Charles
H. Carter, M.D., and Malcolm C. Maley, M.D. 705
Syphilis in Shakespeare’s Tragedies, Theodore F. Hahn Jr., M.D. 714
Office Study of the Infertility Problem. John J. Fisher, M.D. 715
Labor With Emphasis on Stage I, Frederick C. Andrews, M.D. 72C
Abstracts
Drs. DeWitt C. Daughtry, Raymond J. Fitzpatrick, H. Clinton Davis,
Irwin S. Morse. Benedict R. Harrow, and H. J. Roberts 111'.
Editorials and Commentaries
A Trend Toward Less Hospitalization? 725'
Advance Planning for Annual Meetings of Specialty Groups 72C
“What Is An Ophthalmologist?” 727
Southern Medical Association Meeting Held at Miami Beach 725
Dade County Medical Association Executive Office Building Dedicated 725
Statewide Medico-Legal Institute Held in Jacksonville 73C
Dr. Babers Addresses District Meetings 731
1958 Mediclinics of Minnesota, Fort Lauderdale, March 2-12 732
Occupational Medicine Conference, Miami, Aug. 18-22, 1958 735
Physician Celebrates Golden Anniversary of Career 735
Central Florida Medical Meeting, Orlando, March 13, 1958 73f
Cardiovascular Diseases Annual Seminar, Jacksonville, Feb. 20-22 737
Medical District Meetings, 1957 735
General Features
Letter to the Editor 737
Others Are Saying 737
New Members 74-
State News Items 74'
Classified 755
Component Society Notes 755
Obituaries 762
Births and Deaths 765
Woman’s Auxiliary 77(
Books Received 77'
Schedule of Meetings 785)
Florida Medical Association Officers and Committees 78'
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price S5.00 a year: single numbers. 50 cents. Address Journal of Florid;
Medical Association, P.O. Box 2411. 735 Riverside Ave„ Jacksonville 3, Fla. Telephone EL 6-1571. Accepted for mail
ing at special rate of postage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville
Florida. October 23, 1924
r. Florida, M.A.
January, 1958
685
“Since we put him on NEOHYDRIN he's been
able to stay on the job without interruption [’
oral
organomercurial
diuretic
NEOHYDRIN*
BRAND OF CHLORMERODRIN
LAKESIDE
24657
686
Volume XLI\
Number 7
To each of you is extended the sincere wish that the
year 1958 will he a happy one , and that it will be success-
fid and prosperous.
During 1957, the description of your products ivas a
vital part of each issue of The Journal. You assisted in
the satisfying task of producing a publication worthy of
its place in medical literature.
This association with you in
service to the medical profession
has been pleasant.
Throughout the year 1958,
our efforts shall be directed to-
ward providing you the best serv-
ice at our command.
The Journal of the
Florida Medical Association
. Florida, M.A.
anuary, 1958
687
• debilitated
• elderly
• diabetics
• infants, especially prematures
• those on corticoids
• those who developed moniliasis on previous
broad-spectrum therapy
• those on prolonged and/or
high antibiotic dosage
• women — especially if pregnant or diabetic
the best broad-spectrum antibiotic to use is
MYSTECLIN-V
Squibb Tetracycline Phosphate Complex (Sumycin) and Nystatin (Mycostatin) Sumycin plus Mycostatin
for practical purposes, Mysteclin-V is sodium-free
for “built-in” safety, Mysteclin-V combines:
1. Tetracycline phosphate complex (Sumycin) for superior
initial tetracycline blood levels, assuring fast transport of
adequate tetracycline to the infection site.
2. Mycostatin— the first safe antifun-gal antibiotic— for its
specific antimonilial activity. Mycostatin protects
many patients (see above) who are particularly prone to mondial
complications when on broad-spectrum therapy.
Capsules (250 mg./250,000 u.), bottles
of 16 and 100. Half -Strength Capsules
(125 mg./125.000 u.), bottles of 16
and 100. Suspension (125 mgr./125,000
u.), 2 oz. bottles. Pediatric Drops (100
mg./100,000 u.), 10 cc. dropper bottles.
SQUIBB
Squibb Quality—
the Priceless Ingredient
•MYSTEClIN,* •MYCOSTATIN ,® and 'SUMYCIN' ARE SQUIBB TRAOCMARKS
MYSTECLIN-V PREVENTS MONILIAL OVERGROWTH
25 PATIENTS ON
25 PATIENTS ON
TETRACYCLINE ALONE
TETRACYCLINE PLUS MYCOSTATIN
After seven days
After seven days
Before therapy
of therapy
Before therapy
of therapy
• • • •
• ••DO
• • • • •
• • •
• • • • •
•
Monilial overgrowth (rectal swab)
None 4) Scanty 0 Heavy
Childs, A J.: British M. J. 1:660 1956.
688
Volume XLI
Number 7
How +© win1 friends ...
The Best Tasting Aspirin you can prescribe.
The Flavor Remains Stable down to the last tablet.
25 p Bottle of 48 tablets (Hi grs. each).
We will be pleased to send samples on request.
THE BAYER COMPANY DIVISION
of Sterl ing Drug I nc.
1450 Broadway, New York 18, N. Y.
J. Florida. M.A
January, 1958
689
respiratory congestion
relief in minutes . . lasts for
orally
hours
In the common cold, nasal allergies, sinus-
itis, and postnasal drip, one timed-release
Triaminic tablet brings welcome relief of
symptoms in minutes. Running noses stop,
clogged noses open — and stay open for 6 to
8 hours. The patient can breathe again.
With topical decongestants, “unfortu-
nately, the period of decongestion is often
followed by a phase of secondary reaction
during which the congestion may be equal
to, if not greater than, the original condi-
tion. . . The patient then must reapply
the medication and the vicious cycle is
repeated, resulting in local overtreatment,
pathological changes in nasal mucosa, and
frequently "nose drop addiction.”
Triaminic does not cause secondary con-
gestion, eliminates local overtreatment and
consequent nasal pathology.
‘Morrison, L. F.: Arch. Otolaryng. 59:48-53 (Jan.) 1954.
Each double-dose "timed-release" triaminic
Tablet contains:
Phenylpropanolamine hydrochloride 50 mg.
Pyrilamine maleate 25 mg.
Pheniramine maleate 25 mg.
Dosage: 1 tablet in the morning, afternoon, and
in the evening if needed.
Each double-dose “timed-release”
tablet keeps nasal passages
clear for 6 to 8 hours —
provides “around-the-clock”
freedom from congestion on
just three tablets a dag
disintegrates to give 3 to 4
more hours of relief
Also available: Triaminic Syrup, for children and
those adults who prefer a liquid medication.
Triaminic
"timed-release”
tablets
running noses.
SMITH-DORSEY • a division of The Wander Company •
and open stuffed noses oi’ally
Lincoln, Nebraska • Peterborough, Canada
690
Volume XLI
Number 7
IBf ll%#
SENSITIZE
Ml
m
PQLYSPORIN
J
POLYMYXIN B— ’BACITRACIN OINTMENT
to tied Ml bAMji-QhMttm tbmjby
otitic
For topical use: in Vi oz. and 1 oz. tubes.
For ophthalmic use: in V» oz. tubes.
BURROUGHS WELLCOME & CO. (U.S.AJ INC., Tuckahoe. n. y.
J. Florida, M.A.
January, 1958
691
1. TRAPPED - This highly mo-
tile, viable sperm becomes non-repro-
ductive the instant it contacts
IMMOLIN Cream-Jel.
a. WEAKENED - Devitalized,
and no longer motile, the sperm
swerves from line of travel and is
pulled aside by spreading matrix.
3. KILLED — Motion, whiplash
stop as sperm succumbs to matrix.
“freezes,” weakens and kills
even the most viable sperm
The unique sperm-trapping matrix formed with explo-
sive speed when semen meets IMMOLIN® Vaginal
Cream-Jel accounts for the outstanding effectiveness
of this new contraceptive for use without diaphragm.
These unusual pictures, taken at high speed and mag-
nification, show the IMMOLIN matrix in action — how
a single sperm “freezes,” weakens and dies — within the
distance it normally travels in one-quarter of a second.
DEPENDABLE WITHOUT DIAPH RAG M-With this
new contraceptive technique, a pregnancy rate of 2.01
per 100 woman-years of exposure is reported.* “This
extremely low pregnancy rate indicates that IMMOLIN
Cream-Jel used without an occlusive device is an effi-
cient and dependable contraceptive.”
•Goldstein, L. Z.: Obst. & Gynec. 70:1 33 (Aug.) 1957.
JULIUS SCHMID, INC.
423 West 55th Street, New York 19, N. Y.
IMMOLIN is a registered trade-mark of Julius Schmid, Inc.
4-. BURIED — The dead sperm is trapped
deep in the impenetrable IMMOl.IN matrix.
692
Volume XLIV
Number 7
See anybody here you know, Doctor?
I’m just too much
AMPLUS
• *>,
for sound obesity management
dextro-amphetamine plus vitamins
and minerals
I’m too little
STIMAVITEf
stimulates appetite and growth
vitamins Bi, B6, Bi2, C and L-lysine
I’m simply two
„®
OBRON
a nutritional buildup for the OB patient
OBRON9
HEMATINIC
when anemia complicates pregnancy
m
And I’m getting brittle
/%M\
Jr
_®
NEOBON
5-factor geriatric formula
hormonal, hematinic and
nutritional support
With my anemia,
I’ll never make it up
that high
®
ROETINIC
one capsule a day, for all treatable anemias
HEPTUNA* PLUS
when more than a hematinic is indicated
solve their problems with a nutrition product from
( Prescription information on request)
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
Results with "... antacid therapy with DAA are essentially the same as . . . with
potent anticholinergic drugs.”
Alglyri
Dihydroxy aluminum aminoacetate, N.N.R.
In recent years, a number of new synthetic anticholiner-
gic drugs with numerous and varying side effects have
been investigated for treatment of peptic ulcer. However,
a double-blind study conducted recently by Gayer et al
suggests that the use of such anticholinergic drugs is
seldom necessary. The authors concluded that "The
percentage of 'good to excellent’ results obtained in
patients on continuous long-term antacid therapy with
DAA (74%) is essentially the same as that previously
noted in ulcer patients treated under similar conditions
with potent anticholinergic drugs alone.”
The authors’ choice of dihydroxy aluminum amino-
acetate (DAA) was based on the fact that "the tablet
form of DAA (is) more active than a variety of straight
aluminum hydroxide magmas.” They further commented
that "Because of the convenience of tablet medication
as compared with the liquid gel — a convenience which
in the use of other tablets is gained at the expense of
therapeutic effectiveness — dihydroxy aluminum amino-
acetate was used exclusively.”
Alglyn (dihydroxy aluminum aminoacetate) Tablets
are supplied in bottles of 100 tablets (0.5 Gin. per tablet).
BRAYTEN PHARMACEUTICAL COMPANY • Chattanooga 9, Tennessee
retr
NOW... for the first time in tetracycline history!
significar
1-hour blood levels
on a SINGLE intramuscular dose,
in minimal injection volume
This achievement is made possible by the unique solubility of Tetrex (tetracycline
phosphate complex) , which permits more antibiotic to be incorporated in less volume
of diluent. Clinical studies have shown that injections are well tolerated, with no more
pain on injection than with previous, less concentrated formulations.
Tetrex Intramuscular ‘250’ can be reconstituted for injection by adding 1.6 cc. of
sterile distilled water or normal saline, to make a total injection volume of 2.0 cc.
When the entire 250 mg. are to be injected, and minimal volume is desired, as little as
1.0 cc. of diluent need be used. (Full instructions for administration and dosage for
adults and children, accompany packaged vial.)
Each one-dose vial of TETREX Intramuscular ' 250 ' contains:
TETREX (tetracycline phosphate complex) (tetracycline HCI activity) 250 mg.
Xylocaine* hydrochloride 40 mg.
plus ascorbic acid 300 mg. and magnesium chloride 46 mg. as buffering agents.
*® of Astra Pliarm. Prod. Inc. for lidocaine
SUPPLY: Single-dose vials containing Tetrex — tetracycline phosphate complex — each
equivalent to 250 mg. tetracycline HCI activity. Also available in 100-mg. single-dose vials.
ITRAMUSCULAR 250'
WITH XYLOCAINE
STOL LABORATORIES INC., SYRACUSE, NEW YORK
"... especially suitable
for out-patient and
office use
the full-range tranquilizer
EXCEPTIONAL THERAPEUTIC RANGE
. . . dosage range adaptable for tension and anxiety states,
ambulatory psychoneurotics, agitated hospitalized psychotics
EXCEPTIONAL POTENCY
• At least five times more potent than earlier phenothiazines
EXCEPTIONAL ANTIEMETIC RANGE
• From the mildest to the severest nausea and vomiting due
to many causes
ADEQUATE SAFETY IN RECOMMENDED DOSAGE RANGES
• Jaundice attributable to the drug alone not reported
• Unusual freedom from significant hypotension
• No agranulocytosis observed
• Mental acuity apparently not dulled
TRILAFON — grey tablets of 2 mg. (black seal), 4 mg. (green seal), 8 mg.
(blue seal), bottles of 50 and 500; 16 mg. (red seal), for hospital use,
bottle of 500.
Refer to Schering literature for specific informa-
tion regarding indications, dosage, side effects,
precautions and contraindications.
SCHERING CORPORATION
BLOOMFIELD, NEW JERSEY
•T.M. TR-J 3297
outmoding older concepts
key to oral penicillin effectiveness
V-CILLIN K
Penicillin V Potassium
Lilly)
stability plus solubility provides greater absorption
—twice as much absorption of penicillin as from buffered
potassium penicillin G given orally.
A greater total penicillemia is produced by 250 mg. of
‘V-Cillin K’ t.i.d. than by 600,000 units daily of intra-
muscular procaine penicillin G. Also, high serum levels
are attained more quickly with this new oral penicillin.
These unique advantages of ‘V-Cillin K’ assure maxi-
mum penicillin effectiveness, and dependable therapy,
for penicillin-sensitive infections.
Scored tablets of 125 and 250 mg. (200,000 and 400,000
units).
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A.
as*,
QUALITY J RESEARCH j INTEGRITY
698
Volume XL1 V
Number 7
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville Florida, January, 1958 No. 7
Diuresis and Antidiuresis
Thomas Findley. M.D.
AUGUSTA. GA.
Commonplace though it may be, dropsy is
one of the most extraordinary events in human
biology, and the reasons why an organism finds
it necessary to enlarge itself with brine are far
from being understood. It has been stated that
sodium retention and therefore edema represent
the response of the body to a failing circulation.1
Contrarily, patients with hypertension excrete
sodium with increased facility.2 Broad general-
izations are always dangerous, but with a few
notable exceptions the ability of the kidney to
excrete salt and water seems to parallel the effici-
ency of the circulation. The exceptions include
principally those few conditions in which exces-
sive amounts of salt-active hormones reach the
kidney, but these are seldom confused with hemo-
dynamic disorders.
Edema is always of renal origin in the sense
that it cannot occur unless the kidneys excrete less
salt than is brought to them. Intake remaining
constant, a positive sodium balance is achieved
either by reduced glomerular filtration, by in-
creased tubular resorption, or by both. Simple
calculations show that even modern clearance
technics are incapable of separating these two
processes with precision. For example, when the
plasma sodium concentration is 140 mEq./l and
the glomerular filtration rate as measured by the
inulin clearance is 130 cc./min. the daily load of
filtered sodium offered to the tubules is about
25,000 mEq., of which less than 200 usually ap-
pear in the urine; if the filtered load drops by
less than 2 per cent, salt will disappear from the
urine provided tubular function remains constant.
Conversely, if the rate of glomerular filtration re-
mains constant and that of tubular water resorp-
tion diminishes by only 1 per cent, the rate of
urine flow will increase by approximately 100 per
cent. The important causes of a reduced filtered
sodium load are hyponatremia, renal vasoconstric-
tion and disease of the glomerular capillaries
From the Department of Medicine and the Georgia Heart As-
sociation Laboratory for Cardiovascular Research, Medical Col-
lege of Georgia, Augusta, Ga.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 6, 1957.
while tubular resorption of sodium and of water
is regulated in large part bv aldosterone from the
adrenal cortex and by vasopressin from the neuro-
hypophysis. respectively. Better methods for
evaluating glomerulotubular balance are obviously
needed.
Failure of the Circulation
Inadequate Cardiac Output. — The common
cause of sodium retention is inadequate cardiac
output, and in mild cases it may be accompanied
by no measurable decrease in the rate of glomer-
ular filtration. Reductions in renal blood flow and
glomerular filtration rate are usually apparent,
however, and these are not of neurogenic origin.
The Pappenheimer group at Harvard has recently
advanced some revolutionary ideas concerning
the paths by which plasma and red cells traverse
their different routes through the kidney,3 but
the impact of these important experiments upon
electrolyte metabolism has hardly begun to be ap-
preciated. It is idle, therefore, to speculate about
intrarenal events which alter salt and water out-
put. but the clinician can regard them as useful
responses, the oliguria of exercise being an ob-
vious example of the way in which the kidney
salvages water and electrolytes during circulatory
stress. Indeed, the kidney can be likened to a
built-in intern ever ready to infuse variable pro-
portions of saline and blood into the peritubular
capillaries according to the patient’s needs — al-
though we do not yet know precisely how he re-
ceives or executes his orders. The fact that the
infusion often continues to and beyond the edema
level indicates not that the kidney is deranged
but merely that the cause of the circulatory dis-
order cannot be corrected by simple replacement.
Myocardial infarction or valvular incompetence
requires more fundamental treatment than this.
Diminished Blood Volume. — The second
important cause of circulatory inadequacy is
diminished blood volume. It occurs most often
in the protein-depletion states of malnutrition,
700
FINDLEY: DIURESIS AND ANTIDIURESIS
Volume XLIV
.Number 7
liver disease and the nephrotic syndrome. After
all, the strongest force which determines plasma
volume is the oncotic pressure of its own proteins
and, when this is reduced, water leaves the blood
stream. Again, the means by which this shift in-
forms the kidney that fluid replacement is needed
are not known, but hypothetic volume receptors
which act upon the neurohypophysis and the
adrenal cortex seem somehow to be involved.4
In any event, edema appears to be useful to the
hypoproteinemic patient for it prevents his blood
volume from shrinking to dangerously low levels.
Exceptions which prove the rule that edema
equates with circulatory failure are found in (1)
acute glomerulonephritis wherein the reduced load
of filtered sodium is attributed to swelling of the
glomerular capillaries and (2) a few rare examples
which are as yet quite idiopathic. Mueller, Surt-
shin, Carlin and White5 have clearly shown that
salt retention is not entirely dependent upon
hormonal action.
Treatment
Heart Failure. — The antidiuretic process
stops if cardiac output can be made equal to the
metabolic needs of the body (time, bed rest,
digitalis, venesection, antibiotics, vascular sur-
gery). If not, then ways of reducing sodium in-
take (diet, ion exchange resins) or of increasing
renal output (diuretics) must be found. Should
reduced sodium intake be ineffective or unaccept-
able, it is necessary to interfere with the tubular
resorption of sodium.
One technic is that of raising the osmotic
pressure of glomerular filtrate, and this may be
done by giving substances like urea, mannitol,
ammonium chloride and Diamox. Urea is un-
pleasant to swallow, no matter how disguised, and
only mildly effective. Mannitol must be given by
vein. The action of ammonium chloride is better
understood if it is regarded as an indirect way of
administering HC1— , Cl~ being liberated when
the liver converts NH + 4 to urea, for a day or two
thereafter the kidney excretes the extra chloride
in the form of sodium or potassium salts, but, if
renal tubular activity is normal, ammonia then
diffuses into the tubular lumen, the excretion of
extra Na+ and K+ subsides, and within three to
five days practically all of the administered
NH(C1 is excreted as such. (It must be remem-
bered that the NH + 4 ion which comes out in the
urine is not the one with which the Cl- ion was
originally combined.) The drug should therefore
be administered in short interrupted courses, per-
haps 6 to 9 Gm. daily for four or five days to be
followed by a brief rest period. It is not very use-
ful by itself, but may potentiate the action of mer-
cury.
Osmotic diuresis due to increased loss of base
and water can be induced by inhibitors of car-
bonic anhydrase, an intracellular enzyme which
ordinarily allows the distal tubule to salvage Na +
by exchanging it for H + ; drugs like acetazol-
amide (Diamox) force the kidney to use K+ for
this purpose by diminishing the supply of H +
since they inhibit the enzyme which drives the
following reaction to the right — CCD + H20 -*
H2CO.t -*■ H+ + HCO- ;i. The result is excretion
of extra amounts of bicarbonate combined with
Na+ and K + . Metabolic acidosis of course en-
sues, but water losses are not often as large as
may be desired. At the present time many com-
pounds with similar but more potent actions are
being investigated; at least one currently under
trial is said to accelerate the excretion of chloride
also, thus reducing the possibility of metabolic
acidosis and increasing the resemblance of its ac-
tion to that of a mercurial diuretic. Currently
available carbonic anhydrase inhibitors have on
the whole been disappointing diuretics.
The xanthines produce an uncertain and in-
constant increase in glomerular filtration rate and
may therefore be moderately useful when given
intravenously about one hour after the admin-
istration of a mercurial diuretic.
As a class, the mercurial diuretics act by spe-
cifically paralyzing the tubular transport mechan-
ism for salt and water, and are vastly superior to
all others. Since the predominant effect seems to
be directed against chloride resorption, the fre-
quent and continued administration of organic
mercurials may cause metabolic alkalosis charac-
terized by hypochloremia, bicarbonate excess, and
a relatively normal serum sodium concentration.
This is the condition perhaps most frequently
responsible for refractory edema, and the specific
remedy for it is ammonium chloride by mouth.
It is not to be confused with the so-called “low
salt syndrome,” nor it in turn with hyponatremic
edema. It is probable that the initial error arose
from a tendency to assume from low serum chlo-
ride estimations that the serum sodium concen-
tration must also be low. As flame photometers
came into common use, however, the dissociation
became apparent, and accumulated experience
has shown that the administration of hypertonic
J. Florida. M.A.
January, 1958
FINDLEY: DIURESIS AND ANTIDIURESIS
701
saline to patients with congestive heart failure is
usually disappointing and sometimes harmful.
Given an edematous patient with hypona-
tremia, there is no easy laboratory method for
distinguishing between salt depletion and salt
dilution. It is unlikely, however, that a reduction
in total body sodium content can coexist with an
excess of water; so it is much safer to interpret
a low serum sodium concentration in an edema-
tous patient as being due to an excess of water
rather than to a deficit of salt. It may occasion-
ally be wise to give 200 to 300 cc. of 3 to 5 per
cent saline intravenously to a patient with truly
refractory edema, but usually the resulting eleva-
tion in serum sodium content is transient, and
the blood volume becomes only further expanded.
It is obvious that drugs are badly needed which
will cause the kidney to release water faster than
it does electrolytes; alcohol partially fulfils these
requirements because it inhibits the formation of
antidiuretic hormone, and there is no reason why
it cannot be given in highball form, 3 to 4 ounces
of whisky daily in divided doses. Persistent
hyponatremia is, however, usually an ominous
sign and it may indicate neither salt depletion nor
water excess but a general disorganization of the
electrical processes vital to cell membrane per-
formance. In this situation nothing can be done.
Finally, ACTH and cortisone-like steroids
may be used in refractory cases, but a successful
outcome probably depends upon a fortuitous com-
bination of increased glomerular filtration rate
and suppression of aldosterone production. Not
many physicians have been bold enough to give
this approach a thorough trial.
Hypovolemia. — When due to a low hemato-
crit value, the antidiuretic process is checked by
correcting the anemia. The edema associated with
protein deficiency of one kind or another, how-
ever, is a much more complex problem, and the
diuretic measures discussed are relatively ineffec-
tive so long as hypoproteinemia persists. The
difficulties concerned in raising and sustaining
plasma oncotic pressure by artificial means (salt-
poor human albumin, dextran) are well known,
particularly so in nephrosis where protein is both
excreted and destroyed at abnormally high rates.
Perhaps the chief indication for salt-poor human
serum albumin in the management of the nephrot-
ic syndrome is persistent hyponatremia, a situa-
tion which sharply limits steroid responsiveness;
it often increases the output of water in excess of
salt, raises the concentration of serum sodium and
enhances the effectiveness of another course of
hormone therapy.
A variety of renal lesions has been found by
punch biopsy,6 the frequency of diabetes mellitus
(Kimmelstiel-Wilson lesion) and disseminated
lupus erythematosus being notably high. The
cause of the hypoproteinemia is unknown, but
proteinuria alone does not seem to account entire-
ly for the large total protein deficits. It is tempt-
ing to stop treatment when diuresis subsides, but
there is a growing belief that hormone therapy
should be pushed until proteinuria is controlled as
thoroughly as possible. The therapeutic target
has therefore shifted from edema to proteinuria,
and available statistics suggest that life is pro-
longed if the proteinuria can be abolished.7 Prob-
ably no two physicians agree as to the choice,
dosage, and schedule of hormone therapy, but
steroids which can be taken orally are probably
just as effective as ACTH, which cannot. I have
seen one death from adrenal rupture in a child
given large doses of ACTH for three weeks.
Whereas there is fair general agreement that
large doses of steroids should be used for two to
three weeks, there is much confusion about what
to do thereafter. Sometimes a diuresis occurs
early in such a scheme, sometimes not until after
drug administration has been discontinued. In
any event, treatment should not be stopped sim-
ply because edema has disappeared, but should
be pushed until proteinuria has been controlled for
perhaps a month, or until it seems obvious that
the proteinuria will not subside. The dangers of
sustained hyperadrenocorticism are real, particu-
larly those of latent infection and of collapsed
vertebrae; the Cushing state must be carefully
weighed against any advantage to the renal lesion
which may accrue as a result of long term hor-
mone administration. It appears futile and unwise
to maintain a patient in such a state for longer
than four months whether the proteinuria is con-
trolled or not, even though all protective adju-
vents are also used (K=b salts, antibiotics). The
usual dosage of cortisone is 300 to 400 mg. daily,
and no clearcut advantages for hydrocortisone and
other derivatives have yet been shown.
Summary
The kidney responds to an inadequate cardiac
output or reduced blood volume by returning in-
creased amounts of brine and blood to the general
circulation. If heart function cannot meet meta-
702
ANDERSON AND EMM EL: PULMONARY FIBROSIS
Volume XLIV
Number 7
bolic needs, the sodium retention mechanism must
be suppressed. Means for accomplishing this ob-
jective are discussed. These measures are not
likely to be effective when edema is due to hypo-
proteinemia and its attendant hypovolemia; here
treatment should be directed toward protein re-
pletion. In the nephrotic syndrome, hormone
therapy should be directed against proteinuria and
not discontinued simply because edema has dis-
appeared.
References
1. Dock, W.: Physiological Problems in Treatment of Heart
Disease, J. Mt. Sinai Hosp. 13:310-317 (March-April) 1947.
2. Hirchali, R., and others: Renal Excretion of Water, Sodium
and Chloride; Comparison of Responses of Hypertensive Pa-
tients with Those of Normal Subjects, Patients with Specific
Adrenal or Pituitary Defects, and a Normal Subject Primed
with Various Hormones, Circulation 7:258-267 (Feb.) 1953.
3. Pappenhcimer, J. R., and Kinter, W. B.: Hematocrit Ratio
of Blood Within Mammalian Kidney and Its Significance for
Renal Hemodynamics, Am. J. Physiol. 185:377-390 (May)
1956.
4. Selkurt, E. E.: Sodium Excretion by Mammalian Kidney,
Physiol. Rev. 34:287-333 (April) 1954.
5. Mueller, C. B.; Surtshin, A.; Carlin, M. K., and White, II.
L. : Glomerular and Tubular Influences on Sodium and Wa-
ter Excretion, Am. J. Physiol. 165:411-422 (May) 1951.
6. Kark, R. M.: Personal communication.
7. Proceedings of the Seventh Annual Conference on the Ne-
phrotic Syndrome: National Nephrosis Foundation, Inc.,
1956, p. 192.
Diffuse fnterstitial Pulmonary Fibrosis:
The Hamman - Rich Syndrome
Augustus E. Anderson Jr., M.D.
JACKSONVILLE
AND
G. Leonard Emmf.l, M. D.
GAINESVILLE
Interstitial pulmonary fibrosis has been defined
by Mallory1 as a proliferation of fibrous tissue
in the alveolar walls or in relation to the lymphat-
ics that run in the walls of air passages and be-
neath the pleura. It is distinguished from organ-
ized intra-alveolar exudate and the scarring
resulting from necrotizing lesions of the lungs
and healed infarcts. There are many causes and
frequently a characteristic interstitial distribu-
tion. Thus, the basic lesion in pulmonary sar-
coidosis arises in the vicinity of the terminal
bronchiole2 and rarely involves the interalveolar
septum to the extent sometimes seen in sclero-
derma3 and rheumatoid disease.4
This report is concerned with a unique type
of diffuse fibrosis of the alveolar wall, first de-
scribed in 1935 as “fulminating acute interstitial
fibrosis of the lungs”5 and frequently referred
to as the Hamman-Rich syndrome in deference
to the original authors. Obscure in etiology and
supposedly rare, it presents a dramatic picture
of progressive interstitial disease of the lungs
with an almost invariably fatal outcome which
has been the subject of considerable interest in
recent years. Despite an awareness of the dis-
order, it was fully nine years after the original
study before another example appeared in the
Head before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957,
literature :c and even up until 1950, they were |
medical oddities. Since then, however, reports
have accumulated in such a fashion as to suggest
an increasing incidence, as well as a better gen-
eral alertness to the existence of such cases. By :
1956. Grant, Hillis and Davidson7 were able to I
collect 36 examples from the literature in addition
to three of their own. Were it not for the fact
that individual cases have varied remarkably little
from earlier descriptions, notably in a longer to- I
tal duration of disease, many more reports un-
doubtedly would have found their way into medi-
cal writings. The three cases included in the
present study were encountered in a moderate- I
sized Southern community and its environs over a
period of less than one year.
Clinical Aspects
Diffuse interstitial pulmonary fibrosis (the
Hamman-Rich syndrome) is usually observed in
mature adults, although several reports have con- :
cerned children.8-9 White and Negro, male and
female may be affected.
The entire course of obscure, relentlessly in- ; I
creasing respiratory insufficiency is dependent up-
on changes occurring at the alveolar-capillary |
level. Dyspnea and cough dominate the clinical
picture, though they may be preceded for an in-jrfl
definite period by a vague feeling of ill health
J. Florida, M.A.
January, 1958
ANDERSON AND EMMEL: PULMONARY FIBROSIS
703
and fatigability. The breathlessness, at first mild
and noted only with exertion, progresses at a
variable rate and eventually is experienced at rest.
Even in long-standing cases, however, lying flat
usually does not increase the difficulty. Cough
may be severe and paroxysmal, but tends to be
nonproductive, except in the presence of secondary
infection. Other symptoms consist of an occa-
sional small hemoptysis, pain in the chest and
loss in weight.
Respiratory difficulty is quickly confirmed by
the appearance of the patient. Breathing is rapid
and shallow, and intense cyanosis and clubbing
are evident in advanced instances. Despite ob-
vious distress, examination of the chest usually
reveals a paucity of findings. This disparity be-
tween symptoms and signs may be attributed to
the fact that the major pathology is interstitial
and therefore associated with a minimum of phys-
ical findings as is primary atypical pneumonia.
Inspiratory, crackling rales, particularly in the
lung bases, are frequently the only abnormality.
Fever, significant production of sputum, leuko-
cytosis and acceleration of the sedimentation rate
occur, as a rule, only when the course is compli-
cated by intercurrent or terminal pyogenic in-
fection. Such episodes are not unusual and con-
stitute severe medical emergencies in the presence
of an already diminished respiratory reserve.
Since the predominant fibrosis lies within the
alveolar wall, rather than the bronchiole, expira-
tion is not prolonged, the timed vital capacity
fails to indicate air trapping (case 2), and sig-
nificant emphysema seldom develops. Alteration
of the relationship of the pulmonary capillaries
to the alveolar lumen produces a typical “alveo-
lar-capillary block.” Thus, studies10 have shown
normal ventilatory function with low arterial
oxygen saturation. In addition to the diffusion
defect, the collagenous hyperplasia reduces the
size of the vascular bed, resulting in increased
resistance in the pulmonary circuit and accentua-
tion of the pulmonic second sound. Right heart
failure, intractable systemic congestion and edema
may ensue. Secondary polycythemia may con-
tribute to the heart failure and a tendency to-
ward thrombosis.
The roentgenologic features11 are character-
istic but nonspecific. An initial slight diffuse
prominence of the lung markings is easily over-
looked, even in the presence of symptoms. With
moderate progression, the linear shadows are
better seen, and there is a superimposed nodu-
larity. The sharp definition of these generalized
reticulonodular densities may be lost in advanced
cases. The picture then is one of a diffuse mot-
tling. Eventually diaphragmatic motion is limit-
ed. It may be difficult to outline the cardiac sil-
houette in some instances; in others, it is possible
to determine right ventricular enlargement. Hilar
adenopathy is usually inconspicuous; and al-
though postmortem examination frequently re-
veals small amounts of pleural fluid, this change
is seldom pronounced in roentgenograms.
Aside from a single case12 diagnosed ante-
mortem by lung biopsy and effectively treated
with cortisone, the disease has been uniformly
fatal, the total duration of the illness varying in
extreme cases from 31 days5 to nine years.13 Al-
though it was originally described as a fulminating
illness, it has subsequently become apparent that
in subacute and chronic cases the patients living
several years far outnumber those having the
acute variety. In some of the clinically acute
cases the condition may actually represent end
stages of a gradual subclinical exhaustion of res-
piratory reserve.
The possible existence of mild nonprogressive
and localized forms of the disease has been sug-
gested repeatedly,7-13 d-r but proof of the occur
rence of these variants has not been forthcomi \g.
It appears that the pathologic process, once set
in motion, continues unabated until the deatl of
the organism.
Pathology
Definitive diagnosis is dependent on pa :ho-
logic study of lung tissue (thoracotomy or au-
topsy). Grossly the lungs are heavy and firm, and
they sink in water. The pleura is frequently
uninvolved, but may be covered with small blebs
of lung tissue surrounded by tiny depressed scars,
giving a cobblestone appearance. The cut surface
is dry except in the presence of edema or infec-
tion.
The microscopic appearance of the lungs is
by far the most distinctive feature of the dis-
ease. Throughout all lobes, there is striking thick-
ening of the alveolar wall due to pervasion by a
profuse fibrous reaction. This varies in different
patients, and even in different sections of the
lung in a single case, from a vigorous prolifera-
tion of young fibroblasts to the deposition of
enormous quantities of hyalinized connective tis-
sue. In cases of recent origin, fibroblastic pro-
liferation predominates, while in others of longer
704
ANDERSON AND EMMEL: PULMONARY FIBROSIS
Volume XFI V
Number 7
standing, this component is overshadowed by the
presence of collagen. In all instances, however,
both types of change can be found on careful
search, reflecting continued activity of the under-
lying process.
Intermingled with the fibrous elements, vary-
ing numbers of lymphocytes and monocytes, and
occasionally a significant number of eosinophils,
can be seen. Polymorphonuclear leukocytes may
be present, but are seldom prominent, and the
absence of stainable bacteria is of critical im-
portance.
Alveolar spaces are encroached upon by the
massive interstitial reaction, frequently appearing
as mere slits in a mass of connective tissue. In
areas where they are obliterated, one sees only
a sheet of hyalinized fibrous tissue. Alveolar lin-
ing cells frequently undergo cuboidal hyperplasia,
occasionally to such an extent as to give a pseudo-
glandular appearance. These cells may desqua-
mate, and an eosinophilic hyaline membrane can
often be seen in close apposition to the alveolar
walls. Characteristically, intra-alveolar exudate
does not organize.
Pulmonary arterioles not infrequently show
thickening, but it is not settled whether this is
a primary change or the result of long-standing
pulmonary hypertension.
Diagnosis
When confronted with an obscure respiratory
illness characterized clinically by dyspnea, cough,
cyanosis, a paucity of physical findings and a
relentless, unresponsive course, radiographically
by bilateral, eventually diffuse mottled or reticulo-
nodular shadows, and physiologically by a re-
strictive ventilatory defect with alveolar-capillary
block, diffuse interstitial fibrosis (the Hamman-
Rich syndrome) should be suspected. A multi-
tude of other disorders present certain similarities,
however. Those most commonly requiring differ-
entiation are pulmonary edema, interstitial pneu-
monia, sarcoidosis, tuberculosis and the pneumo-
conioses, while occasional confusion may result
from lymphangitic carcinomatosis, lymphoma,
leukemia, the collagen disorders, bronchiolar can-
cer, fungus disease and the histiocytoses. Con-
ventional methods should, of course, be exhausted
in an effort to establish an etiology in such situa-
tions, but are frequently disappointing in dis-
ease confined to the pulmonary interstitium. The
subsequent plan of action then lies between an
uncertain course of continued observation, on the
one hand, or open thoracotomy and lung biopsy
on the other. Too often, the decision on which
course to pursue is affected by misconceptions
regarding the dangers of surgical biopsy and eco-
nomic factors. The procedure entails minimal
risk in the hands of a competent surgeon, provid-
es a definitive diagnosis and frequently proves
less drastic than prolonged temporizing with in-
determinate pulmonary disease.
Report of Cases
Case 1.— -A 52 year old white male barroom proprietor
first became ill in February 1953, with grippal symptoms
necessitating hosp'talization. Examination disclosed many
crepitant rales over both lung fields but nothing else of
significance. A posteroanterlor roentgenogram of the
chest with the patient in the erect position (fig. 1) show-
ed prominent markings throughout both lungs. He was
treated symptomatically for a week and discharged as
improved. Thereafter, exertional dyspnea became ap-
parent. This gradually increased and became associated
with a persistent, nonproductive cough, fatigability, in-
somnia. anorexia and loss in weight. By Dec. 20, 1954,
his weight had decreased from an average cf 195 pounds
to 166 pounds. He had always smoked heavily, but
finally discontinued smoking because it seemed to exag-
gerate the pulmonary symptoms. At no time did he
experience hemoptysis or fever.
Because of the progressive course, the patient was
hospitalized for further study in December 1954. The
only physical abnormalities noted were generalized crepi-
tant rales and an accentuated pulmonic second heart
sound. There were no cyanosis, distention of neck veins,
heart murmurs, or peripheral lymphadenopathy. The
blood pressure was 126 systolic and 80 diastolic. Roent-
genographic studies of the chest revealed much exagger-
ation of markings throughout both lungs; the heart size
and configuration were normal. Maximum breathing
capacity was 48.1 liters per minute (predicted normal,
106 liters), and vital capacity was 1.43 liters (predicted
normal, 3.57 liters). The sedimentation rate was 44 mm.
per hour. The total serum proteins were 6.3 Gm. with
3.3 Gm. of albumin and 3.0 Gm. of globulin. The com-
plete blood count, urinalysis, stool examination, serolcgic
test for syphilis, fasting blood sugar, blood nonprotein
nitrogen, serum cholesterol, carbon dioxide combining
power, serum chlorides, electrocardiogram, cholecystograrn
and upper gastrointestinal series were normal.
The patient was subsequently followed as an outpa-
tient. He was digitalized, and a low salt diet was
ordered. On Jan. 20, 1955, hydrocortisone was begun
with a daily maintenance oral dose of 60 mg. Mild
svmptomatic improvement occurred, although varying
degrees of cyanosis were noted. On April 8, it was ob-
served that his color was good and that the dyspnea and
cough were better. On that day hydrocortisone was dis-
continued, and Meticorten, 20 mg. daily, divided into
four equal doses was prescribed. His condition abruptly
became worse. On April 22, because of extreme dyspnea
and cyanosis, Meticorten was increased to 40 mg. daily
without noticeable benefit. Hydrocortisone was then
substituted ; however, he became progressively worse and
was finally hospitalized again on April 27. On examina-
tion, he was extremely dyspneic and cyanotic even in an
oxygen tent, and there were numerous inspiratory crack-
les throughout both lungs. The pulmonic second sound
was accentuated, the pulse rate was 120, the temperature
was 101 F.(R), and the blood pressure was 136 systolic
and 82 diastolic. Despite therapy with oxygen, Cedilanid,
Mercuhydrin, antibiotics, Alevaire nebulization, hydrocor-
tisone, 20 mg. every four hours, and Orthoxine, the pa-
tient died on April 28, after an illness of slightly over
two vears total duration.
J
J. Florida. M.A.
January, 1958
ANDERSON AND EMMEL: PULMONARY FIBROSIS
705
to
Fig. 1., Case 1. — Posteroanterior chest roentgeno-
gram showing prominent markings and diffuse nodula-
tion.
AUTOPSY. — -Pertinent findings were limited to the
thorax. No free fluid or pleural adhesions were present.
The pleural surfaces were coarsely nodular, and there were
moderate amounts of watery, frothy fluid in the airways.
No bronchiectasis was noted. The pulmonary artery
and veins appeared normal. The cut surface of the lung
was firm and granular, and moderate amounts of watery
fluid could be expressed with slight pressure. The hilar
nodes were slightly enlarged. Anthracotic pigmentation
was noted in both the pulmonary substance and lymph
nodes. Mediastinal structures appeared normal, and
examination of the heart revealed no abnormalities.
Microscopic findings (fig. 2) consisted of a dense in-
terstitial sclerosis, minimal fibroblastic reaction and
superimposed acute diffuse pneumonia.
Case 2. — A 48 year old white male cab driver was
first seen in the office on Oct. 12, 19SS. For about two
years, he had experienced increasing dyspnea, dry cough
and weakness. Fie was still able to drive his cab without
difficulty at that time. No history of pain in the chest,
wheezing, hemoptysis or occupational exposure could be
elicited.
Physical examination revealed mild cyanosis. The
blood pressure was ISO systolic and 90 diastolic, the re-
spiratory rate was 24, and the pulse rate was 80. There
were many inspiratory crackling rales in both lung bases,
anteriorly and posteriorly. No other physical abnormal-
ities were noted. A roentgenogram of the chest (fig. 3)
disclosed diffuse mottled densities bilaterally, especially
in the parahilar regions and medial bases; the heart ap-
peared normal. The total vital capacity was 2.1 liters
with a three second volume of 2.0 liters (95 per cent
of total). The blood count and urinalysis gave normal
results.
The patient was hospitalized, and on Jan. 17, 1956,
open lung biopsy was performed. The entire right lung
had a faintly nodular consistency. Examination of the
hilum revealed no unusual lymph nodes. Microscopic
study of the biopsy specimen (fig. 4) disclosed a promi-
nent loss of alveolar structure associated with a decided
increase in interstitial fibrous connective tissue. There
were irregular scattered foci of stromal round cells. The
remaining alveolar spaces were lined with a single layer
of hyperplastic low columnar cells, and the lumina con-
tained aggregates of macrophages and sloughed lining
cells.
On January 30, the administration of cortisone was
begun with an initial daily dose of 300 mg. This was
gradually reduced to a maintenance level of 100 mg.,
which has been continued until the present time. By
Feb. 20, 1956, there was moderate subjective improve-
ment in dyspnea, cough, appetite, strength and general
sense of well-being; however, the vital capacity showed
no change from previous values, and there was no
Fig. 2., Case 1. — Microphotograph (66X) of autopsy
specimen of lung revealing diffuse dense interstitial
sclerosis. There is minimal fibroblastic reaction.
Fig. 3., Case 2. — Posteroanterior roentgenogram of
chest showing diffuse mottled densities bilaterally,
especially in the parahilar regions and medial bases.
Fig. 4., Case 2. — Microphotograph (152X) of lung
biopsy specimen revealing prominent loss of alveolar
structure associated with decided increase in interstitial
fibrous connective tissue and scattered foci of stromal
round cells.
706
ANDERSON AND EMMEL: PULMONARY FIBROSIS
Fig. 5., Case 3. — Posteroanterior roentgenogram of
chest. There are diffuse reticulonodular densities
throughout both lungs, especially in the bases.
Fig. 6., Case 3. — Microphotograph (66X) of biopsy
specimen of lung showing severe interstitial fibrosis
with round cell infiltration.
radiographic improvement. Although cortisone was
continued, the initial subjective improvement was grad-
ually lost. On May 7, because of increasing dyspnea,
cough, a four pound gain in weight and a trace of ankle
edema, digitalis and a low salt diet were added to the
regimen, as well as intermittent use of mercurial diuretics.
Periodically, antibiotics have been required for febrile
episodes and purulent sputum.
Despite all therapy, the patient’s condition has stead-
ily deteriorated, and there has been a gradual progression
of the radiographic densities in the lungs. Periodic search
has failed to elicit evidence of involvement of organs
other than the lungs; on December 11, an L.E. study
on peripheral blood gave negative results. At the time
of this writing, the patient is still living, but unable to
work and even has difficulty caring for his body needs
because of severe dyspnea.
Case 3. — A 62 year old white woman was hospital-
ized on May 12, 1955. The presenting illness began
around March 1954 with cough, dyspnea and fever, and
she was told she had a pulmonary disease consistent
with sarcoidosis. Subsequently, there was a gradual 27
pound loss in weight and several febrile episodes. Four
days before admission, there developed an elevation of
temperature to 103 F., orthopnea and purulent sputum,
and she was treated with tetracycline without benefit.
Physical examination revealed cyanosis, a pulse rate
of 88, a blood pressure of 100 systolic and 60 diastolic,
Volume XL1V
Number 7
and a respiratory rate of 24. Other findings included grade
II apical and aortic systolic murmurs, cataract of the
left eye, aphakia of the right eye, a barely palpable liver
and pea-sized left supraclavicular and axillary nodes.
Fluoroscopic and radiographic study of the chest (fig. 5)
disclosed small, diffuse, linear and nodular densities
throughout both lungs, especially in the bases. A hemo-
gram was as follows: red blood cells 3.0 million, hemo-
globin estimation 12.3 Gm., white blood cells 8,550,
66 per cent polymorphonuclear leukocytes, 32 per cent
lymphocytes and 2 per cent eosinophils. The corrected
sedimentation rate was 47 mm. per hour. The total
serum proteins were 7.5 Gm. per hundred cubic centi-
meters with 3.6 Gm. of albumin and 3.9 Gm. of globulin.
Urinalysis showed 1 plus albuminuria, but nothing else of
note. Roentgenograms of the hands were consistent with
minimal osteoarthritis. The fasting blood glucose, blood
urea nitrogen, serologic test for syphilis, blood culture,
sputum studies for tubercle bacilli and tuberculin skin
tests gave normal results.
Oxygen was administered for dyspnea. Initial temper-
ature elevations as high as 104 F. gradually subsided over
a 12 day period under the influence of chloramphenicol,
and the patient was discharged from the hospital on May
28. Roentgen examination revealed some clearing of the
pulmonary shadows; however, diffuse reticulonodular
shadows remained. At the time of discharge she was
receiving cortisone, which was continued until July 9,
with no apparent benefit. There was no particular dif-
ficulty in discontinuing the drug.
In May 1956, the patient was studied at a diagnostic
center where multiple examinations, including three prep-
arations for L.E. cells, liver function studies and a hemo-
gram were normal. Surgical lung biopsy was then
carried out on the left in an effort to clarify the nature
of the diffuse pulmonary process. Study of the biopsy
specimen (fig. 6) revealed severe interstitial fibrosis with
some round cell infiltration; the changes were almost
exclusively of the chronic variety, there being little or
no fibroblastic reaction. There were no tubercles of
sarcoidosis. She was discharged with instructions to take
cortisone, 50 mg. daily.
While taking cortisone, the patient became febrile.
There was no response to erythromycin and Terramycin.
A petechial rash developed, and she was again hospital-
ized on June 18.
On examination, the patient was pale and disoriented,
and there were fine petechial hemorrhages over the trunk
and extremities. Moist rales were present throughout
both lungs. Blood studies revealed red blood cells 2.65
million, hemoglobin estimation 8.8 Gm., white blood cells
4,800, 2 per cent eosinophils, 71 per cent polymorphonu-
clear leukocytes, 24 per cent lymphocytes and 3 per cent
plasma cells. The bleeding time was three minutes, 30
seconds, and the clotting time, six minutes. Platelet
counts ranged from 30,000 to 75,000. The prothrombin
time was 19 seconds (control, 12 seconds). There was
partial clot retraction after 24 hours. The Coombs tests,
direct and indirect, gave negative results. Study of a
bone marrow aspirate revealed numerous large cells inter- |
preted as giant megakaryocytes.
The patient initially responded to oxygen, chloram-
phenicol, digitalis, intravenous fluids and transfusions of
whole blood, and the petechiae gradually faded. On
July 17, however, she again became febrile, progressively j
weaker and disoriented, and finally died on July 30.
A postmortem examination was not performed.
Comment
The first two cases seem acceptable as ex- .
amples of the Hamman-Rich syndrome of the
chronic variety, but certain aspects of the third
case render its inclusion subject to question.
Anemia, thrombopenia and bone marrow changes i
have not been associated features in previously
T. Florida, M.A.
January, 1958
ANDERSON AND EMMEL: PULMONARY FIBROSIS
707
reported cases. The case is otherwise typical.
Inclusion of such borderline examples and com-
parisons with other situations having certain simi-
larities may lead to broader concepts and perhaps
an appreciation of a clinical spectrum. The most
obvious direction indicated by this line of reason-
ing is to a consideration of the collagen disorders
(vide infra).
Lung biopsy, which was performed on the last
two patients, proved relatively innocuous, even in
the face of severe respiratory insufficiency; and
while it unfortunately failed to alter significantly
the eventual outcome, the insight it provided
more than justified it to all concerned. Utiliza-
tion of the procedure at an earlier, presumably
more proliferative stage, may have resulted in
a more satisfactory response to steroid therapy.
Treatment
Therapy, in general, has been disappointing,
most information on the subject having empha-
sized its limitations and pitfalls. The obscure
pathogenesis, difficulty in establishing a diagnosis
and fibrous nature of the process have all con-
tributed to the problem.
It might be anticipated that the adrenal ster-
oids would be beneficial. While they have been
used with success in isolated instances of recent
onset, shortcomings have been apparent. In one
acute example, reported by Peabody, Buechner
and Anderson,13 remarkable symptomatic and
radiographic clearing resulted from the use of
corticotropin and cortisone. A few days after
cessation of therapy, however, there was a violent
recurrence of symptoms and a return of abnormal
roentgen shadows. The patient died within 24
hours despite reinstitution of massive steroid ther-
apy. Precipitous deaths in two other patients
with more chronic illnesses under similar cir-
cumstances of dosage manipulation prompted the
writers to recommend extreme care in the use of
the drugs. Pinney and Harris12 described an
acute case in which the diagnosis was established
antemortem by lung biopsy. A sustained remis-
sion was produced by the use of continuous
cortisone therapy. They emphasized the need for
early diagnosis and the institution of therapy
while the reaction is still predominantly fibro-
blastic. Success is obviously dependent on the
use of an effective agent before significant scle-
rosis has occurred, a fact which probably accounts
for the universally poor results obtained by others.
The value of surgical lung biopsy in this connec-
tion is obvious.
Our experience with three cases of the chronic
variety parallels the general experience of others.
In all, the patient failed to improve significantly
on adrenal steroids. Moreover, the abrupt down-
hill course in the first case coincided with the
substitution of a different type of preparation for
the steroid already in use and strongly suggested
to all observers, including the patient’s family,
that the change had something to do with the
outcome.
While the lack of improvement in the face
of an established fibrous process is understand-
able, the mechanism responsible for the exacerba-
tion of symptoms that can occur following altera-
tion of the dosage is less clear. The role of pitui-
tary insufficiency, atrophy of the adrenals and
secondary infection seems unlikely.13 A more
plausible explanation pertains to the limited re-
spiratory reserve which these patients exhibit. In
such a borderline state, a minor insult, for exam-
ple, manipulation of a therapeutic agenL, may be
all that is required to upset irreversibly the al-
ready precarious balance in favor of complete re-
spiratory insufficiency.
In any event, corticotropin and cortisone
should not be administered indiscriminately for
the treatment of diffuse indeterminate pulmonary
disease. A correct diagnosis is desirable, and it
should be appreciated that established fibrosis,
which predominates in the majority of the cases
of the Hamman-Rich syndrome, precludes an
effective response to steroids. Once they are in-
stituted, extreme caution should be exercised in
any adjustment of dosage.
Etiology
Speculation on the etiology of the Hamman-
Rich syndrome has run the gamut of most of the
common causes of respiratory disease. A bac-
teriologic origin seems unlikely. No organism has
been consistently isolated from the sputum, and
an absence of stainable bacteria in pathologic
specimens has been a universal experience. Simi-
larly, history has not disclosed exposure to noxi-
ous inhalants.
Several cases reported have had interesting
genetic implications. Peabody, Peabody, Hayes
and Hayes15 observed the disease in identical
twin sisters. Since they had led widely separated
lives for at least 25 years prior to the onset of
their illness, the presence of some inherent ten-
dency, rather than an exogenous factor, is likely.
The disorder has been reported in brothers,13-15
who also had different environmental back-
708
ANDERSON AND EMMEL: PULMONARY FIBROSIS
Volume XL1V
Number 7
grounds.* Thus, of the approximately 39 cases
which have been reported from various parts of
the world, a familial incidence has been apparent
in four, a situation which is difficult to attribute
to chance.
One of the most popular hypotheses is that
which proposes a viral etiology. The similarity of
the pathologic changes of acute interstitial pneu-
monia of viral origin to some of the more acute
examples of the Hamman-Rich syndrome is strik-
ing, and it has been suggested that such a recur-
rent interstitial pneumonitis could initiate a dif-
fuse fibrosis.17 Heppleston,18 on the other hand,
has pointed out that the lesions in interstitial
pneumonia have a distinctly focal distribution
centered on the bronchiole, unlike that found in
diffuse interstitial fibrosis. He further empha-
sized that in acute interstitial pneumonia there is
disruption of the elastica, which in diffuse inter-
stitial fibrosis remains intact. Inclusion bodies
have never been demonstrated, and a virus has
never been isolated. Despite these objections,
however, a virus etiology cannot be disregarded.
The presence of eosinophils, a finding em-
phasized by some workers,5 is compatible with an
allergic etiology. More tangible evidence of such
a connection is provided by reports of toxic re-
actions that have occurred under the influence of
certain antihypertensive preparations. Morri-
son19 described three patients in whom changes
in the lung developed which were probably a com-
plication of hexamethonium therapy for hyper-
tension. All three had been improving satisfac-
torily, radiologic signs of heart failure had disap-
peared, and they had returned to active life when
dyspnea suddenly developed. In contrast to pre-
vious cardiac dyspnea, it was relieved by lying
flat. Roentgen examination of the lungs reveal-
ed bilateral opacities, and necropsy in one of
the cases showed “extensive cornification.” In
a report of the toxic reactions of Hyphex, a com-
bination containing 1-hydrazinophthalazine and
hexamethonium. Morrow, Schroeder and Perry29
commented on the frequent occurrence of colla-
gen disease on the one hand and a disorder re-
sembling the Hamman-Rich syndrome on the
other. Thus, there were five deaths from a con-
dition identical pathologically with “acute inter-
stitial fibrosis of the lungs.”
The similarity between the microscopic ap-
pearance of the Hamman-Rich syndrome and
some of the pulmonary manifestations of the dif-
*One of the cases of Wildberger anti Barclay11’ had been
previously reported in detail,13 note being made then that the
brother was ill with a clinically indistinguishable illness.
fuse collagen disorders has been the basis for the
intriguing proposal that the former may represent
a collagen disease localized to the lungs. Prac-
tically identical histologic changes have been ob-
served in the lungs of patients with scleroderma,3
rheumatoid disease1 and dermatomyositis.21 Lo-
calization to one system, namely, the locomotor
apparatus, has been the rule in rheumatoid dis-
ease, and only in recent years has the frequency
of visceral lesions been appreciated. Predominant
or exclusive involvement of some other system,
such as the lungs, is not beyond the realm of
imagination.
In summary, it may be stated that the etiology
of diffuse interstitial fibrosis is unknown. One or
more precipitating agents may be operative on a
background of inherited predisposition to produce
a histologic pattern not unlike that seen in the
lungs of certain examples of the diffuse collagen
diseases.
References
1. Mallory. T. R. : Pathology of Pulmonary Fibrosis. Includ-
ing Chronic Pulmonary Sarcoidosis, Radiology 51:468-476
(Oct. ) 1948.
2. Ziskind, M. M.: Late Phases in Pulmonary Sarcoidosis,
Bulletin of Tulane University Medical Faculty 13:11, 1953
3. Leinwand. 1.; Duryee, A. YV., and Richter. M. N.: Sclero
derma (Based on Study of Over 150 Cases), Ann. Int.
Med. 41:1003-1004 (Nov.) 1954.
4. Rubin. K. II.: Pulmonary Lesions in Rheumatoid Disease
with Remarks on Diffuse Interstitial Pulmonary Fibrosis,
Am. J. Med. 19:569-582 (Oct.) 1955.
5. Ilamman. L.. and Rich., A. R.: Fulminating Acute Inter-
stitial Fibrosis of Lungs, Tr. Am. Clin, and Climatol. A.
51:154-163, 1935.
6. Ilamman, L., and Rich, A. R. : Acute Diffuse Interstitial
Fibrosis of Lungs, Bull. Johns Hopkins Hosp. 44:177-212
(March) 1944.
7. Grant, I. YV. B ; Hillis, B. R., and Davidson, J.: Diffuse
Interstitial Fibrosis of Lungs (Hamman-Rich Syndrome),
Am. Rev. Tuberc. 74:485-510 (Oct.) 1956.
8. Aranson, A.: Hamman-Rich Syndrome, J. Maine M. A.
47:105-107 (March) 1956.
9. Bradley. C. A. Ill: Diffuse Interstitial Fibrosis of the
Lungs in Children, J. Pediat. 48:442-450 (April) 1956.
10. Silverman, J. J., and Talbot, T. J.: Diffuse Interstitial
Pulmonary Fibrosis Camouflaged by Hypermetabolism and
Cardiac Failure: Antemortem Diagnosis with Biopsy and
Catheterization Studies, Ann. Int. Med. 38:1326-1338
(June) 1953.
11. Robbins, L. L. : Idiopathic Pulmonary Fibrosis; Roent-
genologic Findings, Radiology 51:459-466 (Oct.) 1948.
12. Pinney, C. T., and Harris, H. Y\ . : Hamman-Rich Syn-
drome; Report of Case Diagnosed Antemortem by Lung
Biopsy and Successfully Treated with Long-Term Cortisone
Therapy, Am. J. Med. 20:308-313 (Feb.) 1956.
13. Peabody. J. YV. Jr.; Buechner, H. A., and Anderson,
A. E. : Hamman-Rich Syndrome; Analysis of Current Con-
cepts and Report of Three Precipitous Deaths Following
Cortisone and Corticotropin (ACTH) Withdrawal, A. M.
A. Arch. Int. Med. 92:806-824 (Dec.) 1953.
14. ('lough. P. W.: Diffuse Interstitial Pulmonary Fibrosis,
editorial, Ann. Int. Med. 40:641-645 (March) 1954.
15. Peabody, J. \\\ ; Peabody, J. W. Jr.; Hayes, E. W., and
Hayes, E. YV. Jr.: Idiopathic Pulmonary Fibrosis; Its
Occurrence in Identical Twin Sisters, Dis. Chest 18:330-
344 (Oct.) 1950.
16. Wildberger. H. L., and Barclay, W. R. : Diffuse Interstitial
Pulmonarv Fibrosis, Ann. Int. Med. 43:1127-1138 (Nov.)
1955.
17. Katz, H. L., and Auerbach, O. : Diffuse Interstitial Fibrosis
of Lungs (Report of Case YY'ith L’nusual Features), Dis.
Chest 20:366-377 (Oct.) 195i.
18. Heppleston, A. G.: Chronic Diffuse Interstitial Fibrosis
of Lungs, Thorax 6:426-432 (Dec.) 1951.
19. Morrison. B. : Parenteral Hexamethonium in Hypertension,
Brit. M. J. 1:1291-1299 (June 13) 1953.
20. Morrow, J. D. ; Schroeder. H. A., and Perry, H. M. Jr.:
Studies on Control of Hypertension by Hyphex; Toxic
Reactions and Side Effects, Circulation 8:829-839 (Dec.)
1953.
21. Mills, E. S., and Mathews, W. II. : Interstitial Pneumonitis
in Dermatomyositis, J. A. M. A. 160 :1467-1470 (April 28)
1956.
1441 Chaseville Road (Dr. Anderson).
808 Southwest Fourth Avenue (Dr. Emmel).
J. Florida, M.A.
January, 1958
CARTER AND MALEY: TREATMENT OF MONGOLOIDS
709
Discussion
Dr. Jack Reiss, Miami: Dr. Anderson and Dr. Emmel
are to be congratulated on the presentation of this ex-
cellent paper. They reported three new cases of this
unusual condition which they observed in less than one
year. To date approximately 46 authenticated cases have
appeared in the literature. Most of them have been re-
ported since 1950. There are probably many more cases
in the autopsy files of hospitals that have not been re-
ported. The true incidence of the disease is therefore
unknown.
At the Veterans Administration Hospital in Coral
Gables, there were 2,400 autopsies during the past 10
years. Four cases of Hammon-Rich syndrome were diag-
nosed, all of them in the years 1953 and 1954. They
were not reported.
Of all the problems in pulmonary diseases, there is
probably none more challenging than the differential
diagnosis of diffuse pulmonary lesions. The diagnostic
possibilities are endless, clinical findings tend to be ob-
scure, and seldom are the usual laboratory tests of any
help.
The diagnosis may be suspected on clinical grounds,
but ultimately hinges upon the demonstration of the
more or less typical microscopic picture in sections ob-
tained from lung biopsy or at autopsy. Biopsy should
be performed early when treatment might be most ef-
fective. Two essential requirements are the absence of
any demonstrable etiologic organism and the lack of a
significant acute inflammatory response.
The various facets in the etiology of the disease have
been well covered by the authors. There is no assurance
that there is a single cause. There is no question that the
problems relative to this disease will be resolved only by
studying the pathogenesis of this syndrome.
The management of this disease has been universally
disappointing. The steroids may be useful in the acute
fulminating cases and in those cases diagnosed early. In
recent years publications indicate that a basically similar
condition can be rapidly fatal or slowly progressive over
a few years. Clinical features of great interest are the
remarkable clearing of the lungs with ACTH or cortisone
therapy and the equally remarkable recrudescence of the
process on cessation of such therapy. Once steroids are
instituted, a permanent maintenance might be the safest
course to follow. Patients with chronic disease should
probably not receive the steroid since the long-established
fibrosis precludes fibrolysis.
I thank the authors for the privilege of discussing
their stimulating paper.
Preliminary Report on Treatment
Of Mongoloids
Charles H. Carter, M.D.
AND
Malcolm C. Maley, M.D.
GAINESVILLE
During the past few years there has been a
renaissance of interest in mongolism. This has
been evident from the numerous publications on
this subject. Comprehensive studies by Benda,1
Gilston- and Levinson, Friedman and Stamps-'*
have described this disease entity, its variations
and, relationship to other diseases. Penrose4 and
Friedman5 have discussed the etiology of mongol-
ism, while Smith and McKeown6 have described
the prenatal growth of mental defectives. The
morphologic study of a mongoloid newborn and
related genetic problems have been described by
Pecchiai and Bencini.7
The metabolism of mongoloids, with special
attention to cholesterol and lipoprotein levels in
these children, has been clarified by Benda and
Mann.8 There has been further delineation of this
problem as to iodine uptake by Friedman,9 and
other types of metabolic changes have been dis-
cussed by Simon, Ludwig, Gofman and Crook.10
Pennacchietti and Ferrio11 have reported a fairly
large series of electrocardiographic studies on
mongoloids with special emphasis on cerebral de-
velopment while the occurrence of convulsions in
mongoloids has been described by Schachter.1-
The problem of investigation in this disease
entity has been outlined by Prichard, 13 but other
than the report of Tatafiore14 in 1952, the treat-
ment in this disease has not been thoroughly dis-
cussed. This does not imply any lack of interest
but rather a necessity for greater effort towards
vigorous attempts to correct this abnormality in
its early phase.
These publications do not constitute a survey
of the literature on this subject. They demon-
strate, however, that a tremendous amount of
work has been done in this field and that con-
tinued progress is being made.
The purpose of this report is to present our
preliminary results obtained in the treatment of
mongoloid children with young calf pituitary ex-
tract. This type of therapy was first suggested by
Benda.1 Initial dosage has been 1 grain daily, in-
creased at two week intervals until tolerance of 4
grains is reached. Tolerance is indicated by hyper-
irritability. Treatment is started as early as pos-
sible, in some instances as early as five days.
We use Armour’s young calf pituitary. The pow-
der is mixed with milk or food and is given at the
longest possible intervals. There has been no
710
CARTER AND MALEY: TREATMENT OF MONGOLOIDS
Volume XLIV
Number 7
problem in administration or tolerance. The only
untoward reaction has been hyperirritability,
which disappeared when the dose was decreased.
Method
Twenty-six monologoid children have been
studied with this type of therapy. The majority
of these children have been under the care of their
private physicians and have been followed care-
fully by us, with special attention to mental and
physical development over long intervals of time.
Several of these children have been started on
treatment below six weeks of age and a number
of them between the ages of two and eight
months. Clinical judgment of the degree of in-
volvement at birth has been given to us by the at-
tending physician. In the majority of these infants
psychometric testing was done with Cattell’s in-
fant intelligence scale.
Results
Our observations should be interpreted only
as preliminary impressions and not as completely
controlled observations. Three patients appear to
have developed a normal I. Q. range at the pres-
ent time and have lost some of the mongoloid
stigmas. In the remaining cases studied the results
have varied from no real degree of I. Q. improve-
ment to significant degree in others. Results as to
I. Q. development and clinical impressions are
summarized in table 1. Improvement is charted
in table 2.
Report of Cases
Case 1. — A premature infant, delivered at eight months’
gestation, was thought by the pediatrician to be mod-
erately mongoloid at birth. Medication was started at
seven weeks of age, consisting of 1 grain of calf pituitary,
and was gradually increased to 3 grains by the time the
child was four months old. The I. Q. rating at one year
was 72. He has had several respiratory infections, has
gained weight poorly, has poor muscle tone and has
not developed too well physically. Mongoloid stigmas are
still prominent, but it is thought that he is developing
better than the average mongoloid according to the phy-
sician.
Case 2. — A full term child, whose birth weight was
8 pounds and 6 ounces, appeared to be moderately mon-
goloid. Treatment was started at seven weeks of age,
consisting of 1 grain of young calf pituitary, and was
increased to 3 grains at the end of two and one-half
months. The child has developed extremely well. At the
age of eight months most of the mongoloid stigmas had
disappeared except the flat bridge of the nose and the
eye signs. The estimated I. Q. at eight months was 110.
He was tested at 14 months with an estimated I. Q.
of 10S. At 18 months the I. Q. rating was 98. The child
has made excellent progress. He says 30 to 40 words and
has had only one respiratory infection and no serious
illnesses. He is an exceptionally alert child and is devel-
oping rapidly.
Case 3. — An infant, whose birth weight was 6 pounds
and 8 ounces, appeared to be a moderately severe mon-
goloid. Medication was started at five weeks of age.
The patient has developed rapidly. He sat at five months,
stood at eight months, walked at 1 1 months, and began
to say words at 13 months. At two years of age, he had
an I. Q. rating of 94 and had lost practically all of his
mongoloid stigmas except the eye signs. At 30 months
the I. Q. rating was 92. On roentgen examination, the
hand appeared to be within normal limits.
Case 4. — A premature infant, delivered at eight
months’ gestation and weighing 5J4 pounds at birth,
apparently was only slightly mongoloid. He gained
weight rapidly. Treatment, started at six weeks of age,
consisted of 1 grain of young calf pituitary and was
increased to 4 grains by three months of age. He has had
no respiratory infections. The mongoloid stigmas appear
to be fading. At six months of age his I. Q. rating was
105 ; at nine months of age the rating was still estimated
to be 105. At one year the 1. Q. rating was 100. The
child seems to be most alert and within normal limits
in every way.
Case 5. — A child, delivered at term with a birth
weight of 7 pounds and 2 ounces, was a moderately severe
mongoloid, as diagnosed by the pediatrician. One grain
of young calf pituitary was started at five weeks of age
and increased to 3 grains by the end of the third month.
He appeared to become more alert almost immediately
and at four months of age had an estimated I. Q. of 86.
At eight months the I. Q. was estimated at 88. Some of
the mongoloid stigmas appear to be fading although ap-
pearances are definitely mongoloid.
Case 6. — A full term child, with a birth weight of 6
pounds and 4 ounces, appeared at birth to be mildly
mongoloid. She was given treatment, consisting of 1 grain
of pituitary at three weeks of age, which was increased to
3 grains by the end of the second month. She has had
no skin infections or respiratory infections. The child
was developing well at seven months and had an esti- |
mated 1. Q. of 78. At one year the I. 0- was estimated
at 80.
Case 7. — A full term infant weighed 6 pounds and 4
ounces at birth. A congenital anomaly of the heart was
present. The diagnosis was severe mongolism. The child
was given treatment at six weeks of age, consisting of 1
grain of pituitary, which was increased to 3 grains a day i
by the third month. The child has had no infections and
appears to be developing well, although at five months
the estimated I. Q. is only 58. Most of the mongoloid
stigma is still present.
About 25 patients, ranging in age from 16
months to four years, have been treated in various
cities. The mothers of most of the patients think
they see varying degrees of improvement, but
we are not optimistic about the results in th'em.
A Pensacola pediatrician has been treating
three children, one of whom was started on treat-
ment at five days of age and is now a little over
one year of age. The physician thinks that the
muscle tone may be a little above the average for
the untreated monogoloid. The physical activity is |
definitely retarded for the age. She has almost
chronic respiratory infection. The I. Q. rating now i
is 71, which classifies this child as a mild mental
defective. The I. Q. rating at the age of foui
months was 73. Treatment may have been worth
while in this case, but it is still questionable. Thf
next child, a severe mongoloid whose treatment
was started at five months of age, has shown nc
improvement whatsoever. The third child reportec
on by this physician received treatment beginning
at four weeks of age and is four months old a
Table 1. — Summary of I. Q. Development and Clinical Impressions
Expressed in Per Cent of Change
CARTER AND MALEY: TREATMENT OF MONGOLOIDS 711
Side
Effects
None
Occasional Hypertension
None
None
None
Occasional Hypertension
None
None
None
None
None
None
None
None
None
None
<L>
c
o
£
None
None
None
None
None
None
None
None
None
Eosinophil
Count
6%
14%
16%
tR
CM
tR
to
tR
00
10%
&
00
9%
tR
VO
6%
12%
*R
CO
12%
12%
tR
o
10%
tR
O
&
00
tR
to
6%
12%
11%
*R
00
*R
Respiratory
Infection
1
1
1
1
1
1
1
1
75%
SR
>o
rvj
O
o
tR
to
50%
*R
to
*R
to
SR
'O
£
*R
O
to
*R
to
rvj
25%
50%
SR
to
f'-
*R
to
|
*R
to
r^.
Skin
Infection
1
1
1
1
1
1
1
1
&
to
iR
to
rvj
O
o
50%
50%
O
'O
tR
to
*R
to
75%
tR
O
to
CsJ
*R
to
r—
*R
o
to
*R
to
*R
to
*R
to
*R
to
Social
Response
1
1
1
1
1
1
1
1
25%
*R
to
o
o
O
*R
O
10%
io%
O
o
O
O
O
O
£
SR
to
50%
sR
to
Learning
1
1
1
1
1
1
1
1
o
*R
to
o
o
10%
*R
to
SR
to
iR
to
O
sR
to
o
O
O
o
tR
§
sR
to
rvj
O
Activity
25%
SR
tO
SR
to
hR
to
SR
to
*R
to
sR
to
OnI
*R
to
CM
SR
to
CNJ
10%
o
o
25%
*R
O
10%
IR
O
5%
O
o
O
o
o
O
O
sR
O
to
o
Physical
Appearance
o
SR
tO
*R
to
90%
&
to
f''.
O
to
25%
&
to
0-1
10%
10%
o
o
*R
to
CM
sR
to
O
*R
to
o
o
o
o
o
o
O
O
*R
to
SR
to
Age
Medication
Started
7 weeks
7 weeks
5 weeks
6 weeks
5 weeks
3 weeks
6 weeks
5 weeks
3 years
11 years
1 1 years
12 years
6 years
9 years
10 years
9 years
12 years
13 years
13 years
16 years
10 years
16 years
10 years
11 years
9 years
4 years
Case
-
CV1
<0
to
VO
00
Ov
o
Cvj
<o
■*1-
to
vO
5
oo
O'
o
CVI
rsj
Csj
r-i
CO
<NJ
to
CN
vO
CN
Table 2. — Improvement Under Medication
712
CARTER AND MALEY:
TREATMENT OF MONGOLOIDS
Volume XLIV
Number 7
J. Florida, M.A.
January, 1958
CARTER AND MALEY: TREATMENT OF MONGOLOIDS
713
the time of this report. He has not definitely de-
cided as to progress made by this child.
A pediatrician of Orlando has been treating a
child since approximately one month of age. In
his opinion this child is making excellent progress,
although more susceptible to respiratory infec-
tions than the average child. He believes this
child has done much better than the untreated
mongoloid child.
In Daytona Beach, another pediatrician has
been treating a child since seven weeks of age.
We have checked his I. Q. and found it to be in
the neighborhood of 92. He is now two and one-
half years old.
A pediatrician of Gainesville has treated a
mongoloid from six days of age. At one month
this child had much better muscle tone and was
much more active than the average untreated
mongoloid.
Discussion
Though the rationale for calf pituitary therapy
has not been established, it is believed that the
growth-stimulating factors should be much more
prevalent in calf than pooled pituitary. We are
not able to explain our results since the majority
of endocrinologists are of the opinion that oral
pituitary is destroyed in the stomach. There is a
uniform eosinophil response in the differential
counts while treatment is being administered.
This suggests absorption of calf pituitary extract.
Certainly further investigation in this field is
warranted by our preliminary findings. The oc-
currence of three mongoloids with normal I. Q.’s
and two others with low normal I. Q.’s might be
explained by increased attention on the part of
persons involved, but this would be unusual. Some
increase in I. Q. may be explained by the in-
creased physical activity of these children since
much of the test results at this age depends on
performance.
These results indicate that a need for further
study of metabolic and endocrine function in these
children is warranted. The types of mental and
physical changes need further exploration. It may
be that the avenue of investigation should be in
studies of maternal metabolism and endocrine
function during the prenatal period. Should this
type of study prove productive it possibly would
contribute toward eventual early detection of fac-
tors conducive to and prevention of mongolism.
Summary
Young calf pituitary, in a dosage of 1 grain
daily increased at two week intervals until 4
grains is administered, has been given to mongo-
loids over a period of approximately two years,
with varying results. In this series three patients
have developed to within the normal I. Q. range,
and some of the mongoloid stigmas have dis-
appeared. .
Clinical improvement observed in this pre-
liminary study warrants continuation of this ther-
apy and expansion of research along these lines.
References
1. Benda, Clemens E. : Mongolism and Cretinism, ed. 2, New
York, Grime & Stratton, 1949.
2. Gilston, R. J.: Mongolism, GP 12:90 (Aug.) 1955.
3. Levinson, A.: Friedman, A., and Stamps, F. : Variability
of Mongolism Pediatrics 16:43-54 (July) 1955.
4. Penrose, L. S.: Observations on Aetiology of Mongolism,
Lancet 267:505-509 (Sept. 4) 1954.
5. Friedman, A.: Mongolism in Twins; Its Bearing Upon
Question of Etiology of Mongolism, A. M. A. Am. Dis.
Child. 90:43-50 (July) 1955.
6. Smith, A., and McKeown, T. : Pre-natal Growth of Mon-
goloid Defectives, Arch. Dis. Childh. 30:257-259 (June)
1955.
7. Pecchiai, L., and Bencini, M. A.: Minerva Pediatrica Inda-
gine morfologica su un neonata mongoloide; considerazioni
sul problema etiopatogenetico del mongolismo 6:126-14 2
(Feb. 28) 1954.
8. Benda, C. E., and Mann, G. V.: Serum in Cholesterol and
Lipoprotein Levels in Mongolism, J. Pediat. 46:49-53
(Jan.) 195 5.
9. Friedman, A.: Radioiodine Uptake in Children with Mon-
golism, Pediatrics 16:55-66 (July) 1955.
10. Simon, A.; Ludwig, C. ; Gofman, J. W., and Crook, G. H.:
Metabolic Studies in Mongolism: Serum Protein-Bound
Iodine. Cholesterol, and Lipoprotein, Am. I. Psychiat.
111:139-144 (Aug.) 1954.
11. P'ennacehietti, Mi, and Ferrio, L. : Dati eleettrocefalografici
sull’idiozia mongoloide, Riv. neurol. 23:363-366 (Tuly-Aug.)
1953.
12. Schachter, M. : A propos des convulsions chez les mon-
goliens, Acta Pediat. espan. 13:311-314 (May) 1955.
13. Prichard, VV. I.: Research in Mongolism, Virginia M.
Month. 81:485-486 (Oct.) 1954.
14. Tatabore, E.: Ulteriore Contributo alia profilassi eterapia
del mongolismo, Rassegna Clinico-Scientifica 28:276-281
(Sept.) 1952.
Florida Farm Colony.
714
Volume XLIV
Number 7
Syphilis in Shakespeare’s Tragedies
Theodore F. Hahn Jr., M.I).
DELAND
Between 1601 and 1609 Shakespeare pub-
lished a series of tragedies in which mental illness
or mental changes were an integral part of the
plot and produced some of the tragic results.
Hamlet, the introvert, feigned schizophrenia,
while Ophelia’s symptoms seem typical of that
disease. In “King Lear” the old king suffered
from senile dementia, while Edgar’s portrayal of
insanity was so realistic that one feels his gibber-
ish, his hallucinations and his delusions could
only have been gained from actual observation of
such a case. Othello’s pathologic suspiciousness
brands him as a victim of a paranoid state, and
in “Julius Caesar” are seen some of the results of
the hero’s epilepsy. Lady Macbeth’s sleepwalking
and amnesia suggest a hysterical state.
The last play in this series of tragedies is
“Timon of Athens,” in which an entirely different
mental disease is portrayed. Timon is described
in Shakespeare’s play as a vigorous, healthy,
cultured and influential man, a military leader, a
dictator who is given the complete rule of Athens
to deliver it from the enemy, a man in whom
there then develops a severe dementia, a dementia
which is rapid and characterized by symptoms
typical of those occurring in paresis. In the de-
velopment of Timon, Shakespeare has also
brought in many signs and symptoms of syphilis,
a disease prevalent in his time. Other plays in
which symptoms or signs suggestive of syphilis
are mentioned are: “Measure for Measure” (Act
1, Scene 2); “Troilus and Cressida” (Act II,
Scene 3 and Act V, Scene 4); and “Henry the
Fifth” (Act V, Scene I).
In analyzing “Timon of Athens” from the
medical viewpoint one finds in the hero a clinical
picture of paresis, an intriguing and curiously
accurate picture. This Timon is not to be con-
fused, however, with the original picture of
Timon, a character clearly defined by Plutarch,1
treated with much charm and with justice to his
wrongs in a dialogue by Lucian,2 a hero who
from the personage of an obscure Athenian
misanthrope of the fifth century B.C. became a
Read before the Regional Meeting of the American College
of Physicians, Charleston, S. C., Oct. 8, 1955.
traditional figure, a type or personification of
misanthropy, adapted from Plutarch with only
slight variations by a later writer,3 and still
later dramatized.4 Then Shakespeare infused him
with new life, with tragic intensity and profundity
of feeling, surrounded him by the darkness of
human greed and ingratitude, and adorned him
with magnificence in passages of scorn and sys-
tematized delusions.
This picture one sees of paresis in Shakes-
peare’s Timon has little to do with the obvious
meaning of the tragedy, for no tragic hero is the
victim of merely" a disease. The heroic nature is
vigorous in its nobility, with a single or few
weaknesses, as the jealousy of Othello (which
assumes paranoid proportions only under the
pressure of villainy), and its fall, as Lear’s mad-
ness, is brought about not by its own imperfection
alone, but by spectacular external circumstances
comprising the dramatic action. In short, the
development of Timon’s paresis is only a part of
the tragedy of man with which Shakespeare con-
cerns himself in his plays. The flaws in the
nature of Timon he himself describes when he
finds himself in debt after lavishing his wealth
on his friends: “Unwisely, not ignobly, have I
given.”5
This fault, however, in itself is relatively
unimportant. It disturbs Timon himself very
little. The tragedy lies in its effect on his friends. |
The senators of Athens, whom he has protected
and served with his money and military leader-
ship, the other friends, who have crowded his
house and repeatedly professed their devotion
to him, will surely save him from poverty (a
serious mistake indeed) ; but they do not. His
friends prove false. Therein, in their nature, lies i
the tragedy. Such is the central theme of the
play, essentially a portrayal of human baseness, I
the parasitic nature of man and the perfidy of
false friends, their effect upon a character both
generous and ingenuous — a theme set forth in
the first, the introductory scene:
When Fortune in her shift and change of mood
Spurns down her late beloved, all his dependants
Which labor’d after him to the mountain’s top
J. Florida. M.A.
January, 1958
HAHN: SYPHILIS IN SHAKESPEARE’S TRAGEDIES
715
Even on their knees and hands, let him slip down,
Not one accompanying his declining foot.
’Tis common: . . .6
In his affluence, while he gave unwisely, him-
self a model of the friend in need, Timon with
naive faith in friendship, part and parcel of his
excessive generosity, attributed to all men his own
virtue, though the bitter wisdom of the surly,
cynic Apemantus sounded a continual refrain of
warning in his ear. When, with one excuse and
another, the former recipients of his bounty, his
former companions, refuse to help him:
They have all been touch’d and found base metal, for
They have all denied him. 7
Their evil so outweighs the good of his loyal
steward as to obliterate it and to nullify its effect,
just as the evil daughters of Lear overpower their
one good sister. In his great disillusionment
Timon rejects that “One honest man.”8 The
shock of this disillusion, the impact of ingratitude
on his too generous and confiding spirit, effects a
transformation, even as the cruelty of filial in-
gratitude ruins the too generous and confiding
Lear. From extreme magnanimity, indiscreet,
indiscriminate charity, all-embracing good will,
he is then thrust by the worthlessness of his
friends, the chief citizens of the city, into a state
of extreme, all-inclusive misanthropy, terminating
in the defeat of Athens by the banished Alci-
biades, whom he assists as a means of revenge,
and ending in his own death. That he loses
judgment and experiences paranoid delusions does
not detract from the main fact of the evil of
man’s ingratitude, but serves better to emphasize
man’s disregard and exploitation of weakness and
sickness.
This theme of predominant evil — though the
play, because of its uneven quality, its frequently
poor rhythm and imagery, and its inferior action,
is usually assumed by literary critics to have been
written in part by a less gifted playwright — is in
accord with Shakespeare’s consistent despair. This
lusty, clear-sighted despair is echoed throughout
his tragedies, as in the welcome to Lear’s death, a
relief that the old king be stretched out no longer
on the rack of the world, or in Hamlet’s soliloquy
of frustration. In Timon this theme of predomi-
nant evil is continuous and it is integrated by the
fact of Timon’s progressive dementia so that the
play must have been written as a continuous proc-
ess, one in which one sees the continuous clinical
picture of syphilitic encephalitis.
Turning now to consideration of the clinical
picture, one focuses attention on quite a different
aspect of the many-sided playwright. Even a
casual study of the plays reveals his remarkable
knowledge of subjects medical and surgical, of the
symptoms and progress of physical disease, even
of psychopathology — an aspect of his universality
of characterization, his penetrating and compre-
hensive portrayal of the human scene, most in-
teresting and significant to physicians. Numerous
passages demonstrating this knowledge have been
collected from his plays by Wainwright9 and
subdivided into the various medical branches
which they seem to illustrate. Certain characters
alone, such as Lear in his madness and the dis-
tracted Ophelia, appear to be prototypes of the
afflicted.
Whether Shakespeare understood in the aca-
demic sense all the medical data that he used, or
whether he borrowed his information from sources
at hand — the heterogeneous mass of literature
from which he derived material, or the physicians
themselves with whom he was acquainted10 — it
is evident that he knew the facts of disease as
they influence human behavior. With astounding
insight, he even evokes psychotherapy:
Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain,
And, with some sweet oblivious antidote
Cleanse the stuff’d bosom of that perilous stuff,
Which weighs upon the heart?1!
The frequency of his mention of medical mat-
ters provides ample proof that much of the med-
ical lore and superstition of his day was familiar
to him. In “The Tempest” an acquaintance with
tuberculosis is suggested: “As if it had lungs and
rotten ones.”12 Lines in “Julius Caesar,” printed
in 1623 in the same folio with “Timon of Athens,”
describe the circulation of the blood back to the
heart13 — a most recent discovery, for Harvey’s
views on the movements of the heart and blood
were first made public in his course of lectures
begun in 1616 at the Royal College of Physicians
in London, though his “Exercitatio anatomica de
motu cordis et sanguinis” was not published until
1628.
References to the manifestations of syphilis
are numerous, attesting its prevalence in Shake-
speare’s time. About 1500 or earlier, it had ap-
peared as a new disease or a highly active form of
an old one. Whether or not it had been brought
back from the West Indies by Spanish sailors
with Columbus is beside the point. It spread
from Italy, where the soldiers of Charles VIII of
France carried it to Naples, then throughout
Europe, so widely that one observer wrote: “It
716
HAHN: SYPHILIS IN SHAKESPEARE’S TRAGEDIES
Volume XLIV
Number 7
involved the Pope on his throne to the humblest
workman.”14 Following the first description by
Leonicenus15 and a description by Astrock, it
became more and more a subject of general dis-
cussion. About 1530 Fracastorius, an Italian phy-
sician, published his poetic description of the
symptoms in a shepherd called “Syphilus,” whence
the disease takes its name. By 1600 it had be-
come still more widespread, pursuing the course
of unusual severity characteristic of an infectious
disease occurring among a people unprotected by
any previous infection with it. It is, therefore,
not difficult to assume that Shakespeare may
have known personally people in whom paretic
dementia developed. This type of insanity, in the
light of purely medical analysis, a narrowly
specialized examination of the subject, seems re-
flected in this character. Timon.
While fully discounting the flamboyance of
Elizabethan diction and the necessity for over-
emphasis in the drama, one discerns in Timon’s
extravagant generosity, fantastic, pathologic ele-
ments:
He pours it out . . .
No meed, but he repays
Sevenfold above itself; no gift to him,
But breeds the giver a return exceeding
All use of quittance. i<>
He imagines the pleasure of lavishing even more:
Methinks, I could deal kingdoms to my friends,
And ne’er be weary. 17
while his steward complains:
He commands us to provide, and give great gifts,
And all out of an empty coffer: . . .
His promises fly so beyond his state
That what he speaks is all in debt; . . .is
and Apemantus comments:
O you gods, what a number of men eat Timon, and
he sees ’em not ! It grieves me to see so many dip
their meat in one man’s blood; and all the madness is,
he cheers them up too.19
Grandiose ideas, a failure to grasp reality, a pro-
nounced exaltation — symptoms typical of paresis,
not the simple dementing type but the grandiose
form — are clearly apparent. To one familiar with
the usual case of this form of syphilitic encephali-
tis, the picture of progressive paretic dementia,
seemingly condensed here for purposes of the dra-
ma, is amazing in its accuracy.
As if the syphilitic spirochete, Treponema pal-
lidum, were indeed destroying his brain cells,
Timon further furnishes abundant evidence of
mental deterioration, so strongly suggestive are
his actions. He speaks of friendship with what
might be called all the maudlin sentimentality of
an enfeebled mind and an almost paranoid self
satisfaction. His words, his views, so frequently
childish, are scarcely credible in a man of his
years and experience unless one bears in mind the
fact that it is usually in middle age that paresis
manifests itself. Oblivious, blind to the most
obvious frauds, divorced from reality,
There is no crossing him in ’s humor . . .20
He neglects his affairs, and refuses to believe his
steward when informed of his dwindling fortune.
No care, no stop ! so senseless of expense,
That he will neither know how to maintain it,
Nor cease his flow of riot: takes no account
How things go from him, nor resumes no care
Of what is to continue . . .21
These warnings of Flavius fall on deaf ears.
What is evident to others Timon cannot see, his
own condition least of all — a lack of insight noto-
rious in one who suffers from grandiose paresis.
Equally symptomatic, as the drama develops,
are his emotional instability and lack of self re-
straint. At the mock banquet (of water) to which
he invites his former friends, he showers on them
furious abuse, and the water and dishes as well.
He disintegrates rapidly, giving way to wild rage
and violence. In his failure to recognize his stew-
ard, one perceives his loss of memory. In the
coarseness of his speech — a coarseness not extreme
by the liberal Elizabethan standards, but far out
of keeping with his customary gentleness as an
aristocrat — one finds further disintegration. Sa-
distically, he rails at the courtesans of Alcibiades:
This fell whore of thine
Hath in her more destruction than thy sword,
For all her cherubin look . . .22
Be a whore still: they love thee not that use thee;
Give them diseases, leaving with thee their lust.
Make use of thy salt hours: season the slaves
For tubs and baths; bring down rose-cheeked youth
To the tub-fast and the diet. 23
Timon further waxes incoherently eloquent:
Matrons, turn incontinent !
or
... to general filths
Convert o’ the instant, green virginity
or
Maid, to thy master’s bed ;
or
Son of sixteen,
Pluck the lined crutch from thy old limping sire,
With it beat out his brains !
or
Lust and liberty
Creep in the minds and marrow
of our youth . .
or
Itches, blains,
Sow all the Athenian bosoms; and their crop
Be general leprosy 124
f. Florida, M.A.
January, 1958
HAHN: SYPHILIS IN SHAKESPEARE’S TRAGEDIES
717
He talks insanely, yet he values himself highly:
But myself,
Who had the world as my confectionary,
The mouths, the tongues, the eyes and the hearts of
men
At duty, more than I could frame employment, . . ,23
After such outbursts he is repeatedly labeled
by those who observe him as a madman, until
“full of decay and failing”26 he succumbs to sud-
den death.
Not only are the findings here ample for a
diagnosis of paresis, but the most violent dramatic
form of the disease is here uncannily though,
without a doubt, unintentionally pictured. Cer-
tainly, paresis as a clinical entity was not de-
scribed in the time of Shakespeare. That the pres-
ence of the disease paresis is superfluous to the
tragedy as a whole can be admitted, particularly
when one reads some of the passages describing
syphilitic symptoms which actually have no effect
on the over-all plot, such as:
Consumptions sow
In hollow bones of man; strike their sharp shins,
And mar men’s spurring. Crack the lawyer’s voice,
That he may never more false title plead,
Nor sound his quillets shrilly; hoar the flamen,
That scolds against the quality of flesh,
And not believes himself: down with the nose,
Down with it flat; take the bridge quite away. .
or
. . . make curl’d-pate ruffians bald;
And let the unscarr’d braggarts of the war
Derive some pain from you: plague all;
That your activity may defeat and quell
The source of all erection. 28
Actually, for the purposes of the play, Timon as a
clearcut character of an overly generous man
whose wits are “drowned and lost in his calami-
ties”29 would suffice. The fact, however, of his
having been described as a victim of paranoid
dementia at the same time that many overtones
of syphilis are thrown into the description can
only suggest that Shakespeare thought that the
disintegration of the hero would be much more
striking and much more calamitous by this addi-
tion of the paretic state, thus giving Wainwright
the argument that the whole play was written
by Shakespeare, not by lesser playwrights in the
last three acts, as many critics have insisted.
Shakespeare must have observed persons once, or
perhaps several times, with symptoms of paresis
and in his creation of the character of Timon
blended his observations. The resemblance is so
striking that were a skillful actor to simulate in
the part certain physical manifestations of the
disease — tremors and speech defects — the picture
would certainly be complete.
One can assume, for the sake of argument,
that Shakespeare recognized that certain syphili-
tic processes lead to a type of insanity which is
now called paresis, and this argument, of course, is
well documented by the descriptions and the
speeches of Timon. Nevertheless, it is equally argu-
able that Shakespeare merely used symptoms
of syphilis and paresis to emphasize the de-
struction of a personality by the overwheh ling
evil of the world and men, a necessary attribute
for the heroic state in the play. If, however, one
keeps in mind the protean nature of the disease,
paretic dementia, the uncanny ability of Shake-
speare to describe medical subjects, and his great
interest in mental disease, the play “Timon of
Athens” becomes, not a partial work of Shake-
speare, not a lesser play, but a classic, a source
book for students of the history of syphilis.
References
1. Plutarch: Antony.
2. Timon, or the Man-Hater.
3. Paynter, William: The Palace of Pleasure, 1566.
4. In a comedy written about 1600, it is thought, perhaps
at Oxford or Cambridge.
5. Act II, Scene 2, line 183.
6. Act I, Scene 1, lines 84-89.
7. Act III, Scene 3, lines 6-7.
8. vct TV, Scene 3, line 504.
9. Wainwright, John W. : The Medical and Surgical Knowl-
edge of William Shakspere, New York, private printing
1915.
10. Shakespeare’s son-in-law, John Hall, a physician, is dis-
cussed in Leftwich, Ralph W.: Shakespeare’s Handwriting
and Other Papers, Worthing Gazette Company, 1919.
11. Macbeth, Act V, Scene 3, lines 40-45.
12. The Tempest, Act II, Scene 1, line 47.
13. Julius Caesar, Act II, Scene 1.
14. Astroek, cited by Wainwright.1*
15. I.eonicenus, cited by Wainwright.9
16. Act I. Scene 1, lines 287-291.
17. Act I, Scene 2, lines 226-227.
18. Act I, Scene 2, lines 198-199, 203-204.
19. Act I, Scene 2. lines 38-42.
20. Act I, Scene 2, line 166.
21. Act II, Scene 2, lines 1-5.
22. Act IV, Scene 3, lines 61-63.
23. Act IV, Scene 3, lines 83-84.
24. Act IV, Scene 1, lines 3, 6-7, 12, 13-15, 25-26 and 28-30.
25. Act IV, Scene 3, lines 259-261.
26. Act IV, Scene 3, line 466.
27. Act IV, Scene 3, lines 151-158
28. Act IV, Scene 3, lines 160-164.
29. Act IV, Scene 3, line 89.
231 East Rich Avenue.
718
Volume XLIV
Number 7
Office Study of the Infertility Problem
John J. Fisher, M.D.
Jacksonville
One portion of the general field of gynecology
that has shown great progress during the past two
decades is that of the study and treatment of the
relatively sterile, or infertile woman. So much
attention has been accorded this problem that the
care of the infertile couple has become almost a
subspecialty of its own. Such specialization should
not deter the practicing gynecologist from en-
gaging in this type of work; nor, in communities
where no gynecologist practices, deter the gen-
eral practitioner from helping infertile couples.
Although these patients are not ill, they number
among their group the most appreciative of all
patients; and many complaints of a psychosomatic
nature are assuaged, or indeed dissolved by the
happy occurrence of a successful conception.
At the same time, it behooves the physician
who assumes the study of one of these problems
to devote to it a sufficient amount of time as
well as training. In few other instances is an in-
sufficient amount of attention more harmful, as
a half-performed study may often lead to early dis-
couragement, and the failure later to seek more
complete assistance at competent hands for this
complaint. If adequate physician time or interest
for a complete work-up is not available, the pa-
tient is best served by referral to that physician
who owns these equally precious qualities in ad-
dition to the necessary training.
Many plans and procedures have been advo-
cated for the study of the infertile woman. The
plan proposed here combines the advantages of
thoroughness with the attributes of systematic
ease and relative inexpense. Throughout this pa-
per I have avoided any discussion of the treat-
ment of the infertility problem, this being in it-
self an equally large field of endeavor, although
dependent throughout upon the results of the di-
agnostic study.
The proposed infertility study is arranged over
a course of five office visits, four visits following
the original consultation and statement of the
problem. The patient is allowed the opportunity
to become pregnant throughout most of the study,
which happy circumstance would make the later
visits totally unnecessary.
Initial Consultation
At the time of the first visit a complete his-
tory is taken, with especial interest as regards ill-
nesses, injuries, or operations. A complete physical
examination is also performed, with interest cen-
tering in constitutional deficiencies which would
possibly affect fertility. Elaboration on this point
is not necessary.
A careful pelvic examination is included, and
any deviation from normal pelvic development and
anatomy is noted. The cervix is especially re-
garded from standpoints of position, stenosis, and
inflammation. The cervix is sounded if the uterus
is firm and small and the last menses within the
preceding two weeks; otherwise, this procedure
is left to a subsequent visit.
The patient is returned to the consultation
room, and the results of the examination are ex-
plained, with particular emphasis on normalcy
when present, but equal recognition of poor prog-
nostic findings. If the condition of absolute ste-
rility has been uncovered, the study ceases. If a
correctable pelvic pathologic condition exists,
this is attended to before continuance.
Following reassurance to the patient that the
necessary anatomy is present and apparently nor-
mal. the physiology of reproduction is outlined
and the further study thereof explained. The cost
of the visits is discussed frankly. If the patient
desires to undergo the remainder of the study,
she is given a basal temperature chart with in-
structions to keep this from the viewpoint of a
factual reporter only, to bring it with her on each
subsequent visit, and to attempt to draw no con-
clusions of any kind from this chart. She is further
instructed to telephone the office on the first day
of her next menses, at which time she is given
an appointment for the fourteenth day of her
cycle, or the fourteenth day premenstrual to the
following expected menses. If she should skip
her next menses, she is told to arrange an examina-
tion three weeks later for a possible diagnosis of
early pregnancy.
If the patient does not wish to undergo the
proposed study, the consultation is regarded as a
routine examination. The patient is advised to
J. Florida, M.A.
January, 1958
FISHER: OFFICE STUDY OF INFERTILITY PROBLEM
719
return for routine check-up examinations, and
during the interim between visits both physician
and patient hope for a spontaneous solution to
her problem. It might be added that for some
reason, possibly a psychosomatic one rather than
a purely statistical one, pregancy follows no study
or treatment other than the original consultation.
Second Visit, Cervical Mucus Evaluation
At the second visit, the patient is placed on
the examining table, having been instructed when
she called to make the appointment to have had
intercourse within six hours, and preferably two
hours, before her office appointment. There should
be no precoital or postcoital douche and no med-
ication or contraception. A bivalve speculum is in-
troduced, and the cervix wiped dry with a clean
cotton ball without medication. A smooth thumb
forceps is introduced into the external os, and
cervical mucus is obtained by a twisting motion,
placed on a slide, and examined immediately un-
der the microscope. The patient is kept on the
table in case of a poor specimen, when a second
specimen is taken, or for a recheck pelvic ex-
amination to confirm that of the initial visit. At
this time the cervix is sounded. She is then re-
turned to the consultation room.
If the specimen shows 20 to 50 active sperm
per field, it is assumed that the husband is con-
tributing his share, and that the technic of coitus
is satisfactory. If the cervical mucus is below par,
the husband is referred to a urologist for infertility
study, and there is further investigation into the
coital technic employed, which otherwise is only
touched upon. Further work-up awaits the report
of the urologist in this event.
Assuming a good specimen, the patient is re-
assured, any questions raised by the foregoing
work-up are answered, and the basal temperature
chart is examined. The patient is instructed to
call with the next menses, at which time appoint-
ment will be given for the twelfth day of the cycle,
or the sixteenth premenstrual day.
Third Visit, Rubin Test
The patient makes the third visit on the six-
teenth day preceding her expected menses, follow-
ing at least four days of abstinence from inter-
course. Pelvic examination is performed following
examination of the basal temperature chart, the
physician being careful to note the size and the
position of the fundus. The Rubin test is then
performed in the usual manner with carbon di-
oxide gas, confirming the visual positive result
on the gauge by auscultation and the shoulder
pain sign.
If the result is a negative one, the procedure of
the third visit is repeated. With a second nega-
tive result, roentgen investigation by means of
hysterosalpingography is recommended.
If the result is positive, the patient is advised
that the optimum time for intercourse now exists,
and that there should be coitus on the next three
or four nights, or more if possible. There should
be an interval of another month without further
investigation if pregnancy does not ensue. The
month following, the patient should abstain from
marital relations, and an endometrial biopsy
should be scheduled for two to three days before
the next expected menses. If there is reason in the
individual case to hesitate losing even this one
month from exposure to pregnancy, the biopsy
can be scheduled for the first day of menstrual
flow in either of the succeeding months.
Fourth Visit, Endometrial Biopsy
At the time of the fourth visit, the patient is
prepared for examination while the basal tempera-
ture chart is reviewed. Endometrial biopsy is
performed, with or without an accompanying vag-
inal smear. With the Novak curet, this is no more
of a procedure than the Rubin test. This is also
a good time to perform a cautery of the cervix,
if indicated. The patient is given an appoint-
ment to return following her next menses unless
cautery has been performed, in which event the
appointment is made for three weeks following.
Fifth Visit, Summarization Consultation
At the fifth visit, the patient has a general
summarization of the results of the entire investi-
gation explained to her. There is an attempt
made to give her a fertility quotient. The weak
points in her fertility makeup are discussed at
some length, and the treatment program outlined.
In a small number of cases the results of study
to this point will have pointed in the direction of
one unusual or a combination of unusual factors
which dictate specialized and advanced study.
This is on the borderline of therapy in itself, and
beyond the scope of the present discussion.
Summary
A simplified method of the office study of the
infertile woman is presented that is adaptable to
the average private practice of gynecology. The
entire study outline as well as a simplifed explana-
tion of the physiology of reproduction is presented
to the patient at the initial visit, in order that
720
ANDREWS: LABOR WITH EMPHASIS ON STAGE I
Volume XLIV
Number 7
she may understand exactly what is entailed. It is
explained that the entire study must be per-
formed, since often there is a combination of
factors present to account for the infertility. Nat-
urally, conception may occur at any time through-
out the progress of the study, and the remainder
precluded. No attempt is made to elaborate on
the deviations from the basic study pattern oc-
casionally indicated, nor to discuss the therapeutic
aspects of this subject, an equally large topic
in its own right. It should be emphasized that a
thorough understanding of the entire subject be
transmitted to the patient in order to obtain
complete cooperation on her part and the full
benefits of the psychosomatic component.
1 707 San Marco Boulevard.
Labor With Emphasis on Stage I
Frederick C. Andrews, M.D.
MOUNT DORA
The advent of new agents for stimulating labor
makes it necessary for the physician to re-evaluate
its management. More and more it is becoming
the fashion to induce labor in the expectant moth-
er as she approaches term or to stimulate the
“sluggish” labor or primary inertia. These pro-
cedures carry with them certain dangers.
This article probably could more appropriately
be said to deal with the conduct of the physician
during labor rather than the “conduction” of
labor. Its purpose is to stress primarily stage I,
that portion of labor that all too frequently the
physician fails to observe. He leaves the pa-
tient in the care of the nurses, orders medication
over the telephone and makes his appearance at
the more active and stimulating phase of labor,
stage II. During stage I the course of stages II
and III is plotted, and it is here that the final out-
come of the pregnancy usually can be determined.
The onset of stage I is signified by uterine
contractions occurring at regular intervals. These
may commence spontaneously or be induced.
The spontaneous onset of stage I may be either
of good quality, consisting of strong contractions
occurring at eight minute intervals, then dropping
to five minute and three minute intervals, lasting
at least 40 seconds with progressive effacement
and dilatation of the cervix, or it may be sluggish
with short contractions 30 seconds or less in dura-
tion occurring at irregular intervals varying in
length from 15 minutes to three minutes. There is
no progress in the effacement or dilatation of the
cervix. Fundal dominance is absent.1
In the “sluggish” or hypotonic type of labor,
much can be done to help shorten the time the
expectant mother spends in stage I. Often a minim
of Pitocin given subcutaneously is sufficient to
cause the uterus to enter into a labor of good
quality with contractions occurring at three min-
ute intervals and lasting 40 seconds or longer.
The contractions obtained are frequently extreme-
ly hard, near tetanic in character; they relegate
the method to selected cases which should be in
multiparas with a well effaced, “ripened” cervix
dilated 4 cm. with the vertex well down in the
pelvis and the membranes already ruptured.
Method of Administering Oxytocics
Giving Pitocin or oxytocics subcutaneously or
intramuscularly in this stage carries with it dan-
gers which can be circumvented by giving the
substance intravenously. One is not able to con-
trol the patient’s “pick-up” of the medication from
the site of the injections; therefore, the desired
effect may not be obtained.
The most satisfactory and safest method that
the physician may use to aid and stimulate the
progress of labor at this stage is the administra-
tion of Pitocin intravenously.2 This also applies
to other medications which are given, such as
Demerol and scopolamine. The response is more
readily controlled when the drug is given intrave-
nously. A 1 : 5,000 solution of Pitocin is preferable
to the 1:1,000 solution, for I have found that the
control of the more dilute solution is easier at the
onset and up to 40 minims per minute may be
given.3 With a stronger solution no more than
8 minims per minute should be given.
Regardless of the method used, the physician
who is responsible for the course of the labor
should be with the patient. During the first 30
minutes of induction he should have one hand on
the abdomen and the other ready to stop the
Pitocin if the contractions become too strong.
J. Florida. M.A.
January, 1958
ANDREWS: LABOR WITH EMPHASIS ON STAGE I
721
This procedure should be carried out for at
least the first 30 minutes. The patient should be
followed closely by the physician throughout the
period that she is receiving the Pitocin. Unless
the physician is attending the patient continuously,
adequate control is not obtained, and accidents
may result.
Prior to giving Pitocin by either of these
methods, it is wise to carry out a few simple pro-
cedures: 1. Wipe the membranes away from the
cervix. 2. Rupture, if possible, the membranes.
Often this is enough to stimulate the “sluggish
uterus” into an active procedure. Occasionally,
there is no fluid between the oncoming head and
the membranes, or the cervix may be posterior,
which makes rupture of the membranes difficult.
In such cases, merely wiping the membranes will
usually suffice. This, of course, requires the phy-
sician to be standing by and managing the case
rather than the nurse assigned to the labor room.
Induction of Labor
The physician who embarks upon an induc-
tion of labor should well consider the state of the
patient and fetus prior to induction. The patient’s
emotional status as well as physical condition
must be considered. If certain criteria are ful-
filled, the induction can be undertaken fairly
safely. If not, then one is assuming the respon-
sibility of added risks against a satisfactory out-
come.
The requirements that are necessary for in-
duction of labor are a vertex presentation at mid
pelvis with a well effaced cervix dilated 2 to 4 cm.
and with the membranes either stripped from the
cervix or ruptured. If the membranes are not
already ruptured, then they should be manually
ruptured as soon as possible. Labor should then
terminate in six to eight hours.
Here again a 1:5,000 dilution of Pitocin is
preferred because of the ease with which it can
be controlled. The physician should be with the
patient throughout the first portion of the induc-
tion, one hand resting on the abdomen to feel the
uterine activity and the other used to control the
flow of Pitocin, gradually increasing it as is in-
dicated to him through his hand on the uterus.
Contractions should be approximately 45 seconds
in duration at three minute intervals.
Too rapid a flow of Pitocin may produce one
or more of the following conditions: uterine te-
tanic contractions; rupture of the uterus; lacera-
tion of the cervix, vagina and perineum; or fetal
damage.
It is advisable to use a Y tube with a bottle
of 5 per cent dextrose in water in tandem with the
Pitocin solution. This setup allows fluids to be
given to keep the vein open if the Pitocin is tem-
porarily discontinued.
If tetanic contractions or Bandl’s ring occurs,
the Pitocin should be stopped. Deep anesthesia
with ether will often cause the uterus to relax.
Ether requires 10 to 30 minutes to give, depend-
ing upon the previous medication that the patient
has received. Magnesium sulfate, l Gm. in 20 cc.
of diluent, given intravenously is a much easier
method.4 Often amyl nitrite, when inhaled, will
relax the contracting ring.
With rupture of the uterus, rapid surgical in-
tervention is indicated. Lacerations of the cervix,
vagina or perineum are usually not detected un-
til after the end of stage II or III. These, of
course, are repaired. The damage to the infant
may be apparent early or may not be detectable
until long after the delivery.
It is important to remember that the use of
Pitocin brings increased responsibility for the phy-
sician who desires to use it in his armamentarium.
Pitocin is a powerful agent and should be handled
with respect. It should not be used with a laissez-
faire attitude. Above all, the patient should be
under the constant supervision of the physician.
Summary
This article deals principally with the conduct
of labor during stage I.
Emphasis is placed upon the physician’s re-
sponsibilities during this stage of labor with spe-
cial emphasis on the proper use of Pitocin.
References
1. Danforth, D. N. : Distribution and Functional Activity ot
Cervical Musculature, Am. J. Obst. & Gynec. 68:1261-1271
(Nov.) 1954.
2. Hofbauer, J.: Forty Years of Postpituitary Extract in Ob-
stetrics Am. J. Obst. & Gynec. 69:822-825 (April) 1955.
cited in Greenhill, J. I*.: Year Book of Obstetrics and
Gynecology 1955-1956, Chicago, The Year Book Publishers,
1955, p. 149.
3. Stone, M. L. ; Gordon, M. F., and Folsome, C. E.: Further
Observations upon Use of Intravenous Pitocin in Obstetrics,
Am. J. Obst. & Gynec. 69 : 1 40-146 (Jan.) 1955.
4. •< tz*'ii. \v . I.. niiu Shuhn-in, A. Intravenous Pit ■•cm a”*l
Elective Induction of Labor, Obst. & Gynec. 6:493-498
(Nov.) 1955.
Clinic Building.
722
Volume XLIV
Number 7
ABSTRACTS
Traumatic Torsion of the Lung. By De-
Witt C. Daughtry, M.D. New England J. Med.
256:385-388 (Feb. 28) 1957.
Torsion of the lung is a rare complication of
thoracic trauma. Its diagnosis should be sug-
gested by crushing or compression injury of the
lower thorax associated with the early x-ray find-
ing of a vascular pattern that radiates superiorly
and laterally, with rapid disappearance of breath
sounds and prompt progression to a homogeneous
density of a ground-glass type.
A case of traumatic torsion of the lung in a
seven year old girl is reported in which the pa-
tient survived after extensive surgery and is in
excellent condition. The one remaining segment
of the left lung occupies most of the left side of
the thorax and is apparently serving a useful
purpose. There is some experimental and clinical
evidence that lung growth takes place in a child
seven years of age. Serial pulmonary function
studies will appear in a subsequent report. The
only other reported case terminated fatally.
Early recognition of what seems to be a diag-
nostic x-ray sign should alert one to proceed
with operation before irreversible pulmonary
changes have occurred.
In addition to the salient features of diagnosis,
the pertinent differential diagnoses are discussed.
A theory of the mechanism of torsion of the lung
is proposed.
Removal of Urethral Calculi by Johnson
Stone Basket. By Raymond J. Fitzpatrick. J.
Urol. 77:377-381 (March) 1957.
A simple method for the removal of impacted
or obstructing urethral calculi under 2 cm. in
diameter is proposed. Three cases are presented
in which calculi impacted in the urethra were
readily extracted at the office by means of a John-
son stone basket attached to a 33 cm. woven ure-
thral filiform (No. 56 thread). A finger should be
inserted into the rectum for stones in the prostatic
urethra, or the stone should be grasped between
the thumb and index finger when located in the
more accessible portions of the urethra, as simul-
taneous basket manipulation with the opposite
hand is accomplished. The procedure may be per-
formed under topical anesthesia with or without
trilene analgesia. The size of the stone and the
existence of an urethral caliber estimated to be
adequate for its passage should be known before
one attempts to ensnare and extract it. Calibra-
tion should extend down to the stone but not
beyond it for fear of possibly pushing the cal-
culus back into the bladder. For calculi greater
than 1.0 cm. in diameter, it is suggested that the
capacity of the basket cage be increased by out-
ward bending of its wires. Whether meatotomy,
urethrotomy or endoscopy is indicated depends
upon each individual case.
After the preparation of this paper, five of
several calculi found on routine urethral calibra-
tion, none of which was obstructing the urethra,
were readily removed by this method from the
prostatic urethra of a patient awaiting admission
to the hospital for urologic surgery. The largest
of the stones was 1.2 cm. in diameter.
Segmental Liver Revascularization. An
Experimental Study. By H. Clinton Davis,
M.D., and Irwin S. Morse, M.D. A. M. A. Arch.
Surg. 74:525-527 (April) 1957.
Since Vineberg’s observation that implanta-
tion of the internal mammary artery into the
myocardium will result in collateral circulation
had not been experimentally applied to other or-
gans, this study was undertaken for investigative
purposes in the hope that it might lead to a meth-
od of segmental arterialization of the liver in
which both a revascularized lobe and control lobes
could be evaluated in the same animal. The
method employed and the results obtained are
described. It is concluded that direct implanta-
tion of the splenic artery into a normal canine
liver lobe can result in endothelial proliferation
and collateral circulation with hepatic vessels.
From a quantitative standpoint the amount of
collateral anastomoses created by this technic in
normal liver tissue is not impressive.
Experiences in Intravenous Urography
Using Hypaque. By Benedict R. Harrow,
M.D. Am. J. Roentgenol. 75:870-876 (May)
1956.
A new urographic agent, containing 59.9 per
cent iodine with 3 iodine atoms per molecule,
was introduced in 1954 under the name of Hy-
paque. In the study reported here, this medium,
supplied as a 50 per cent solution, was used in
a series of 50 patients, half receiving 30 cc. and
J. Florida, M.A.
January, 1958
ABSTRACTS
723
half receiving 60 cc. It was concluded that this
agent was an excellent, almost ideal, urographic
substance with minimal side reactions, and yet
with roentgenographic densities equal to urokon,
when equivalent molecular loads are utilized.
No pain in the arm occurred with slow injec-
tions. No proteinuria or crystalluria resulted
even after the 60 cc. dosage.
The urine concentration of all organic iodides
is limited to a 0.2 molar concentration no matter
how great the molecular load. Hypaque results
in a decreased hydrogen ion concentration of the
urine in contrast to other organic iodides, per-
haps because of the inhibition of renal carbonic
anhydrase. Some of the osmotic relationships in
excretion are discussed.
The most important factor in obtaining ex-
cellent urograms, the author observes, is the
proper use of adequate compression for two min-
utes. Most technicians do not understand the
factors involved so that poor filling is obtained,
leading in most hospitals to discontinuance of
this valuable procedure. The physician in charge
must take an active interest in teaching the
correct intravenous pyelographic procedure to
technicians.
The Clinical Problem of Adiposity of the
Heart and Cardiac Enlargement of Un-
determined Etiology. By H. J. Roberts, M.D.,
F.C.C.P. Dis. of Chest 31:84-92 (Jan.) 1957.
In this report, the problem of fatty infiltration
of the heart is discussed, and a probable case of
adiposity of the heart diagnosed clinically in a
living 30 year old man is presented. The patient’s
asymptomatic cardiomegaly decreased radiographi-
cally but slightly after six months, even with de-
cided reduction in weight. The author observes
that this entity, which to his knowledge has here-
tofore been only a postmortem diagnosis, should
be suspected in patients demonstrating unexplain-
ed cardiomegaly in the presence of a recent rapid
and profound gain in weight and in the absence of
the stigmata of the other causes of heart disease.
The condition may be either asymptomatic or
manifested by heart block and congestive heart
failure.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 241, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
THE SCIENTIFIC EXHIBIT
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With words, pictures; with light and sound.
If your special scientific interest
Lends itself to portrayal, then consider
THE SCIENTIFIC EXHIBIT
EIGHTY-FOURTH ANNUAL MEETING
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Contact the Association, P. O. Box 2411, Jacksonville, for an application blank.
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turning your application, attach a general statement briefly describing vour subject,
together with a photograph if available.
THOUGHT FOR A
NEW YEAR
ta but a Uraam, attb ®u-utnrrnui 10
mtly a Utatmt, but ulu-bag wall liuab
utakaa nu'nj
a 0 mutt uf If apjriuaaa, attb auarij
a n-murrmu a U taunt uf If uju.
IGuuk tuall, tljmfum tutSlgaSag!
J. Florida. M.A.
January, 1958
725
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON, M.D.. Editor
STAFF
Assistant Editors Managing Editor
Webster Merritt, M.D. Editorial Consultant
Franz H. Stewart, M.D. Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. JarvIis
Committee on Publication
Shaler Richardson, M.D., Chairman. . . .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr. M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean. School of Medicine. University of Miami
A Trend Toward Less Hospitalization?
Until the late nineteenth century, the hospital
was generally viewed as a pest house or as a
suitable place for the confinement of patients in
the terminal stage of illness. Surgical and nursing
technics were of such a nature as to discourage
rather than encourage the use of the hospital.
In the past 75 years, however, this picture has
changed completely. Improved technics have
made the hospital a “safe’’ place, and Blue Cross
and other insurance plans have helped to fill our
hospitals to overflowing. This trend toward ac-
ceptability has become so general, in fact, that
the number of hospital beds per 1 ,000 population
has become one of the indices of a community’s
health — or, at least, of its concern for health.
There are beginning signs, however, that
such an index may become less reliable in the
future. Two examples — both within Florida -
will suffice to illustrate this fact. Several decades
intervened between the time when tuberculosis
was seen to be a major health problem and that
when the provision of an adequate number of
specialized hospital beds for tuberculous patients
was thought to be economically possible. The first
state hospital for the treatment of tuberculosis
in Florida was opened 20 years ago; almost 15
additional years were required before the goal
of a complete state system of such hospitals was
achieved. (Few States, incidentally, have made
comparable progress in this area.) Even before
the last of these hospitals was opened, however,
the picture was changing. Better medical care,
improved economic conditions, more adequate
case finding methods, more diligent search for
infected persons, and a more general knowledge
of health and illness — all of these contributed
to a decided decline in death rates from tubercu-
losis.
Almost coincident with the completion of
the tuberculosis hospital system was the avail-
ability of new drugs to shorten the period of
necessary hospitalization and to make home care
and treatment medically, economically and social-
ly feasible. Disagreement still exists as to
the length of time the person with tuberculosis
should remain in the hospital, but the fact re-
mains that in Florida, as elsewhere, there is less
need for hospital beds for this disease, and that
the hospital censuses are declining. For tubercu-
losis. at least, we have arrived at a point where
the number of beds devoted to patients with this
726
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 7
disease is neither an adequate index of the rela-
tive freedom from the disease nor of the effi-
ciency of measures being undertaken as treat-
ment.
A comparable development in the area of men-
tal disease is apparently in its initial stages. The
feverish building of facilities for care of the
mentally ill has been the recent answer to our
self castigation for the past neglect; the ratio of
psychiatric beds to population has become an
important index in measuring both sensitivity to
the problem of mental illness and the extent of
treatment. As in the case of tuberculosis, however,
new concepts of treatment and new therapies
have now appeared; these give more than casual
promise of decreasing the hospital stay of many
psychiatric patients, and of shifting the site of
treatment to the psychiatrist’s or even the gen-
eral practitioner’s office and to the patient’s
home.
Nor should we think only in terms of special
purpose hospitals in this connection. In the case
of general hospitals similar factors have been at
work. Modern medical technology has reduced
radically the average stay of a patient, and many
persons are now treated in the physician’s office
who formerly would have required hospitaliza-
tion.
The need for additional hospital beds is not a
spurious one, however. The dramatic increase in
population, improved economic conditions and
insurance coverage of hospital care have together
greatly increased the demand for hospital beds.
The alertness to need and demand for more medi-
cal care on the part of the general public is real.
What, then, is the challenge to the medical pro-
fession?
Fortunately, the physician is by education,
training and experience able to adapt himself
to the changes occurring in the practice of medi-
cine. If he views medical care in its largest per-
spective, the modern physician is able to empha-
size preventive measures, to use his office as a
treatment center, and thus to continue many
patients in their job, home and community re-
lationships. With the new technics at hand,
the physician is less rather than more dependent
upon the hospital; with such, the patient is less
subject to the economic, psychologic and social
distortions of life for himself and his family
which are so often caused by hospitalization, and
the latter, obviously, is an important goal of the
modern physician.
If, therefore, the trend toward less need for
hospital beds is real, it is a healthy one, and
every physician should use his best efforts to
promote it.
Advance Planning for Annual
Meetings of Specialty Groups
Specialty groups approved by the Florida
Medical Association which regularly hold meet-
ings at the time of the Association’s Annual Meet-
ing are being requested to schedule their sessions
this year on May 10, Saturday morning, after-
noon and evening, and May 11, Sunday morning
and evening. These dates have been reserved for
the meetings of specialty groups by the Board of
Governors of the Association and are identical
with arrangements followed last year at the con-
vention in Hollywood.
The dates for the Association’s Eighty-Fourth
Annual Meeting are May 10 to 14, and the place
is the Hotel Americana, Bal Harbour, just north
of Miami Beach. The first session of the House
of Delegates convenes on Sunday afternoon, and
the Board of Governors has ruled that no con-
flicting meetings are to be scheduled. All specialty
societies, therefore, are urged to conclude their
programs before this time, or recess until the
meeting of the House of Delegates is finished.
Letters requesting certain information about
the meetings of specialty societies have been sent
to the secretaries of the various societies by the
Association's executive office. The secretary of
each group is requested to give the number and
time of the sessions scheduled and also infor-
mation about luncheons, dinners and other social
activities.
It is expected that some societies may desire
to combine meetings because of the importance
of a speaker or the overlapping of his subject
into the field of a closely allied specialty. Ar-
rangements should be worked out between the
specialty groups involved before the information
is sent to the Florida Medical Association. The
problem of closely related societies meeting at
the same time has been a source of annoyance
to many physicians. Each society may have an
outstanding program which would attract a siz-
able audience if the meetings were combined.
When the meetings conflict, the physician feels
his duty is to his own specialty group and there-
fore may have to forego hearing an outstanding
speaker whom he desired to hear.
J. Florida. M.A.
January, 1958
EDITORIALS AND COMMENTARIES
727
The programs of the meetings of the specialty
groups are scheduled for publication in the April
issue of The Journal along with the program of
the Annual Meeting of the Association. Specialty
group program chairmen or other officers in
charge of the program are urged to begin com-
piling their program as soon as possible in order
that a copy may be sent to The Journal on or
before March 1, the deadline for copy for the
April issue.
The importance of the completeness of the
program cannot be overemphasized. Speakers
should be identified by title and city. The titles
of all addresses should be given. If there is to
be an afternoon and an evening session, this
schedule should be made clear in the program.
Cocktail parties and dinners should be planned
in advance and made a part of the program. If
a speaker has been scheduled for the dinner ses-
sion, he should be identified and the title of his
address given. Basic planning would assure ade-
quate accommodations for the social affairs, add-
ing to the enjoyment of members of the specialty
group as well as guests.
Physicians in charge of arrangements for
alumni and fraternity functions to be held at the
time of the Association’s Annual Meeting should
provide information about these affairs to the
Association’s executive office. The date, time and
number of persons expected are important.
“What Is An Ophthalmologist?”
A notorious example of public confusion in the
field of medical care pertains to the difference in
the training and functions of ophthalmologists,
opticians and optometrists. Recently, the National
Medical Foundation for Eye Care was established
by American ophthalmology to create a better
public understanding of the professional and sci-
entific standards of good eye care, and of the
qualifications and functions of ophthalmologists
and all the related technical personnel who assist
them in providing eye care to the public. The
Foundation gathers, studies and disseminates in-
formation to the medical profession and the public
alike relating to scientific eye care.
A leaflet entitled “What Is An Ophthalmolo-
gist?” has now been published by the Foundation,
defining an ophthalmologist, an optician and an
optometrist. It is being widely distributed by
ophthalmologists to their patients and should be
quite as interesting and useful to other members
of the medical profession as to ophthalmologists.
It is available on request to the Foundation, which
has executive offices at 250 West Fifty-Seventh
Street, New York 19, New York. The definitions
are as follows:
An Ophthalmologist is a physician — a
doctor of medicine — who specializes in the
care of the eye and all the related struc-
tures. He diagnoses and treats defects of
focus, disorders of function, and all other
diseases of the eye, prescribing whatever
is required, including glasses. He is often
concerned, as a consultant member of the
medical team, with diseases of other sys-
tems of the body or general diseases which
manifest themselves in the eyes — diabetes,
toxemia of pregnancy, cancer, multiple
sclerosis, tuberculosis and other infections,
hypertension, muscular dystrophy and
heart disease, among others. Ophthalmol-
ogy is a branch of medicine and the oph-
thalmologist is an eye physician and usual-
ly also an eye surgeon.
An ophthalmologist has first completed
the full course of medical studies, received
the degree of M.D., served an internship
in general medicine and surgery in an ap-
proved hospital, and has then taken spe-
cial training in ophthalmology. Like the
family physician, the ophthalmologist and
all other medical specialists are licensed to
practice all branches of medicine and
surgery.
Oculist is a less commonly used name for
ophthalmologist.
Other terms which you should understand
in connection with eye care are:
An Optician is a skilled technician, aux-
iliary to medicine, who supplies and fits
glasses on the prescription of a physician.
He is trained to make the necessary facial
measurements; to formulate the specifica-
tions necessary, and to make the glasses or
other appliances; and to adapt them to the
patient, placing them properly in relation
to the eyes. He supplies glasses or other
appliances only on the doctor’s authoriza-
tion.
An Optometrist is a licensed person
who has met certain legal and educational
728
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 7
requirements and is permitted by the state
to engage in the practice of optometry. He
is not a physician or doctor of medicine.
The word optometry comes from two
Greek words — opto meaning “eye,” and
meter, “measure.” The optometrist meas-
ures the focus of the eye for glasses. He
is not qualified or permitted to use drugs
for these tests or for any other purpose.
He is not qualified or permitted to diag-
nose or to treat ocular disease. He may
supply glasses on his own prescription.
In most states he is also permitted, like
the optician, to fill the ophthalmologist’s
prescription for glasses. By law he is a
limited practitioner.
Southern Medical Association
Meeting Held at Miami Beach
The Fifty-First Annual Meeting of the South-
ern Medical Association, held at Miami Beach,
November 11 to 14. 1957, was the major medical
event in Florida during that month. Over 300
scientific papers in 100 different meetings were
presented before the 20 sections, comprising one
of the world’s largest medical meetings. Some
5,000 physicians and their wives were in attend-
ance, and many social affairs enlivened the oc-
casion. More than 50 medical association officials
and specialists from Cuba and other Latin Ameri-
ican countries were present.
At the closing night session. Dr. W. Kelly
West of Oklahoma City was installed as president.
Dr. Milford O. Rouse of Dallas was chosen
president-elect to take office next year, and Dr.
Edward H. Lawson of New Orleans was named
first vice president. Dr. Donald F. Marion of
Miami, chairman of the Greater Miami Commit-
tee on Arrangements for the meeting, was elected
second vice president.
The broad scope of the scientific sessions had
wide appeal to practitioners in all branches of
medicine. This most complete refresher course,
with discussions, all condensed within four days
and held right on the doorstep of Florida physi-
cians, gave them an unusual opportunity for pro-
fessional stimulus, of which many took advantage.
Members of the Florida Medical Association in
large numbers participated in the program as
essayists, panel members, moderators and discus-
sants.
Among the group of Florida physicians pre-
senting papers at the meeting were the following:
Coral Gables: Philip Samet, Hyman Turken,
William H. Bernstein. Daytona Beach: Thomas
E. Scott Jr. Fort Lauderdale: Curtis D. Benton
Jr. Fort Myers: Joseph L. Seldon Jr. Gainesville:
Charles H. Carter, J. Maxey Dell Jr., George
T. Harrell Jr., William C. Thomas Jr. Jackson-
ville: Joseph A. J. Farrington, J. Champneys
Taylor, G. Dekle Taylor. Miami: Theodore J. C.
Von Storch, Ralph E. Kirsch, John E. Burch,
William A. D. Anderson, John G. C'hesney, Rob-
ert B. Lawson, Benedict R. Harrow, Bertrand E.
Lowenstein. Samuel Gertman. Robert J. Boucek,
Walter W. Sackett Jr., Francis N. Cooke, E. Ster-
ling Nichol. Ocala: William H. Turnley. Pen-
sacola: Chas. J. Heinberg, Gretchen V. Squires.
Tampa: Sherman B. Forbes, Mason Trupp, James
N. Patterson, J. Brown Farrior, C. MacKenzie
Brown, Wesley W. Wilson, J. M. Ingram Jr.,
Robert W. Withers, Henry L. Wright Jr. Winter
Park: Nila K. Covalt.
Dade County Medical Association
Executive Office Building Dedicated
The dedication of the Dade County Medical
Association Executive Office Building on Nov. 3,
1957, marked the attainment of a goal long
sought. For more than two decades a home of its
own was the dream and a major objective of the
Dade County Medical Association. The realiza-
tion more than fulfills the dream.
Presiding at the dedicatory service was Dr.
Walter W. Sackett Jr., President, who welcomed
the members and guests. After introductory re-
marks by Mrs. William P. Smith, President of the
Woman’s Auxiliary to the Dade County Medical
Association, Dr. Edward W. Cullipher, senior
member of the Board of Trustees, discussed the
building, and Dr. Nelson Zivitz, President-Elect,
reviewed the history of the project. Dr. William
C. Roberts, President of the Florida Medical
Association, was the guest speaker on this aus-
picious occasion.
Outstanding among buildings of its type in
the nation, this first home of the Florida Medical
Association’s largest component county society
is strategically located at 2 Southeast Thirteenth
Street. On this busy corner at the intersection
with Miami Avenue, it becomes the health focal
point for a population center of approximately a
million people. From the foundations and foot-
J. Florida. M.A.
January, 1958
EDITORIALS AND COMMENTARIES
729
ings for additional height, and the attractive in-
side patio for the easiest and most economical
expansion, to the movable partitions which allow
immediate flexibility of existing floor plan, the
completed building provides adequately for pres-
ent and for future function. The spectacular two
story structure reflects both the progressive
spirit of the association and the dignity of the
profession. With its many facilities offered in the
public interest, it clearly portrays the associa-
tions basic purpose — to serve the physician and
his patient. It now serves a membership of 1,085,
a figure which is expected to be doubled within
the next decade.
The association’s administrative offices are on
the ground floor at the left of the entrance. Fac-
ing the entrance, the precast terrazzo and steel
stairs are the center of attraction in the large
central patio. Beyond them is the combination
doctors’ lounge and board room which easily ac-
commodates five or 50, lending an atmosphere of
casual or formal discussion as the occasion may
demand. This room and its connecting service
facilities are used not only by the association’s
many committees but also by similar groups from
the other organizations in the building.
Along the western corridor of the lower floor
are the offices of the East Coast Dental Society
and of the Woman’s Auxiliary to the Dade Coun-
ty Medical Association. Occupying the northwest
corner is the Dade County Unit of the American
Cancer Society. The stairs, serving the second
floor until a third floor is added and the elevator
is put into use, arise from the patio to open into
a semienclosed outside corridor which surrounds
the offices and service rooms for the upper story.
The glass partitions separating the hall from the
offices are of a type which provides full flexibility
for future changes in office layout and entrance
requirements. On this floor are located the Medi-
cal Service Bureau and the Heart Association of
Greater Miami.
Below: Dr. Walter W. Sackett Jr., President of the Dade County Medical Association (1), delivers the
address of welcome at the dedication of the Association’s executive office building (2). The audience of sever-
al hundred attending the ceremony (3) hears the principal address delivered by Dr. William C. Roberts, Presi-
dent of the Florida Medical Association (4).
730
EDITORIALS AND COMMENTARIES
Volume XLTV
Number 7
The Dade County Medical Association is to
be congratulated on its long range planning and
wise investment in a home which is in keeping
with the character and stature of its membership.
Too, this great county medical society is to be
commended for the breadth of vision and over-
all planning which enable it to share its physical
facilities with allied organizations so that at the
outset its new home becomes truly a health focal
point for Dade County.
Statewide Medico-Legal Institute
Held in Jacksonville
Sponsored by the Florida Bar and the Florida
Medical Association, the second Statewide Medi-
co-Legal Institute was held in Jacksonville on
November 22 and 23, 1957. The attendance was
excellent and representative of the various sec-
tions of the state.
Judge Wallace E. Sturgis and Judge John T.
Wigginton of the Florida First District Court of
Appeals presided over two of the three sessions.
Presiding over the third session was Florida Su-
preme Court Justice Campbell Thornal.
A panel consisting of Dr. Lucien Y. Dyren-
forth, Dr. Ashbel C. Williams and the Hon. C. C.
Howell Jr. presented the first topic, “Relationship
of Cancer and Trauma.” The subject of “Trauma
and Strain on the Cardiovascular System” was
discussed by Dr. Karl B. Hanson, Dr. James E.
Cousar III and the Hon. Jack F. Wayman.
“Electromyograph as an Aid in Evaluating Nerve
and Muscle Injury” was a subject which evoked
particular interest. It was presented by Dr. Simon
Markovich, a pioneer in this field, and Dr. Ben J.
Sheppard.
The second session opened with the presenta-
tion of “Crash Syndrome,” a subject presented
by Dr. Paul W. Braunstein, a member of the
Cornell LTniversity Crash Team. “Whiplash” in-
juries were discussed by Dr. Richard A. Wor-
sham and the Hon. Walter Beckman Jr. The final
subject of the day was “Post Concussion Syn-
drome.” Dr. Edward J. Sullivan Jr. and Dr. Wil-
liam H. McCullagh discussed the anatomic as-
pects and the Hon. Roger J. Waybright the legal
aspects.
The Saturday morning session opened with a
discussion of “Back Injury, Its Cause and Se-
quelae,” presented by Dr. Charles B. Mabry and
the Hon. T. Paine Kelly. The final subject, en-
titled “Disability Evaluation,” was presented
by a panel composed of Dr. Vernon T. Grizzard
Jr., Dr. George I. Raybin, the Hon. John E. Mat-
thews Jr. and the Hon. Harry T. Gray.
Arrangements for the meeting were in charge
of Dr. Sheppard, who is chairman of the Florida
Bar’s committee on medicolegal law and proce-
dures, and Dr. W. Tracy Haverfield, who is the
member of the Florida Medical Association’s
public relations advisory committee responsible
for liaison with the legal group. A social hour
and dinner at the George Washington Hotel,
where all sessions were held, concluded the Fri-
day portion of the program. The next institute
will be held in Tampa late next month.
The discussion of "Disability Evaluation” was presented by the panel shown at left, (seated) Attorneys John
E. Mathews Jr. and Harry T. Gray, and Dr. George I. Raybin; (standing) Dr. Vernon T. Grizzard Jr. and Jus-
tice of the Florida Supreme Court Campbell Thornal. Judges of the First District Court of Appeals attending
the Institute are shown at right with Dr. Paul W. Braunstein. They are (left to right) Judge John T. Wiggin-
ton, Judge Donald K. Carroll, Dr. Braunstein, and Judge Wallace E. Sturgis.
T. Florida. M.A.
January, 1958
EDITORIALS AND COMMENTARIES
731
Dr. Babers Addresses
District Meetings
At the District Meetings, held last October,
Dr. Henry J. Babers Jr., Chairman of the Ad-
visory Committee to Blue Shield, unofficially
known as the Committee of Seventeen, made a
timely address which will be of particular interest
to every member of the Association. The text of
his remarks follows:
It seems that the whole world is in contro-
versy. The French cannot agree among them-
selves on anything and are just about done for.
The middle East is aflame. Our country is beset
by a number of serious controversies. So, perhaps
our own problems in the medical profession,
smaller but just as upsetting, are other symp-
toms of a general disease. This disease is the
apparent inability of men at this particular time
in history to understand common problems and
to work them out peacefully and decently. Yet,
diseases can be cured or at least arrested. The
world has been in controversy many times be-
fore and has survived. Surely we can work out
our problems in medicine in statesmanlike
fashion.
The Blue Shield program in Florida is cer-
tainly a controversial subject. It is quite capable,
along with many other economic problems, of
being a disruptive influence unless we resolve
our mistrusts and misunderstandings.
The facts are these:
1. The Blue Shield operation is a force in
the economic life of every doctor. It is
so complex and poorly understood that
the doctor does not really identify him-
self with it. A new generation of doc-
tors has come along since the original
plan was put into action. Yet, Blue
Shield is completely dominated by doc-
tors, your colleagues. Actually, when
you criticize Blue Shield you are criti-
cizing yourselves and your medical
leadership. Doctors have a tendency to
blame Blue Shield, as if they had no
part in it, and direct their criticism at
the administrative portion of Blue
Shield. This Blue Shield controversy
must be put into proper perspective. It
is an intramedical problem and must be
understood as such.
2. Blue Shield is at the crossroads now.
Laboriously built up by the medical
profession to a large corporation, it has
been put into an untenable position.
Blue Shield is just barely breaking
even and is in serious danger of col-
lapse. Doctors who control it have so
hamstrung its activities that, like the
French Government, it cannot move.
In 1956 President Langley appointed an FMA
committee of 17 doctors to study this serious
problem. Approximately the same group was
reappointed by President Roberts this year.
Please look up the make-up of this committee,
which is conservative and one of the most sin-
cere groups I have ever worked with. Certainly,
we have not been any apologists for Blue Shield.
This committee work has been a real chore;
most of us have studied long and hard, con-
scientiously and with all good faith. We have
been fair in our approach in spite of what some
doctors believe. We believe that what must be
done is this:
1. The doctors in FMA must decide defi-
nitely and in great majority whether
they will support Blue Shield or not.
The present situation cannot go on as
it is. The present situation, if unchang-
ed, guarantees that Blue Shield go
backward and will doom it most sure-
ly. If the membership desires to discon-
tinue Blue Shield, then let’s say so and
get it over. If the majority of doctors
in Florida want to support Blue Shield
wholeheartedly, let’s do it well and
right and let’s agree one way or an-
other and not pick ourselves to death.
You all know our committee sent editorials
to you and have recently put out a comprehen-
sive survey. From our editorial replies and the
survey replies one thing is quite obvious. In
general, whether they know it or not, the doctors
are hopelessly confused as to what they really
want and are hopelessly inadequate at present
to understand how they can get what they want.
Our membership has little knowledge of the
economic forces in action in this nation in respect
to medical practice; and the knowledge of Blue
Shield, their own organization, is abysmal. Be-
fore you can adequately make a decision on this
very serious problem you must, for your own
benefit, know more about it. We are beginning
to get some ideas from our editorial and survey
answers, but so far it is too early to say much.
In general, it appears that about 25 per cent of
732
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 7
the doctors are opposed to any real support of
the Blue Shield program. About 75 per cent are
in favor of support if adequate changes can be
made to make it equitable.
We have had criticism (mostly quite fair
and reasonable, with a few unfairly prejudiced
persons and societies) in reference to our sur-
vey. My answer to this is how would you do it
in our shoes and what alternatives would you
offer? Would you be willing to work? If so, I
feel sure we can use your help. This is a thank-
less job, but some one has to do it, and we are
honestly interested, challenged by what we have
learned, and willing to work.
2. We are supporting an informational
meeting of the active members of Blue
Shield to be held on Saturday, Decem-
ber 7, in Jacksonville. Here we hope to
give each doctor who represents you
and your society a chance to get at
least some information on the Blue
Shield operation. Your representative
then must go back to your society and
acquaint everyone possible with the
facts. So we urge you for your own
good to insist that your delegates, your
active voting member of Blue Shield,
be present at this meeting.
We intend to continue our program of in-
formation to each of you, through editorials,
through making ourselves available to you per-
sonally and to your societies, and through every
means available.
When you are better informed by the time
of the next annual meeting of FMA in the spring
of 1958, the House of Delegates of FMA should
then be able to decide definitely whether to sup-
port Blue Shield or not. This will be a momen-
tous decision and must not be taken lightly. We
will give you the facts fairly; you must discuss
them adequately and be prepared to act on them
at the next annual meeting of FMA. It is only
after such a general decision is made that, if you
desire to continue Blue Shield, specific and long
overdue changes in the fee schedule, service limits,
and premium rates can adequately be adjusted.
Surely we can work out our problems in medi-
cine in a statesmanlike fashion. We “ain’t mad
at nobody” and please be fair and “don’t no-
body get mad at us.” Let’s not be like my friend,
Tom Hickey, a young Irish orderly at New York
Hospital where I interned. One Monday morn-
ing he came in, obviously badly battered and
bruised. “For goodness sakes, Tom,” I asked,
“what happened?” “I really don’t know, doctor.
I saw these two guys fighting and I got into it.”
1958 Mediclinics of Minnesota
Fort Lauderdale, March 2-12
The third annual postgraduate refresher
course presented by Mediclinics of Minnesota
will be held at Governor’s Club Hotel in Fort
Lauderdale on March 2 to 12, 1958. The Ameri-
can Academy of General Practice has certified
this course for 32 hours of formal postgraduate
study, Category I. for the Academy members in
attendance.
The course consists of 32 hours of lectures
and panels conducted by a faculty well able to
present the varied subjects in the several fields
of medicine. The lecturers, all members of the
faculty of the University of Minnesota Medical
School, and their subjects are: Harold F. Buch-
stein, M.D., Neurosurgery; Thomas P. Cook,
B. S.; Harry B. Hall. M.C., Orthopedics; Arthur
C. Kerkhof, M.D., Internal Medicine; Francis
W. Lynch, M.D., Dermatology; Ames W. Nas-
lund, M.D., Roentgenology; O. L. Norman Nel-
son. M.D., Internal Medicine; Owen F. Robbins,
M.D., Obstetrics and Gynecology; Albert V.
Stoesser, M.D., Pediatrics; Robert J. Tenner,
M.D.. Proctology; and Richard L. Varco, M.D.,
Surgery. The panel subjects are: Other Com-
plications of Pregnancy, Childhood Problems,
Gastrointestinal Tract in Childhood, Burns, Sys-
tematic L’se of Laboratory Methods, Jaundice,
Pulmonary Problems. Aftermaths of Poisoning,
Heart Disease Today, Accidental Trauma, Office
Practice. The Problems in Anemia, Medical-
Legal Panel, and Your Hour with the Consul-
tants.
The experience gathered in 1956 and 1957
requires that registration be limited to 300 in
order to preserve the informal and intimate
atmosphere in the lecture room. There is every
assurance that this number of registrants and
their wives can be comfortably accommodated in
Fort Lauderdale at the peak of the tourist season
if reservations are made well in advance. Both
the time of year and the limited number accepted
make early registration particularly important.
The course is sponsored by the Florida Acad-
emy of General Practice. Requests for an appli-
cation should be sent to Walter J. Glenn. M.D.,
1106 East Broward Boulevard, Fort Lauderdale.
J. Florida. M.A.
January, 1958
EDITORIALS AND COMMENTARIES
733
Dr. Glenn is Chairman of the Education Com-
mittee of the Florida Academy of General Prac-
tice and is in charge of arrangements for the
meeting.
Occupational Medicine Conference
Miami, Aug. 18-22, 1958
The Second Conference on Occupational
Medicine, sponsored jointly by the University of
Havana School of Medicine, Havana, Cuba, and
the University of Miami School of Medicine, will
beheld in Miami, Aug. 18-22, 1958. Dr. William
B. Deichmann, Professor of Pharmacology at the
University of Miami School of Medicine, is chair-
man of the conference, and Dr. M. Eugene Flipse,
Associate Professor of Medicine, is chairman of
the program committee. Dr. Francisco Lan-
ds y Sanchez, president of the Cuban Industrial
Medical Society, and Dr. Rafael Penalver Ballina
of the LTniversity of Havana School of Medicine,
are members of the planning committee. Proceed-
ings of the conference will be in Spanish. In-
quiries regarding attendance or papers may be
referred to Dr. Deichmann at the University of
Miami School of Medicine, Coral Gables.
The first occupational medicine conference
sponsored by the two schools of medicine, held
in Miami, Sept. 3 - 6, 1956, brought together
76 specialists in industrial medicine and toxicol-
ogy from Cuba, Venezuela, Peru, Mexico, Puerto
Rico, Spain, Chile and Colombia, as well as from
eight states of the United States. This confer-
ence, the first to be conducted in Spanish on
American soil, considered all phases of industrial
and occupational medicine, ranging from the ef-
fects of disease states on work in various indus-
tries to the substances producing industrial poi-
soning.
The University of Miami has sought to en-
courage cooperative educational and cultural pro-
grams with countries of the Caribbean and South
and Central America. The School of Medicine,
located at the natural gateway to the Latin
Americas, is the medical education facility of
continental United States nearest to medical cen-
ters of the southern hemisphere. As a result, it
has become for many Latin American countries
the focus for informal discussion of medical prob-
lems and also for continuing postgraduate educa-
tion and the development of inter-American re-
search programs.
Physician Celebrates Golden
Anniversary of Career
On completion of a half century of service as
a practicing physician, Dr. I. Kimbell Hicks of
Melbourne was locally honored on Oct. 29, 1957.
At a dinner party given by Mr. and Mrs. Robert
Young, his son-in-law and only daughter, he
visited with physicians and other friends, some
of whom could remember with him back to the
time when he arrived in Melbourne and began
taking an active part in the business, professional,
civic and social affairs of the budding community.
The Melbourne Kiwanis Club declared the
previous evening Kim Hicks Night and issued an
official proclamation to that effect. In it the mem-
bers paid high tribute to Dr. Hicks as a charter
member and a past president who had given
generously of his time and talent to many phases
of civic life as well as to the practice of his chosen
profession.
Dr. Hicks entered the practice of medicine on
Oct. 29, 1907, in Jackson, Ala., in the office of
his father, Dr. L. O. Hicks, after graduation from
the LTniversity of the South in Sewanee, Tenn.
In 1915 he came to Florida, interned at St.
Luke’s Hospital in Jacksonville while preparing
for Florida examinations, and while there met
Miss Grace Hoag, a student nurse, to whom he
was married on Aug. 5, 1916. From 1917 to 1921
he was associated with Dr. Ralph E. Smith, an
outstanding Jacksonville physician.
In 1922, Dr. Hicks located in Melbourne,
where he has continued to engage in the general
practice of medicine for 35 years. He has served
the entire community faithfully and well and in
point of service is the senior of all active practi-
tioners in Brevard County. When Dr. Hicks
arrived in Melbourne, the only physicians in the
vicinity were Dr. I. F. Bean and Dr. William J.
Creel of Eau Gallie. There was no hospital, but
a short time afterward, Dr. Isaac M. Hay, a sur-
geon, arrived and opened The Crenshaw Hospital,
a private institution. Dr. Hicks became its staff
anesthetist, a position he held for 25 consecutive
years. Dr. Creel and Dr. Hay were among the
guests attending the fiftieth anniversary dinner.
In addition to caring for a thriving practice,
Dr. Hicks through the years has entered whole-
heartedly into every civic project. He is a
charter member of the Melbourne Civic Improve-
ment Board, a charter member and organizer of
the Melbourne Hunting and Fishing Club, and
a new chapter in sulfa therapy
New authoritative studies show that Kynex dosage can be reduced even further than that
recommended earlier.1 Now, clinical evidence has established that a single (0.5 Gm.) tablet
maintains therapeutic blood levels extending beyond 24 hours. Still more proof that Kynex
stands alone in sulfa performance —
• Lowest Oral Dose In Sulfa History — 0.5 Gm. (1 tablet) daily in the usual patient for
maintenance of therapeutic blood levels
• Higher Solubility — effective blood concentrations within an hour or two
• Effective Antibacterial Range — exceptional effectiveness in urinary tract infections
• Convenience — the low dose of 0.5 Gm. (I tablet) per day offers optimum convenience
and acceptance to patients
J. Nichols, R. L. and Finland, M.: J. Clin. Med. 49:410, 1957.
NEW DOSAGE. The recommended adult dose is 1 Gm. (2 tablets or 4 teaspoonfuls of syrup)
the first day, followed by 0.5 Gm. (1 tablet or 2 teaspoonfuls of syrup) every day thereafter,
or 1 Gm. every other day for mild to moderate infections. In severe infections where prompt,
high blood levels are indicated, the initial dose should be 2 Gm. followed by 0.5 Gm. every
24 hours. Dosage in children, according to weight; i.e., a 40 lb. child should receive Vx of the
adult dosage. It is recommended that these dosages not be exceeded.
TABLETS: Each tablet contains 0.5 Gm. (7*/2 grains) of sulfamethoxypyridazine. Bottles of
24 and 100 tablets.
SYRUP: Each teaspoonful (5 cc.) of caramel-flavored syrup contains 250 mg. of sulfa-
methoxypyridazine. Bottle of 4 fl. oz.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
•Reg. U. S. Pat. Off,
736
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 7
for several years he has been an active member
and director of the First Federal Savings and
Loan Association of Brevard County. In 1950 he
and Mrs. Hicks, who died two years later, were
organizing charter members of the Eastminster
Presbyterian Church in Indialantic and he has
served as an elder there since that time.
In 1934 and 1935, Ur. Hicks was Mayor of
Melbourne, and after serving as City Commis-
sioner from 1936 to 1941, he was again elected
Mayor in 1942. During his chairmanship of the
City Commission in 1937, he officiated at the
ground-breaking ceremony for the new Brevard
Hospital, which he helped to organize. For 20
years he was the secretary of the Brevard County
ty Medical Society.
During the World War II years, Dr. Hicks
was the only general practitioner in Melbourne,
serving the 7,000 residents of the community.
At the same time he was Mayor, Acting Judge
and Chief of Staff at the hospital.
In an editorial congratulating Dr. Hicks on
the golden anniversary of his career as a practic-
ing physician, the Melbourne Daily Times paid
him this tribute:
“Few men reach a fifty-year milestone in their
profession and at the same time have hundreds
of persons wish them well because of diversified
contributions made to a community. . . . Your
contributions to South Brevard, where you have
spent thirty-five years, are too numerous to re-
count and too valuable to be correctly judged,
except in an over-all picture.
“We know of few civic groups which have not
been aided in some way by your foresight. We
know there must have been countless bedside
vigils which taxed your strength, your knowledge
and your human concern for fellow man.
“We deeply respect your profession. Dr.
Hicks, but even more do we respect your appre-
ciation of the fact that health and happiness
apply not only to body but also to heart and
soul. We are grateful to you, and men like you,
who believe in healing and strengthening.
“In thirty-five years you have seen many
changes in Brevard County. It is our hope that
you are as proud today of the community you
serve as the community is proud of you.
“We are going to take liberty in signing this
letter to you. Dr. Hicks. We think everyone in
this area will be pleased if we sign it not with
our own name but in the name of
The People Who Know You”
Dr. Hicks’ career of diversified service extend-
ing across half a century offers an inspiring ex-
ample to his busy professional colleagues. The
Florida Medical Association and its official organ,
The Journal, salute this distinguished member
whose life and works reflect great credit not alone
upon him but also upon the profession whose
dignity, honor and ideals he upholds.
Central Florida Medical Meeting
Orlando, March 13, 1958
The Fourth Annual Central Florida Medical
Meeting will be held Thursday, March 13, in Or-
lando. This meeting is sponsored by the Orange
County Medical Society. Participating in the
program will be outstanding men in various
fields. Dr. Frank Glenn, Professor of Surgery,
Cornell University Medical College, and Surgeon-
in-Chief, Xew York Hospital, will discuss “Peptic
Ulcer.” Dr. L. W. Diggs, Professor of Medicine
and Director of the Clinical Laboratory, Univer-
sity of Tennessee College of Medicine, will speak
on “Treatment of Hemorrhagic Diseases” and
Hemolytic Anemias.” Dr. Robert Anderson,
Assistant Commissioner of Mental Hygiene for
the State of Ohio, Columbus, Ohio, and formerly
Manager, Winter Yeterans Administration Hos-
pital. Topeka. Kan., will discuss “The Role of
Anxiety in Illness.” Dr. Robert B. Lawson, Pro-
fessor of Pediatrics, University of Miami School
of Medicine, will have as his topics “Use of
Steroids in Children” and “Advances in Pedi-
atrics.”
Registration for the meeting will begin at 8
a.m. The annual banquet will terminate the pro-
gram in the evening.
For the first time, the speakers this year will
conduct informal question and answer discussions.
Following the formal papers, they will meet with
small groups of interested physicians who may
ask questions regarding the papers. At these ses-
sions they may also ask questions regarding
problems that they may have in their own prac-
tice.
The 1957 meeting was well received by the
300 physicians who attended. General practice
credits were granted last year to general practi-
tioners who attended, and it is expected that the
1958 meeting will also be approved for credit.
All physicians throughout the state are cor-
dially invited to be present and bring their wives.
Activities for the wives are planned.
J. Florida, M.A.
January, 1958
EDITORIALS AND COMMENTARIES
737
Cardiovascular Diseases
Annual Seminar
Jacksonville, Feb. 20-22
The Fifth Annual Seminar on Cardiovascular
Diseases will be held on Thursday, Friday and
Saturday, February 20, 21 and 22, 1958, at the
Prudential Auditorium in Jacksonville. This
course is presented by the Northeast Florida
Heart Association and is endorsed by the Florida
Heart Association. It is co-sponsored by the Di-
vision of Postgraduate Education of the College
of Medicine of the University of Florida, the
Florida State Board of Health and the Florida
Medical Association, and has been accepted by
the American Academy of General Practice for
formal postgraduate study in Category I.
The lecturers for the course are Dr. Samuel
Bellet, Professor of Clinical Cardiology, Univer-
sity of Pennsylvania Graduate School of Medi-
cine, Director, Division of Cardiovascular Dis-
eases, Graduate Hospital of the University of
Pennsylvania, and Director, Division of Cardio-
logy, Philadelphia General Hospital; Dr. George
E. Burch, Professor of Medicine and Chairman
of the Department of Medicine, Tulane Univer-
sity School of Medicine; Dr. Denton A. Cooley,
Associate Professor of Surgery, Baylor University
College of Medicine; and Dr. Ben I. Heller, Pro-
fessor of Medicine, University of Arkansas School
of Medicine.
Dr. Bellet will discuss cardiac arrhythmias
and cardiac resuscitation; Dr. Burch, coronary
disease, hypertension, and electrocardiology; Dr.
Cooley, pump-oxygenator machines, open heart
surgery, aneurysmal repairs, and blood vessel
grafts, and Dr. Heller, electrolytes in conges-
tive heart failure, and renal physiology in conges-
tive heart failure.
LETTER TO THE EDITOR
Dear Sir:
In the October issue of The Journal, Dr.
George Gittelson has called timely attention to a
too frequently neglected phase of the management
of bronchial asthma. In pointing this out, how-
ever, the casual reader may feel that he has un-
dervalued the role of hyposensitization in the treat-
ment or prevention of asthma. Many men who
treat vasomotor rhinitis and an occasional bron-
chitis feel that hyposensitization to specific agents
when they are found may truly prevent later su-
pervention of asthma. The simile he draws that
“hyposensitization without elimination is like
prescribing glasses for a man with no eyes” is un-
fortunate. I believe it would be more accurate
to state, using his simile, that hyposensitization
without elimination is like a person with no eyes
prescribing glasses for one who has some vision
even though imperfect.
It should also be pointed out that mold spore
formation in the depths of foam rubber pillows
is now well documented and is a contaminant that
is very difficult to remove. The newer dacron floss
pillows do quite as well as a head rest and have
the advantage of nonmildewing and a ready ease
of soap and water cleansing and very rapid drying.
Further, the dacron floss does not dry crumble
and form dust.
Dr. Gittelson is to be commended for remind-
ing all of us that allergic cleanliness is next to
health godliness. All of our general readers would
do well to follow his sound advice.
Yours respectfully,
Clarence Bernstein, M.D.
OTHERS ARE SAYING
Editorial
A recent article in the Miami Herald “Busi-
ness and Finance” column quotes from a market-
ing survey by Life Magazine that most families
with incomes of $4,000 or less per year are spend-
ing more money than they earn. “The desire to
own and consume goods exceeds the ability to earn
with a substantial segment of Americans.” 47%
of all LT. S. households fall in the income category
of $4,000 or less, and this poses a serious problem
in furnishing adequate medical care to this large
segment of the population, and in receiving com-
pensation for your services.
There have been many changes in the past
several years which have helped create this situa-
tion, in addition to inflation. Installment buying
of furniture, cars, T.V.’s and almost everything a
family uses has become a universal custom. The
tremendous productive capacity of industry has
forced dealers to sell for “little or nothing down”
and “a little each week.” Check-offs from the
weekly pay check for taxes, union dues, and in-
surance complete the picture.
Sickness is rarely expected, and until the ad-
vent of hospitalization and sickness insurance it
was almost never provided for. As long as nothing
happens to hamper the earning power of the
738
MEDICAL DISTRICT MEETINGS
Volume XLIV
Number 7
breadwinner, and as long as there are no unex-
pected expenses, the lower income families go
along without too much difficulty. When serious
illness strikes, then this precarious equilibrium
is thrown out of balance. When an individual
suddenly is faced with heavy medical expenses
and unable to meet his obligations, he is embar-
rassed and unhappy. If the pressure becomes too
great, then he may move to another town or
change doctors. Either way, you are not paid and
you lose the patient.
It is not enough merely to say that he should
have saved money for the emergency and he would
not have been in his predicament. The solution
to this problem lies in continued support and ex-
pansion of voluntary health insurance with service
category for low-income groups. The only com-
pany to which we can safely extend service fea-
tures is Blue Cross and Blue Shield, a company in
which the doctors have an important role in de-
termination of policies. If all the people in the
$4,000 or under income group who apparently do
not have the capacity or inclination to save for ill-
ness are holders of Blue Cross-Blue Shield in-
surance, they can have adequate medical care, and
we can be justly compensated for our work. Then
I doubt if these people can be tempted to turn
to the Federal government for their medical care.
Richard L. Foster, M.D.,
Editor, The Record,
Broward County Medical Association
October 1957.
Medical District Meetings, 1957
The Eighteenth Annual Medical District
Meetings were held October 28 at Panama City,
October 29 at Clearwater, October 30 at Orlando
and October 31 at Fort Pierce. Total registration
for the four sessions was 289 members of the
Florida Medical Association and 47 visitors.
The diagnosis and management of gastroin-
testinal bleeding, both medical and surgical, was
the scientific subject discussed at each of the
meetings. The program was arranged by Dr.
S. Carnes Harvard, of Brooksville, chairman of
the Council of the Association, with the assistance
of the district councilors.
Among the prominent guests at each meeting
were the deans of the two medical schools in
Florida, Dr. Homer F. Marsh. School of Medi-
cine, University of Miami, Dr. George T. Harrell
Jr., College of Medicine, University of Florida,
and Mr. Thomas A. Hendricks, Field Director,
American Medical Association.
The program for each of the four general ses-
sions include an explanation of the function of
the Florida Medical Foundation, by Dr. Edward
Jelks, of Jacksonville, and a discussion of Medi-
care by Dr. John D. Milton, Miami; Blue Shield
by Dr. Henry J. Babers Jr., Gainesville, and
World Medical Association and Rural Health
by Dr. Francis T. Holland, Tallahassee. Also
featured at each general session were short ad-
dresses by the President of the Association, Dr.
William C. Roberts; President-Elect, Dr. Jere
W. Annis, and Secretary-Treasurer, Dr. Samuel
M. Day.
Northwest Medical District
October 28 — Panama City
Dr. Harvard presided at the meeting, assisted
by Dr. Alpheus T. Kennedy, Councilor for Dis-
trict 1. during the scientific assembly, and by
Dr. T. Bert Fletcher Jr., Councilor for District
2, during the general session.
Dr. John J. Benton, president of the Bay
County Medical Society, delivered the address
of welcome, and following, Dr. Charles J. Kahn,
of Pensacola, discussed “Diagnosis and Medical
Management of Gastrointestinal Bleeding,” and
Dr. Frank E. Tugwell, of Pensacola, “Diagnosis
and Surgical Management of Gastrointestinal
Bleeding.”
The 1958 meeting will be held in Marianna.
Total registration was 66, of which 53 were Asso-
ciation members (45 from this district) and 13
visitors. Among those attending were past presi-
dents Dr. John D. Milton, Dr. Julius C. Davis
and Dr. Edward Jelks.
Registration
BLOUNTSTOWN: Grayson C. Snvder. BROOKS-
VILLE: S. Carnes Harvard. CHATTAHOOCHEE: Wil-
liam D. Rogers. DE FUNIAK SPRINGS: William D.
Cawthon, Ralph B. Spires. GAINESVILLE: Henry J.
Babers Jr., George T. Harrell Jr. GRACEVILLE: Red-
den L. Miller, William W. Richardson. JACKSONVILLE:
Samuel M. Day, Edward Jelks, Lorenzo L. Parks. LAKE-
LAND: Jere W. Annis. MARIANNA: James T. Cook
Jr., Albert E. McQuagge, Richard H. Schulz, Sarah M.
Schulz, Francis M. Watson. MIAMI: John D. Milton.
PANAMA CITY: Daniel M. Adams Jr., Donald H. An-
derson, John J. Benton, Jack Corbitt, Charles H. Daf-
fin, Sidney E. Daffin, William C. Fontaine, John J. Hol-
lomon Jr., William F. Humphreys Jr., John H. Kay,
J. Florida. M.A.
January, 1958
739
SEARLE
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minor and major
emotional disturbances
• more effective than most potent tranquilizers
• as well tolerated as the milder agents
• consistent in effects as few tranquilizers are
Dartal is a unique development of Searle Research,
proved under everyday conditions of office practice
It is a single chemical substance, thoroughly tested and found particularly suited
in the management of a wide range of conditions including psychotic, psycho-
neurotic and psychosomatic disturbances.
Dartal is useful whenever the physician wants to ameliorate psychic agitation,
whether it is basic or secondary to a systemic condition.
In extensive clinical trial Dartal caused no dangerous toxic reactions. Drowsiness
and dizziness were the principal side effects reported by non-psychotic patients,
but in almost all instances these were mild and caused no problem.
Specifically, the usefulness of Dartal has been established in psychoneuroses with
emotional hyperactivity, in diseases with strong psychic overtones such as ulcera-
tive colitis, peptic ulcer and in certain frank and senile psychoses.
Usual Dosage • In psychoneuroses with anxiety and
tension states one 5 mg. tablet t.i.d.
• In psychotic conditions one 10 mg. tablet t.i.d.
740
Volume XLIV
Number 7
Michael J. Lingo, Joseph H. Morris, James D. Nixon,
James M. Nixon, William C. Roberts, C. W. Shackel-
ford, Harold E. Wager, Roderick C. Webb. PENSA-
COLA: Constantine A. Asters, Bernard M. Barrett, Frank
L. Creel, Frank B. Hodnette, Samuel G. Holmes, Charles
J. Kahn, Alpheus T. Kennedy, Wendell J. Newcomb,
Frank E. Tugwell, Lockland V. Tyler Jr., Earl G. Wolf.
PORT ST. JOE: John W. Hendrix. QUINCY: Julius C.
Davis. TALLAHASSEE: Francis T. Holland, Robert H.
Mickler, Henry L. Smith Jr.
VISITING DOCTORS: PANAMA CITY: Daniel C.
Campbell, John L. Fishel, David M. Jewett, Leo E.
Reilly, Jack E. Sanders, Henry C. Smallwood.
OTHER GUESTS— ATLANTA: Leyton B. Hunter.
CORAL GABLES: Homer F. Marsh, Ph D. JACKSON-
VILLE: Ernest R. Gibson, Eugene L. Nixon, W. Harold
Parham, H. A. Schroder. PENSACOLA: Luther L.
Smith J r.
Southwest Medical District
October 29 — Clearwater
During the scientific assembly, Dr. Harvard
was assisted as presiding officer by Dr. Gordon
H. McSwain, Councilor for District 6, and at the
general session by Dr. John M. Butcher, Coun-
cilor for District 5.
Dr. Percy H. Guinand, president of the
Pinellas County Medical Society, delivered the
address of welcome, and Dr. George D. Hopkins
II, of Fort Myers, discussed “Diagnosis and
Medical Management of Gastrointestinal Bleed-
ing,” and Dr. Richard A. Martorell, of Tampa,
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“Diagnosis and Surgical Management of Gastro-
intestinal Bleeding.”
At the general session, Fort Myers was select-
ed as the meeting place for 1958. Total registra-
tion was 91, of which 76 were Association mem-
bers (69 in this district) and 15 visitors. Among
those registered were past presidents Dr. Edward
Jelks, Dr. John D. Milton and Dr. Francis H.
Langley.
Registration
ARCADIA: Gordon H. McSwain. BROOKSVILLE:
S. Carnes Harvard. CLEARWATER: Lawrence R.
Buckley, James P. Burns Jr., Douglas W. Carr, Raymond
H. Center, Helen L. T. Dexter, James V. Freeman, John
T. Goodgame, Lewis A. Gryte, Percy H. Guinand, Everett
M. Harrison, Francis C. Hoare, J. Sudler Hood, John
T. Karaphillis, Charles H. Lasley, John A. Lauer Jr.,
James B. Leonard, Raymond M. Lockwood, William G.
Mason, Sherman H. Pace, Samuel T. Register, Henry E.
Smoak Jr., Robert P. Vomacka, Thomas H. Wallace, Ro-
bert M. Wolff. DADE CITY: John S. Williams. DUNE-
DIN: James C. Fleming, John A. Mease Jr., Virgil D.
Smith, James F. Spindler, Walter H. Winchester. FORT
MYERS: George D. Hopkins II, John S. Stewart.
GAINESVILLE: George T. Harrell Jr., JACKSON-
VILLE: Samuel M. Day, Edward Jelks, Lorenzo L. Parks.
LAKELAND: Jere W. Annis, Marion W. Hester. MI-
AMI: John D. Milton. NEW PORT RICHEY: Frank
Y. Robson. PANAMA CITY: William C. Roberts.
PLANT CITY: Madison R. Pope. PUNTA GORDA:
Walter B. Clement, Roscoe S. Maxwell. ST. PETERS-
BURG: Henry J. Jensen, Francis H. Langley, Whitman
C. McConnell, Whitman H. McConnell, John B. O’Neill,
Howard L. Reese. SAFETY HARBOR: David P. Wollo-
wick. SARASOTA: John M. Butcher, Melvin M. Sim-
mons, Henry J. Vomacka. TALLAHASSEE: Francis
T. Holland. TAMPA: Samuel H. Adams, Harold O.
Brown, Joseph D. Brown, Leffie M. Carlton Jr., Robert
H. Soffer, Richard G. Connar, Herschel G. Cole, Joshua
C. Dickinson, Samuel G. Hibbs, Alexander J. Kelly,
Richard A. Martorell, Eugene B. Maxwell, James N.
Patterson, Zack Russ Jr., Marshall E. Smith, Mason C.
Smith, Wesley W. Wilson. TREASURE ISLAND: James
W. Allee.
VISITING DOCTORS: CLEARWATER: Morris W.
Dexter, Harold Gross, R. T. Snider. DUNEDIN: Philip
B. Paty, William T. Williams. HOLMES BEACH:
Trave L. Brown Jr. TAMPA: William M. Douglas,
Harold L. Sanders. FAIRBORN, OHIO: Theodore H.
Winans.
OTHER GUESTS— ATLANTA: Leyton B. Hunter.
CORAL GABLES: Homer F. Marsh, Ph. D. GAINES-
VILLE: Cash B. Pollard, Ph. D. JACKSONVILLE:
Ernest R. Gibson, Eugene L. Nixon, W. Harold Par-
ham, H. A. Schroder.
Northeast Medical District
October 30 — Orlando
Assisting Dr. Harvard as presiding officers
were Dr. Leo M. Wachtel, Councilor for District
3, during the scientific assembly, and Dr. Don
C. Robertson, Councilor for District 4, at the
general session.
Following the address of welcome by Dr.
Frank J. Pyle, president of the Orange County
Medical Society, Dr. Frank C. Bone, of Orlando,
discussed “Diagnosis and Medical Management
of Gastrointestinal Bleeding” and Dr. James M.
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Volume XLIV
Number 7
Davis, of Jacksonville, “Diagnosis and Surgical
Management of Gastrointestinal Bleeding.”
The 1958 meeting is to be held at Cocoa ac-
cording to decision reached during the general
session. Total registration was 109 of which 101
were Association members (95 from this district)
and eight visitors. Bast presidents attending were
Dr. Edward Jelks, Dr. Frederick J. Waas, Dr.
John D. Milton, Dr. Eugene G. Peek Sr., Dr.
Duncan T. McEwan, Dr. William C. Thomas
Sr. and Dr. Herbert E. White.
Registration
BROOKSVILLE: S. Carnes Harvard CLERMONT:
Thomas D. Weaver. COCOA: A. F. Thomas. DAY-
TONA BEACH: John J. Cheleden, C. Robert DeArmas,
Alphonsus M. McCarthy, Russell C. Smith. EUSTIS:
Raymond A. Debo. GAINESVILLE: Eugene H. Cum-
mings, Allen Y. DeLaney, George T. Harrell Jr., John E.
Maines Jr., Samuel P. Martin, William C. Thomas Sr.
JACKSONVILLE: Charles D. Cooksey, James E. Cou-
sar III, James M. Davis, Samuel M. Day, Edward Jelks,
A. Mackenzie Manson, Kenneth A. Morris, Nelson A.
Murray, Arthur R. Nelson, C. Burling Roesch, Clarence
M. Sharp, John H. Terry, Frederick J. Waas, Leo M.
Wachtel, Edward C. Watt. LAKELAND: Jere W.
Annis. LEESBURG: George E. Engelhard, Marion B.
O’Kelley. MELBOURNE: Jack T. Bechtel, Arthur C.
Tedford. MIAMI: John D. Milton. MOUNT DORA:
J. Basil Hall, Robert H. Montgomery, Fred A. Vincenti.
NEW SMYRNA BEACH: Thomas D. Cook. OCALA:
William H. Anderson Jr., Henry L. Harrell, John D.
Lindner, Eugene G. Peek Sr., Eugene G. Peek Jr. OR-
LANDO: Benjamin L. Brock, Thomas C. Butt, J.
TJtalflncicUce ‘P%ofi6yl<zxt4
AVOID LOOSE TALK,
THE ILL WIND
THAT BLOWS NO GOOD
S/zecialcj-cd S&wice
ett-aAed attn doctor
THE |
MjEDIGA^PRQTEGTIiVEt COMPANY
F'QRT.Wayxl. Indiana,
Professional Protection Exclusively
since 1899
m
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. PLAZA 4-2703
l J
Rocher Chappell, Chas. J. Collins, Herbert W. Collins,
Thomas R. Collins, William R. Daniel, James G. Econo-
mon, Horace A. Day, Roger C. Floren, Oscar W. Freeman,
Raymond C. Haley Jr., Keith L. Hanson, Thomas F.
Hegert, Harold W. Johnston, Morton Levy, Duncan T.
McEwan, Carl S. McLemore, James A. McLeod, Meredith
Mallory, J. William Martin, Fred Mathers, William S.
Mitchell, James D. Moody, Charles A. Murray, Franklin
G. Norris, Louis M. Orr, Frank M. Parish, Roger E. Phil-
lips, Frank J. Pyle, Joseph G. Seltzer, Charles R. Sias,
Freeman D. Stanford, W. Dean Steward, Sam N. Sulman,
Robert L. Tolle, A. Fred Turner Jr., Jack P. Ward,
Robert E. Zellner. OVIEDO: Edward W. Stoner. PAN-
AMA CITY: William C. Roberts. ROCKLEDGE: J.
Robert Doty, Myron L. Habegger, Louis C. Jensen Jr.,
ST. AUGUSTINE: Reddin Britt, Herbert E. White.
SANFORD: Orville L. Barks, J. Clifford Boyce, Daniel
H. Mathers, Harrv Z. Silsby. TALLAHASSEE: Francis
T. Holland. TAVARES: 'james R. Hanson. WEST
PALM BEACH: Cecil M. Peek. WINTER PARK:
Dorothy T. Clark, Duane C. Deen, Charles D. Price,
Henry J. Wiser.
VISITING DOCTORS: CLERMONT: Thomas H.
Nichols. GAINESVILLE: S. R. Woodward.
OTHER GUESTS— ATLANTA: Leyton B. Hunter.
CORAL GABLES: Homer F. Marsh, PhD. JACK-
SONVILLE: Ernest R. Gibson, Eugene L. Nixon, W.
Harold Parham, H. A. Schroder. ORLANDO: Mrs.
Berneice T. Mathis.
Southeast Medical District
October 31 — Fort Pierce
Presiding with Dr. Harvard were Dr. Ralph
M. Overstreet Jr., Councilor for District 7, dur-
ing the scientific assembly, and Dr. Nelson Zivitz,
Councilor for District 8, during the general ses-
sion.
Dr. John M. Gunsolus, president of the St.
Lucie-Okeechobee-Martin County Medical So-
ciety, delivered the address of welcome, and fol-
lowing, Dr. Fred E. Manulis, of Palm Beach, dis-
cussed “Diagnosis and Medical Management of
Gastrointestinal Bleeding,” and Dr. Richard M.
Fleming, of Miami, “Diagnosis and Surgical Man-
agement of Gastrointestinal Bleeding.”
The 1958 meeting is to be held at Miami.
Total registration was 70, of which 59 were Asso-
ciation members (50 from this district) and 11
visitors. Among those registered were past presi-
dents Dr. John D. Milton, Dr. Frederick K.
Herpel and Dr. Edward Jelks.
Registration
BELLE GLADE: Wilbert O. Norville (Col.). BOYN-
TON: Charles D. Akes. BROOKSVILLE: S. Carnes
Harvard. CORAL GABLES: Anna A. Darrow, Warren
W. Quillian. FORT PIERCE: Joseph H. Batsche, Al-
fred J. Cornille, Russell L. Counts, Hugh B. Goodwin Jr.,
Martin G. Gould, Howard C. McDermid, Adrian M. Sam-
ple, Wilbur S. Turner, Richard F. Sinnott, George Theo-
dorou, Lester L. Whiddon, Melvin Wolkowsky, Lloyd U.
Young. GAINESVILLE: Henry J. Barbers Jr., George
T. Harrell Jr. JACKSONVILLE: Samuel M. Day, Ed-
ward Jelks, Clarence M. Sharp. LAKELAND: Jere W.
Annis. LAKE WORTH: James H. Rester Jr., A. Scott
Turk, Edward W. Wood. MIAMI: Reuben B. Chrisman
Jr., Edward W. Cullipher, Richard M. Fleming, W.
(Continued on page 744)
J. Florida, M.A.
January, 1958
743
The
Upjohn Company
announces
a major
corticosteroid
improvement
minor
chemical
changes
can mean
major
therapeutic
improvements
1949 cortisone
19.51 hydrocortisone
19.5.5. prednisolone
CH3 Medrol
The most
efficient of all
anti-inflammatory
steroids
• Lower dosage
(Vs lower dosage
than
prednisolone)
• Better tolerated
(less sodium
retention, less
gastric irritation)
Supplied: Tables of 4 mg., in bottles
of 30, 100 and 500.
^TRADEMARK FOR METHYLPREONISOLONE, UPJOHN
For
complete information , consult
your Upjohn representative,
or write the Medical Department,
The Upjohn Company ,
Kalamazoo, Michigan.
Upjohn
744
Volume XLIV
Number 7
(Continued from page 742)
Tracy Haverfield, Ralph W. Jack, Truxton L. Jackson,
John D. Milton, Winston K. Shorey. MIAMI BEACH:
Nelson Zivitz. PALM BEACH: Arthur P. Kaupe, Fred
E. Manulis. PANAMA CITY: William C. Roberts.
STUART: John M. Gunsolus, Julian D. Parker. TALLA-
HASSEE: Francis T. Holland. VERO BEACH: Melton
D. Council, William L. Fitts 3rd, Vernon L. Fromang,
B. Bowman Guerin, Kip G. Kelso. WEST PALM BEACH:
Willard F. Ande, John M. Baber, Edwin W. Brown, Vic-
tor Clarholm, James F. Cooney, Joseph J. Daversa, Frede-
rick K. Herpel, V. Markin Johnson, Edgar A. P. Keller-
man, Philip O. Lichtblau, W. Ambrose McGee, Lloyd J.
Netto, Ralph M. Overstreet Jr.
VISITING DOCTORS: JENSEN BEACH: Richard
Q. Penick. SEBASTIAN: Harold F. Albert. WEST
PALM BEACH: Taufick E. Bendeck, Richard D. Hoover,
Jackson L. Thatcher, Malcolm S. Van de Water.
OTHER GUESTS— ATLANTA: Leyton B. Hunter.
CORAL GABLES: Homer F. Marsh, Ph D. JACKSON-
VILLE: Ernest R. Gibson, Eugene L. Nixon, W. Harold
Parham.
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Aye, Ralph C., Tampa
Ernst, Conrad F., Crystal River
Lanford, William S., Indialantic
Miller, Neill I)., Fort Pierce
Morton, Donald G., Melbourne
Wiswell, Orville O., Cocoa
STATE NEWS ITEMS
Dr. Louis M. Orr of Orlando attended the
Eleventh General Assembly of the World Medi-
cal Association held in Istanbul, Turkey, as a
member of the Board of Directors. While abroad,
he visited clinics and hospitals in France, Italy,
Switzerland, Germany, Holland and England.
Drs. Ruth S. Jewett and Eugene L. Jewett of
Orlando attended the annual meeting of the So-
ciety of Orthopedic Surgery and Traumatology
held in Colombia, South America. Dr. Eugene L.
Jewett presented two papers during the meeting;
one entitled “The Place of Replacement Pros-
thesis and Hip Joint Trauma;” the other “The
Rigid Internal Fixation of Intracapsular Femoral
Neck Fractures.”
Dr. Albert M. Ziffer of Orlando appeared on
the program of the scientific assembly of the
American Heart Association held in Chicago. The
title of his paper was “Hemodynamic Effects of
Vasodilatation Induced by Sodium Nitrate in
Congestive Heart Failure: Relationship to Star-
ling’s Law of the Heart.”
when anxiety and tension "erupts” in the G. I. tract...
IN GASTRIC ULCER
Em
J
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of gastric ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
■Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK.
new for angina
QpETN + 0ATARA>0
(PENTAERYTHRITOL TETRANITRATE) (hYOROXYZINL)
In pain. Anxious. Fearful. On the road to cardiac
invalidism. These are the pathways of
angina patients. For fear and pain are inexorably
linked in the angina syndrome.
For angina patients— perhaps the next one who
enters your office— won’t you consider new
cartrax? This doubly effective therapy combines
petn (pentaerythritol tetranitrate) for lasting
vasodilation and atarax for peace of mind.
Thus cartrax relieves not only the anginal pain
but reduces the concomitant anxiety.
Dosage and supplied: begin with 1 to 2 yellow cartrax
“10” tablets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. When indicated, this may be increased for more
optimal effect by switching to pink cartrax “20” tablets
(20 mg. petn plus 10 mg. atarax.) For convenience, write
"cartrax 10” or “cartrax 20.” In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on
a continuous dosage schedule. Use petn preparations
with caution in glaucoma.
“Cardiac patients who show significant manifestations of
anxiety should receive ataractic treatment as part of the
a >>i
New York 17, New York , Waldman, S., and Pclner, L.: Am. Pract. & Digest Treat. 1075 (July) 1957.
Division, Cbas. Pfizer ir Co., Jnc. ‘trademark
746
Voi.UME XLIV
Number 7
Dr. Alvan G. Foraker of Jacksonville attend-
ed the meeting of the Intersociety Cytology
Council in Augusta in mid-November, partici-
pating in a panel discussion on intraepithelial
carcinoma of the cervix. Dr. Foraker also at-
tended meetings of the Advisory Cytology Com-
mittee, formed to advance research in this field.
Dr. Kenneth G. Gould Sr. of Tampa recently
served a special two week tour of active service
during which he visited United States Air Forces
bases in Germany, France and England. Dr.
Gould is a colonel in the United States Air
Force Reserve.
z^
Dr. Wilson T. Sowder of Jacksonville, State
Health Officer, has been elected a director of the
State and Territorial Health Officers Association.
Dr. William M. C. Wilhoit of Pensacola has
been elected president of the Florida Mental
Health Association. Dr. Wilhoit is a member of
the Committee on Mental Health of the Florida
Medical Association.
Dr. Mason Trupp of Tampa has been award-
ed a citation for his distinguished work in medi-
cine by the Washington College Alumni Associ-
ation. Dr. Trupp received the Bachelor of Science
degree at the Chestertown, Md., college in 1933.
z^
Dr. Reuben J. Plant Jr. of St. Augustine has
been re-elected president of the St. Johns County
Welfare Federation.
Dr. Albert V. Hardy of Jacksonville has
been appointed assistant state health officer, a
position recently created by the Florida State
Board of Health.
z^
Dr. James R. Sory of West Palm Beach has
returned from the Medical College of Georgia
at Augusta where he did postgraduate work in
endocrinology.
z^
Dr. Daniel B. Langley of Naples discussed
the importance of the Rh factor in human blood
at a recent meeting of the Rotary Club of that
city.
z^
Dr. Nelson H. Kraeft of Tallahassee addres-
sed the Leon County Chapter of the Florida
Federation of Social Workers on some of the
(Continued on page 752)
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
429 W. Monroe St. 329 N. Orange Ave.
Telephone EL 4-6661 Telephone 5-3S37
J. Florida, M.A.
January, 1958
747
3
is a factor
Tetracycline (phosphate-buffered) and Nystatin
Combines ACHROMYCIN V with NYSTATIN
Achrostatin V combines Achromycin V . . ,
the new rapid-acting oral form of
AcHROMYCiNt Tetracycline . . . noted for its
outstanding effectiveness against more than
50 different infections . . . and Nystatin . . . the
antifungal specific. Achrostatin V provides
particularly effective therapy for those
patients who are prone to mondial overgrowth
during a protracted course
of antibiotic treatment.
supplied:
Achrostatin V Capsules
contain 250 mg. tetracycline
HC1 equivalent (phosphate-
buffered) and 250,000
units Nystatin,
dosage :
Basic oral dosage (6-7 mg.
per lb. body weight per day)
in the average adult is
4 capsules of Achrostatin V
per day, equivalent to
1 Gm. of Achromycin V.
*Trademark
fReg. U. S. Pat. Off.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER, N. Y.
748
Volume XLIV
Number 7
in bronchial asthma and respiratory allergies
specify the buffered “predni-steroids”
to minimize gastric distress
combined steroid-antacid therapy . . .
‘Co-Deltra’ or ‘Co-Hydel-
tra’ provides all the bene- Tablets”*
fits of “predni-steroid”
therapy and minimizes the
likelihood of gastric distress
which might otherwise im-
pede therapy. They provide
easier breathing — and
smoother control— in bron- 2-5 mB- °r 5-0 me*
, . , . , ,11 of prednisone or
chial asthma or stubborn prednisolone, plus
respiratory allergies. 300 mg. of dried
, aluminum
SUPPLIED: Multiple Compressed hydroxide
Tablets ‘Co-Deltra’ or ‘Co-Hy- . nd 50
deltra’ in bottles of 30, 100, and of magnesium
50°- trisilicate.
Co Deltra
(Prednisone buffered)
CoHydeltra
(flsfr
MERCK SHARP & DOHME
■CO-DELTRA' ami 'CO-HY DELTRA* are
registered trademarks u / MERCK i Co., Inc.
DIVISION OF MERCK a CO., INC.
PHILADELPHIA I. PA.
J. Florida, M.A.
January, 1958
749
5 calorie
diet
f«U»»
«h«
1 or> ,
' *»> u* ,
»urm4
1 ‘bekmdi
““♦“celerity
gtJtOne
rean« ubftrs
wCtr"***
• ***1. peniv. .
**" Plftlt,
Pxkltf
ura'*Tyianr<j
Cr«nbcf7,f5
'hubM/t,
*e on,,,
"•*‘*‘*1
Ouit „
or^ ,u
«'«<* L
cl*nn.
‘•wien
r IO d«**m
Wea«*. StfCh «
” ^ >»*a,
*•“ 'I
THESE DIETS CAN
HELP YOU MANAGE
YOUR PATIENTS WITH
Upon your request, The
Armour Laboratories will
be pleased to send you a
complimentary supply of
1800 and 2400 calorie diets
. . . low in carbohydrate and
high in unsaturated fats . . .
intended for use in conjunc-
tion with ARCOFAC, the
Armour preparation
designed to lower elevated
blood cholesterol.
Arcofac need be
taken only once a day . . .
in relatively small
amounts . . . and allows
the patient to eat
a balanced, nutritious
and palatable diet.
Each tablespoonful of
ARCOFAC emulsion
contains:
Linoleic acid* .... 6.8 Gm.
Vitamin B6 0.6 mg.
Mixed tocopherols
(Vitamin E) .... 11.5 mg.
♦derived from safflower oil which
contains the highest concentra-
tion of unsaturated fatty acids
of any commercially available
vegetable oil.
Arcofac ,
is available
in bottles of 12 fluid ounces.
THE ARMOUR
LABORATORI
S
A DIVISION OF ARMOUR AND COMPANY • KANKAKEE, ILLINOIS
750
Volume XLIV
Number 7
trichomonacide
FUROXONE®
brand of furazolidone
l IRON
VAGINAL SUPPOSITORIES AND POWDER
85% CLINICAL CURES*
In 219 patients with either trichomonal
vaginitis, monilial vaginitis or both,
clinical cures were secured in 187.
71% CULTURAL CURES*
157 patients showed negative culture
tests at 3 months follow-up examinations.
Patients reported rapid relief of burning
and itching, often within 24 hours.
STEPl Office administration of
Tricofuron Vaginal Powder improved
at least once weekly.
STEP 2 Home use of
Tricofuron Vaginal Suppositories ^improved
by the patient, 1 or 2 daily, including
the important menstrual days.
*Combined results of 12 independent clinical
investigators. Data available on request.
suppositories:
0.375% Micofur, 0.25% Furoxone.
powder ;
0.5% Micofur, 0.1% Furoxone.
EATON LABORATORIES. NORWICH. NEW YORK
J. Florida, M.A.
January, 1958
751
^j&n.LyUea£7
F&iA.
. . . and may we
remind ) ou that
a glass of beer
can make high
protein diets
more palatable?
The High
Protein Diet
Meat, of course, is an outstanding source of
protein, but it can easily be reinforced with
other protein foods. For instance, a fluffy
omelet folded over penny-sliced frankfurters,
ground cooked meat, flaked fish or cheese is
both tempting and economical.
A green salad topped generously with shoe-
strings of meat and cheese carries its weight in
protein. Cottage cheese for extra protein is
especially tasty in a salad or as a spread on
dark bread. An egg white whipped into fruit
juice makes a frothy flip— and fruit and cheese
for dessert give a big protein boost. For
variety’s sake a frosty glass of beer* adds zest
to any meal as well as protein to the diet.
•Protein 0.8 Gm.; Calories 104/8 oz. glass (Average of American Beers)
United States Brewers Foundation
Beer — America’s Beverage of Moderation
If you'd like reprints of 12 different diets, please write United States Brewers Foundation, 535 Fifth Avenue, New York 17, N. Y.
752
Volume X I . I V
Number 7
(Continued from pane 746)
psychological and sociological aspects of cancer
at a meeting of the group in October.
Dr. Howard V. Weems Sr. of Sebring has
been honored by the Rotary Club there for his
35 years service as a physician to the community.
Drs. Arnold H. Eichert and Jess V. Cohn of
Hollywood discussed “The Steps Leading Into
and Out of Mental Hospitals” at the October
meeting of the Woman’s Auxiliary to the Broward
County Medical Association held at the home
of Mrs. Scottie J. Wilson.
Dr. Henry G. Morton of Sarasota has been
installed as president of the Florida Pediatric
Society. Dr. Harry M. Edwards of Ocala is
serving as secretary and Dr. Fred I. Dorman
of Lakeland as treasurer. Installation of Dr.
Morton and the election of Drs. Edwards and
Dorman took place at the Twenty-Seventh An-
nual Meeting of the Society held at West Palm
Beach.
Dr. Aubrey Y. Covington of Starke, director
of the Clay-Bradford-L’nion County Health De-
partments, has been elected first vice president
of the Florida Health Officers Association.
Drs. Nelson Zivitz and S. Charles Werblow
directed the activities of the medical division for
the United Fund’s Miami Beach campaign.
Physicians from Florida, Alabama and Missis-
sippi attended the symposium on “The Use of
Antibiotics in Infectious Diseases” held at Pen-
sacola early in November. The symposium was
sponsored by the Escambia County Medical
Society in cooperation with the Lederle Labora-
tories Division of the American Cyanamid Co.
Drs. Paul F. Baranco, president of the Society,
Barkley Beidelnian and John M. Packard, all of
Pensacola, served as presiding officers for the
various sessions.
Fifty members of the Southern Flying Phy-
sicians gathered at Miami Beach during the re-
cent annual meeting of the Southern Medical
Association. Dr. Donald W. Smith of Miami
served as chairman of the local arrangements
committee for the meeting. Dr. Walter G. Robin-
son of Palm Beach is president and Dr. Edwin
H. Andrews of Gainesville is secretary.
Gnderson Surgical Supply Go.
Established 1916
A GOOD REPUTATION
1 1 lakes vears to build, but can be
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quickly destroyed.
1 1 must be carefully guarded.
“A good name is rather to be chosen
than great riches.”
Distributors of Known Brands of Proven Quality
MEMBEli
TELEPHONE 2-8504
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TELEPHONE 5-4362
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ST. PETERSBURG, FLORIDA
J. Florida, M.A.
January, 1958
753
Volume XLIV
Number 7
NO WAITING
in anxiety and hypertension
NEW fast-acting
Harmonyl-N
(Harmonyl* and Nembutal"®)
Calmer days, more restful nights starting first day
of treatment, through synergistic action of
Harmonyl (Deserpidine, Abbott) and Nembutal
( Pentobarbital, Abbott). Lower therapeutic
doses, lower incidence of side effects. Each
Harmonyl-N Filmtab contains 30 mg. Nembutal
Calcium and 0.25 mg. Harmonyl. Each
Harmonyl-N Half-Strength Filmtab combines
15 mg. Nembutal Calcium and
0.1 mg. Harmonyl. Qj$ott
Dr. George A. Dame of Jacksonville was hon-
ered for his “great devotion and high service to
the cause of public health” by the Florida Public
Health Association at its Twenty-Ninth Annual
Meeting held at Fort Lauderdale, October 31-
November 2.
Dr. Milton S. Saslaw of Miami has been
appointed governor for the state of Florida of
the American College of Cardiology.
The College of Medicine of the University
of Florida at Gainesville has received a grant
from the National Institutes of Health to provide
for laboratories for a broad health research pro-
gram. The grant will be used in the construction
of an addition to the present Medical Sciences
Building.
A Symposium on the Management of Cardio-
vascular Problems of the Aging has been planned
for April 12, 1958, at Miami Beach, according
to announcement by Dr. 0. Whitmore Burtner
of Miami, chairman of the Symposium Commit-
tee of the Dade County Medical Association. It
is being sponsored by the Association and the
pharmaceutical firm of J. B. Roerig & Company.
The first Oklahoma Colloquy on Advances
in Medicine to be devoted to problems in fluid,
electrolyte and nutritional balance has been
scheduled for Feb. 6-8, 1958 at the University
of Oklahoma School of Medicine. Information
may be obtained from the Division of Post-
graduate Education, University af Oklahoma
School of Medicine, Oklahoma City, Okla.
Drs. Raymond H. King of Jacksonville and
William W. Richardson of Graceville have been
appointed to the Advisory Council for Hospital
Licensure to the Florida State Board of Health
by Governor LeRoy Collins.
The Atlanta Graduate Medical Assembly has
been scheduled for Feb. 17-19, 1958, in the Atlan-
ta Biltmore Hotel at Atlanta. Subjects include
medicine, surgery, obstetrics and gynecology,
neurology and psychiatry, neurosurgery, pathol-
ogy, pediatrics, radiology and urology. Advance
registration is possible by contacting the Atlanta
Graduate Medical Assembly, 875 W. Peachtree
Street, N.W., Atlanta, attention Mrs. Shafer. The
fee is $10.
ft Filmtab Finn-sealed tablets, Abbott; pat. applied for
aoioeo ♦Trademark
J. Florida, M.A.
January, 1958
755
symptomatic relief ... plus!
achrocidin is a well-balanced, comprehensive formula for
treating acute upper respiratory infections.
Debilitating symptoms of malaise, headache, pain, mucosal
and nasal discharge are rapidly relieved.
Early, potent therapy is offered against disabling complications
to which the patient may be highly vulnerable, particularly
during febrile respiratory epidemics or when questionable middle
ear, pulmonary, nephritic, or rheumatic signs are present.
achrocidin is convenient for you to prescribe — easy for the
patient to take. Average adult dose: two tablets, or teaspoonfuls
of syrup, three or four times daily.
tablets
ACHROMYCIN ® Tetracycline . 125 mg.
Phenacetin 120 mg.
Caffeine . 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Bottle of 24 tablets
syrup
Each teaspoonful (5 cc.) contains :
ACHROMYCIN ® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyriiamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
Available on prescription only
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
•Reg. U. S. Pot. Oft.
Pr» i •
Significant J^ptbins research discovery:
y/ -
/y^y/Y////////
A NEW SKELETAL
MUSCLE RELAXANT
Robaxin — synthesized in the Robins Research Laboratories, and
intensively studied for five years — introduces to the physician an
entirely new agent for effective and well-tolerated skeletal muscle
relaxation. Robaxin is an entirely new chemical formulation, with
outstanding clinical properties:
• Highly potent and long acting.5,8
• Relatively free of adverse side effects.'’2,3 4 6 7
• Does not reduce normal muscle strength or reflex activity
in ordinary dosage.7
• Beneficial in 94.4% of cases with acute back pain
due to muscle spasm. 1'3,4, 6,7
CLINICAL RE I
DISEASE ENTITY
Acute back pain d t
(a) Muscle spasm s
to sprain
(b) Muscle spasm c ti
trauma
(c) Muscle spasm 1 1 ti
nerve irritation
(d) Muscle spasm ! #*
to discogenic d c:
and postopera !
orthopedic pro h
Miscellaneous (bu i<
torticollis, etc.
(Methocarbamol Robins, U.S. Pat. No. 2770649)
Highly specific action
Robaxin is highly specific in its action on the
intemuncial neurons of the spinal cord — with
inherently sustained repression of multisyn-
aptic reflexes, but with no demonstrable effect
on monosynaptic reflexes. It thus is useful in
the control of skeletal muscle spasm, tremor and
other manifestations of hyperactivity, as well
as the pain incident to spasm, without impair-
ing strength or normal neuromuscular function.
Beneficial in 94.4% of cases tested
When tested in 72 patients with acute back
pain involving muscle spasm, Robaxin in-
duced marked relief in 59, moderate relief in
6, and slight relief in 3 — or an over-all bene-
ficial effect in 94.4%.li3'4'c*7 No side effects
occurred in 64 of the patients, and only slight
side effects in 8. In studies of 129 patients,
moderate or negligible side effects occurred
in only 6.2%.1,2,3, 4,6,7
ROBAXII
M IN ACUTE BACK PAIN’ ®
4. O. 7
DURATION
OF
TREATMENT
DOSE PER DAY (divided)
RESPONSE
marked mod. slight
neg.
SIDE EFFECTS
2-42 days
3-6 Gm.
17
1
0
0
None, 16
Dizziness, 1
Slight nausea, 1
-42 days
2-6 Gm.
8
1
3
i
None, 12
Nervousness, 1
1-240 days
2.25-6 Gm.
4
1
0
0
None, 5
!-28 days
1.5-9 Gm.
24
3
0
3
None, 25
Dizziness, 1
Lightheaded-
ness, 2
Nausea, 2 *
1-60 days
4-8 Gm.
6
0
0
0
None, 6
59
6
3
4
* Relieved on
reduction
of dose
References: l. Carpenter, E. B.: Publication pending. 2. Carter,
C. H.: Personal communication. 3. Forsyth, H. F.: Publication
pending. 4. Freund, J.: Personal communication. 5. Morgan,
A. M., Truitt, E. B., Jr., and Little, J. M.: American Pharm. Assn.
46:374, 1957. 6. Nachman, H. M.: Personal communication.
7. O’Doherty, D.: Publication pending. 8. Truitt, E. B., Jr., and
Little, J. M.: J. Pharm. & Exper. Therap. 119:161, 1957.
Indications — Acute back pain associ-
ated with: (a) muscle spasm secondary to
sprain; (b) muscle spasm due to trauma;
(c) muscle spasm due to nerve irritation;
(d) muscle spasm secondary to discogenic
disease and postoperative orthopedic
procedures; and miscellaneous conditions,
such as bursitis, fibrositis, torticollis, etc.
Dosage — Adults: Two tablets 4 times
daily to 3 tablets every 4 hours. Total daily
dosage: 4 to 9 Gm. in divided doses.
Precautions — There are no specific con-
traindications to Robaxin and untoward
reactions are not to be anticipated. Minor
side effects such as lightheadedness, dizzi-
ness, nausea may occur rarely in patients
with unusual sensitivity to drugs, but dis-
appear on reduction of dosage. When ther-
apy is prolonged routine white blood cell
counts should be made since some decrease
was noted in 3 patients out of a group of
72 who had received the drug for periods
of 30 days or longer.
Supply — Robaxin Tablets, 0.5 Gm., in
bottles of 50.
A. H. ROBINS CO., INC., Richmond 20, Va.
Ethical Pharmaceuticals of Merit since 1878
758
Volume XLIV
Number 7
CLASSIFIED
Advertising rates tor this column are S5.IMI pet
insertion for ads of 25 words or less. Add 20c for
each additional word.
WANTED: Physician desires temporary position
beginning January while awaiting residency. Have
two years surgical training. Any type practice con-
sidered. Florida license. Married. Age 28. Write
69-244, P. O. Box 2411, Jacksonville, Fla.
HOSPITAL FOR SALE: 80 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner to associate with
group in South Florida. No Ob or Surgery required.
Give full particulars of training, experience and refer-
ences. Write 69-249, P. O. Box 2411, Jacksonville,
Fla.
WANTED: Information regarding locations. Flor-
ida licensed. One year rotating internship; one year
general surgical residency. Plans General Practice.
Write 69-252, P. O. Box 2411, Jacksonville, F'la.
POSITION WANTED: Desires association or sal-
aried position in Ophthalmology or EENT practice.
44 years of age, white, male, Methodist. Florida li-
cense. Board eligible in Opthalmology with three years
experience in EF1NT practice. Write P. O. Box 69-
253, P. O. Box 2411, Jacksonville, Fla.
F'OUND: Black mechanical pencil on registration
desk at Called Meeting of House of Delegates in
Jacksonville, December 8. Owner should contact
Florida Medical Association, P. O. Box 2411, Jackson-
ville, Fla.
COMPONENT SOCIETY NOTES
Brevard
I)r. Jack T. Bechtel, of Eau Gallie, has as-
sumed the office of president of the Brevard
County Medical Society following his election at
the Society’s November meeting. Dr. Louis C.
Jensen Jr., of Rockledge, was chosen as vice
president, and Dr. Cyrus E. Warden, of Mel-
bourne, secretary-treasurer.
Dr. J. Rocher Chappell, of Orlando, chairman
of the Committee on Civil Defense and Disaster
of the Florida Medical Association, was principal
speaker at the November meeting. He discussed
civil defense as it applies to medical personnel.
The Society has paid 100 per cent of its
state dues for 1957.
Bay
The Bay County Medical Society has paid
100 percent of its state dues for 1957.
Lake
The Lake County Medical Society and its
Woman’s Auxiliary held its annual joint meeting
with the Lake County Bar Association on Novem-
(Continued from page 762)
Where To Find Us...
Jacksonville
Mr. George R. Garre**
Surgical Supply Company
Phone EL 5-8391
Residence Phone EX 8-7940
Mr. John R. Gregory
Surgical Supply Company
Phone EL 5-8391
Residence Phone EX 8-7095
Orlando
Mr. R. E. Jacobus
3708 Hargill Drive
Phone GA 5-5478
Tallahassee
Mr. Loomis P. King
522 Eas* Park Avenue
Phone 3-5067
Mr. J. Bealty Williams Jr.
Surgical Supply Company
Phone EL 5-8391
Residence Phone EV 8-9054
Lakeland
Mr. R. E. Lewis Jr.
41 4 Hillside Drive
Phone Mutual 9-6081
Jacksonville Beach
Mr. Jim W. Basemore
1215 9th Street N.
Phone CH 9-2563
uraica
SUPPLY COMPANY
1050 W. Adams St. P. O. Box 2580 Jacksonville, Fla.
T. B. SLADE, JR.
J. BEATTY WILLIAMS
J. Florida, M.A.
January, 1958
759
probably the easiest-to-use x-ray table in its field
Instant swing-through from fluoroscopy to Horizontal, vertical, interme- Choice of rotating or
radiography (and vice versa). Self-guid- diate, or Trendelenburg posi- stationary anode x-ray
ing to correct operating distance. Nothing tions by equipoise handrock tubes. Full powered
to match up . . . you do it without leaving (or quiet motor-drive). 100 ma at 100 KVP.
the table front.
Certainly the simplest automatic x-ray control ever devised
know why? look ...
1 On this board you select the bodypart you want to x-ray
2 Set its measured thickness
3 Press the exposure button
That's all there is to it. No time, KV, or MA adjusting to do.
No charts to check, no calculations to make.
housed in this
handsome
upright
cabinet
Obviously as canny an x-ray investment as you can make
Modest cost
Excellent value
Prestige "look"
Top Reputation (significantly, "Century" trade-in value has long been highest in its field)
MIAMI 35, FLA., 1363 Coral Way
Jacksonville 7, Fla., 1023 Mary Street
St. Petersburg, Fla., 601 Rutledge Bid*3
Orlando, Fla., 1711 Oakmont Street
W Palm Beach, Fla., 305 South Flagler Drive
760
Volume XLIV
Number 7
both-
orally for
dependable prophyla)
sublingually for
fast relief
J. Flosita. M.A.
<1 UAR V , 1958
76 I
"RANOLr
HMATIC -
eerful instead of fearful
suprel-Franol tablets bring
he-clock relief plus emergency
:ainst sudden attack. Anxiety
'hen patients know they’ll get
1 60 seconds — relief that Con-
or four hours or more.
HC1 (10 mg. for adults, 5 mg.
Iren) , the most potent broncho-
known, makes up the outer
. In a sudden attack, the patient
; tablet under his tongue. Relief
n 60 seconds. A unique feature
flavor-timer.” As the Isuprel is
d a lemon flavor appears. When
pears — about five minutes later
>atient swallows the tablet.
xcelled combination for pro-
bronchodilatation makes up the
-Franol core: benzylephedrine
2 mg.), Luminal® (8 mg.) and
dline (130 mg.). Swallowed, the
vorks for four hours or more.
-Franol tablets are “. . . effec-
controlling over 80% of
s with mild to moderate
of asthma.”1
r, J. L., and DeRisio,
ihey Clin. Bull. 10:45,
. 1956.
LABORATORIES
New York 18, N. Y.
%o /oo
sty /, £
ISUPREL-FRANOL
tablets (Isuprel HC1 10 mg.)
for adults;
ISUPREL-FRANOL
Mild tablets (isuprel HCl
5 mg.) for children:
One tablet every three or
four hours taken orally for
continuous control of bron-
chospasm in chronic asthma.
One tablet taken sublingual-
ly for sudden attack. “Fla-
vor-timer” signals when
patient should swallow.
Bottles of 100 tablets.
“ Flavor-timer ” signals patients
when to swallow tablets
ISUPREL
Immediate effect sublingually —
for emergency use
LEMON “FLAVOR-TIMER”
Disappearance of flavor is the
signal to swallow
! Theophylline
Luminal
Benzylephedrine
Sustained action — reduces fre-
quency and intensity of attacks
BRAND OF ISOPROTERENOL), FRANOL AND LUMINAL (BRAND OF PH E NO B A R B I T A L ) , TRADEMARKS REG. U. S. PAT. OFF.
762
Volume XLIV
Number 7
SupevioT for acne cleansing
The greatest benefit in
acne therapy comes to
those patients who use
pHisoHex® often and
daily in conjunction
with other standard
measures.
For best results, pre-
scribe from four to six
pHisoHex washings of
the acne area daily.
pHisoHex cleans better
than soap, degerms rap-
idly, prevents bacterial
growth, and maintains
normal skin pH.
pHisoHex*
Sudsing,
nonalkaline
antibacterial
detergent —
nonirritating,
hypoallergenic.
Contains 3%
bexachloropbene.
LABORATORIES
New York 18, N.Y.
pHisoHex, trademark reg. U. S. Pat. Off.
(Continued from page 758)
her 6 at the Silver Lake Country Club in Lees-
burg. Approximately 80 persons attended the
dinner meeting. Mr. Wesley A. Sink and Mr. Al-
fred Hawkins, attorneys, gave the presentation
on the subject: AMA-Bar Medico-Legal Problems.
Leon-Gadsden-Liberty-Wakulla- Jefferson
The Leon-Gadsden-Liberty-Wakulla- Jefferson
County Medical Society has paid 100 per cent
of its state dues for 1957.
Pinellas
Dr. John I*. Rowell, of St. Petersburg, was
principal speaker for the December meeting of
the Pinellas County Medical Society. The title
of his address was ‘‘Review of Fluoridation of
Water.”
Putnam
Dr. Edward Jelks, of Jacksonville, a member
of the Board of Governors of the Florida Medical
Association, addressed members of the Putnam
County Medical Society at their November meet-
ing.
Walton-Okaloosa-Santa Rosa
The Walton - Okaloosa - Santa Rosa County
Medical Society has paid 100 per cent of its state
dues for 1957.
William C. Young
Dr. William C. Young died at his home in
Chiefland on Aug. 18, 1957, after an illness of
several months. He was 82 years of age.
Born in South Carolina in 1874, Dr. Young I
received his medical training in Georgia. He was I
awarded the degree of Doctor of Medicine by the I
Medical College of Georgia at Augusta in 1911
and that same year was licensed to practice medi- I
cine in Florida. He engaged actively in the gen- I
eral practice of medicine in Chiefland for 44
years and was a resident of Florida for 60 years, i
Home deliveries were routine for Dr. Young, who 1
delivered over 3,000 babies during his career, in- I
eluding many of Chiefland’s prominent citizens, I
young and old. Noted for a remarkable memory, I
he not only could recall the date but also the time I
of every delivery.
This beloved family physician was so highly I
esteemed in the community that a new street was ll
named W. C. Young Boulevard in his honor last H
year. He was always active in church work, at- I
tending choir and prayer meetings, and until a I
(Continued on page 766)
.
*
care of
the man
rather than merely
his stomach”8
indications: peptic ulcer, spastic and irritable colon, esophageal
spasm, G. I. symptoms of anxiety states.
each Milpath tablet contains:
Miltown.® (meprobamate WALLACK) 400 mjj*
(2-methyl-2-«-propy 1-1, 3-propanediol dicarbamute)
Tridihexethyl iodide . .25 mg.
(3-dicthylamino-l-cyclohexyl-l-phenyl-l-propanoI-eth iodide)
dosage : 1 tablet t.i.d. at mealtime
and 2 tablets at bedtime.
available : bottles of 50 scored tablets.
references: 1 Altscliul. A. and Billow. B : The clinical use of meprobamate. (Miltown*). New York .1 Med. 1 7 : 23fil,
July 1"), 1957. 2. At water. J. S. : The use of anticholinergic agents in peptic ulcer therapy. J. M A. Georgia 4-7:421. Oct. 1950.
3. Borrus, J. (’.: Study of effect of Miltown (2-mct hyJ-2-w-propy I- 1. 3-propanediol (licarbanuUe) on psychiatric states.
J. A. M. A. 7.57:1590. April 30. 1955. 4 Gayer, D : Prolonged anticholinergic therapy of duodenal ulcer. Am. J. Digest. I)ls.
7:301, July 1950. 5. Marquis, D. (1 .. Kelly. 10. I... Miller, J. (*.., Gerard. K. W. and Rnpoport. A : i:\perimental studies of
behavioral effects of. meprobamate on normal subjects. Ann. New York Acad. Se. <77:701. May 9. 1957. 0 Phillips. H 10.:
Use of meprobamate (Miltown*) for the treatment of emotional disorders. Am. Bract A Digest Trent. 7:1573. Oct 1950.
7. Selling. I.. S. : A clinical study of Miltown*. a new tranquilizing agent. J Clin & lOxper. Psychopath. 77:7, March 1950
8. Wolf. S. and Wolff. H. Cl.: Human Gastric Function, Oxford fnlversity Press, New York. 1917.
WALLACE LABORATORIES. New Brunswick, N. J.
two-level control of
gastrointestinal dysfunction
Milpath
Miltown® Q anticholinergic
at the central level The tranquilizer Miltown® reduces anxiety and tension.1-3 °- 7
Unlike the barbiturates, it does not impair mental or physical efficiency.5-7
at the peripheral level The anticholinergic tridihexethyl iodide reduces
hypermotility and hypersecretion.
Unlike the belladonna alkaloids, it rarely produces dry mouth or blurred vision.2-4
ANEW
why Ditnetane ;s the best reason yet for you to re-exam i
the antihistamine you’re now using » Milligram for miiiigA
DIMETANE 'potency is unexcelled . dimetane has a therapeutic index unrivaled b;ai
other antihistamine— a relative safety unexceeded
Diagnosis
No. of
Patients
Response
Side Effect 1
by any other antihistamine, dimetane, even in very
Excellent
Good
Fair
Neaative
H
Allergic
rhinitis and vaso
low dosage, has been effective when other antihis-
motor rhinitis
Urticaria and
30
14
9
5
2
blight Drov.Hp
famines have failed. Drowsiness, other side effects
edema
Allergic
3
«
t
1
Dizzy (1) H
dermatitis
2
1
1
Slight Dro'
have been at the very minimum.
Bronchial asthma
Pruritus
1
1
l
1
» unexcelled antihistaminic action
Tota
37
15
13
7
2
Drowsiness
Dizzy (1) |
From the preliminary Dimetane Extentabs studies of three investigators. Further clinical Investigations will be reported a «•<*
DIMETANE IS PARA8ROMDYLAMINE MALEATE - EXTENTABS 12 MG., TABLETS 4 MG., ELIXIR 2 MG. PER 5 CC.
blanket of allergic protection, covering 10-12
>urs — with just one Dimetane Extentab » dimetane
' tentabs protect patient for 10-12 hours on one tablet.
Periods of stress can be easily han-
dled with supplementary dimetane
Tablets or Elixir to obtain maxi-
mum coverage.
A. H. ROBINS CO., INC.
Dosage:
Adults— One or two i-mg. tabs,
or two to four tcaspoonfuls
Elixir, three or four times daily.
One Extentab q.8-12 h.
or twice daily.
Children over C—One tab.
or two tcaspoonfuls Elixir t.i.d.
or q.i.d., or one Extentab q.l2h.
Children 3-6— Vs tab.
or one teaspoonful Elixir t.i.d.
Richmond, Virginia | Ethical Pharmaceuticals o( Merit Since 1878
766
Volume XLlV
Number 7
(Continued from page 762)
short time before his death he served as lay pastor
in the Baptist Church.
Dr. Young was the oldest member of the
Alachua County Medical Society. He was a life
member of the Florida Medical Association and
also held membership in the American Medical
Association.
Immediate survivors include the widow, Mrs.
Jessie Young, of Chiefland; two daughters, Mrs.
Edward Kielmer, of Gary, Ind., and Mrs. Tom
Barkett, of Chiefland; and two sons, Dr. Wilburn
C. Young, of Canal Point, and Capt. William H.
Young, United States Army, Ann Arbor, Mich.
A sister, Mrs. J. P. Frierson, of Kingstree, S. C.,
and a brother, Harry Young, of Oklahoma City,
Okla., also survive.
Ralph Frederick Allen
Dr. Ralph Frederick Allen of Miami died at
Variety Children’s Hospital in that city on Aug.
9, 1957, a few hours after suffering a heart attack
at his home. He was 46 years of age.
A native Floridian, Dr. Allen was born in
Milton. He completed high school there and then
attended the University of Florida. He received
his medical degree from the Tulane University
School of Medicine in New Orleans in 1935.
Thereafter, he served one year in the United
States Public Health Service Hospital in San
Francisco.
In 1937, Dr. Allen returned to Florida and
entered the private practice of medicine in Mi-
ami. His specialty was proctology. Locally, he
was a member of the Miami Kiwanis Club, Miami
Consistory and Biscayne Bay Lodge, A.F'. St
A.M., and the Riviera Country Club.
During World War II, Dr. Allen served as an
officer in the Navy, conducting surveys of health
and sanitation in the Marshall Islands and other
Pacific areas.
Dr. Allen was a member of the Dade County
Medical Association and the Florida Medical
Association. He also held membership in the
American Medical Association, Southern Medical
Association, American Proctology Association, In-
ternational College of Surgeons and American
Society of Tropical Medicine.
Surviving are the widow, Mrs. Eugenia Allen;
a son, Raymond F. Allen, of Miami; a daughter,
Mrs. Gary Lipe, of Quantico, Va.; and his moth-
er, Mrs. Carrie H. Allen, of Milton.
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St., New York 3.
J. Florida. M.A.
January, 1958
new
“flavor -timed”
dual- action
coronary vasodilator
TRADEMARK
ORAL
for Sustained coronary vasodilation and
protection against anginal attack
SUBLINGUAL
for Immediate relief from anginal pain
DILCORON contains two highly efficient vasodilators
in a unique core-and-jacket tablet.
Glyceryl trinitrate (nitroglycerin)— 0.4 mg. (1/150 grain)
is in the outer jacket-held under the tongue until
the citrus flavor disappears ; provides
rapid relief in acute or anticipated attack.
The middle layer of the tablet is
the citrus “flavor-timer.”
Pentaerythritol tetranitrate — 1 5 mg. (1/4 grain) is in the
inner core— swallowed for slow enteric
absorption and lasting protection.
For continuing prophylaxis patients may
swallow the entire Dilcoron tablet.
768
Volume XLIV
N UMBER 7
Theodore McKee Trousdale
Dr. Theodore McKee Trousdale died at his
home in Sarasota on April 16, 1957. He was 58
years of age. Interment took place in Rome, Pa.
Dr. Trousdale was a native of Platteville, Wis.,
where he was born in 1898. He was graduated
from Cornell University in 1921. He received his
medical degree from the Johns Hopkins University
School of Medicine in 1925 and completed his
postgraduate training at Long Island Hospital in
1931.
Locating first in Peaksville, N. Y., Dr. Trous-
dale engaged in the practice of medicine there
until his entry into World War II. He served
four and one-half years in the Army Medical
Corps. After his separation from military service,
he came to Florida and made his home in Sara-
sota. For 1 1 years he practiced his specialty of
ophthalmology and otolaryngology there. Locally,
he was a member of the Sarasota American Le-
gion Post, and he was affiliated with the First
Methodist Church.
Dr. Trousdale was a member of the Sarasota
County Medical Society and the Florida Medical
Association. He also held membership in the
American Medical Association and in his specialty
societies.
BIRTHS AND DEATHS
Births
Dr. and Mrs. Wade S. Rizk, of Jacksonville, an-
nounce the birth of a daughter, Katherine Wade, on
October 1, 1957.
Dr. and Mrs. William J. Phelan, of Jacksonville, an-
nounce the birth of a daughter, Colleen Teresa, on Octo-
ber 22, 1957.
Deaths — Members
Neill, Robert G., Orlando October 19, 1957
Tolar, Julian N., Sanford October 23, 1957
Brooks, Warren A., Winter Park November 9, 1957
Deaths — Other Doctors
Burns, Joseph P., Lake City October 28, 1957
Carroll, Charles H., Miami November 10, 1957
Stormont, Riley M., Webb City, Mo. July 24, 1957
Eighty-Fourth Annual Mooting
Florida Medical Association
Hotel Americana. Miami Beach
May 10-14, 1958
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 wg.)the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATH1LON (25 mg.)the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
J. Florida, M.A.
January, 1958
769
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or Vz teaspoonful
contains:
Pentylenetetrazol . .100 mg.
Nicotinic Acid 50 mg.
1. Levy, S., JAMA., 153:1260, 1953
2. Thompson, L. , Procter R.,
North Carolina M. J., 15:596, 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
770
Volume X 1. 1 V
Number 7
Digi*attS
in its completeness
33
|
9
JlUIAgbin
Digitalis
t
< Davie*. Rose I
0,1 Gram
Ulgrtl. grain*)
s-
CAUTION: Ferret
luw prohibits ilisperwi-
i‘-
wltboot pc««rHp'
Don.
e,v
Minis. MSI t C8„ Itf.
i%
*«»«. too.. II S.*
4
Each pill is
equivalent to
one USP Digitalis Unit
Physiologically Standardized
therefore always
dependable.
Clinical samples sent to
physicians upon request.
Davies, Rose & Co., Ltd.
Boston, 18, Mass.
WOMAN’S AUXILIARY
TO THE
FLORIDA MEDICAL ASSOCIATION
OFFICERS
Mrs. Perry D. Melvin, President Miami
Mrs. Lee Rogers Jr., President-Elect Rockledge
Mrs. William D. Rogers. 1st Vice Pres. .. .Chattahoochee
Mrs. I.effie M. Carlton Jr., 2nd Vice Pres Tampa
Mrs. Edward W. Ludwig, 3rd Vice Pres Jacksonville
Mrs. James M. Weaver, 4th Vice Pres.. .Fort Lauderdale
Mrs. Wendell J. Newcomb, Recording Sec’y .. . .Pensacola
Mrs. Willard L. Fitzcerald, Treasurer Miami
Doctor’s Day Awards
It looked like a wide Florida beach, the white
sand strewn with driftwood and seashells gleam-
ing in the sun. Only this was different — it was
the cloths as white as the sand and the wood
grayed and weathered on the tables. The drift-
wood was abloom with orchids, white, lavender,
and royal purple, and it was the Blue Room of
the Delano Hotel at Miami Beach.
The annual Doctor’s Day Awards luncheon
of the Woman’s Auxiliary to the Southern Medi-
cal Association, given in honor of our doctors,
had as its theme this year “Orchids to our Doc-
tors,” and each person had an orchid to take
away from the luncheon, carefully kept fresh
in a small container of water.
The exclamations at the beauty of the deco-
rations kept resounding like the surf on the
beach as more and more Southern doctors and
their wives entered the room. Is it any wonder
Southern has been here four times and will be
returning in 1962. We will welcome them again
as before, being well repaid with compliments
during the meeting, and the letters and notes
which continue to arrive recalling the “wonderful
time we had at Southern in Florida, you were so I
friendly and hospitable.”
Doctor’s Day is observed on March 30, the I
anniversary of the day in 1842 when sulphuric!
acid ether was first used in a surgical operation I
by Dr. Crawford W. Long of Georgia. Begun in |
1933 in two Georgia county Auxiliaries, its wasB
shortly thereafter adopted by the Southern Aux-B
iliary and is now part of the program of theB
Auxiliary to the A.M.A. It is the day on which I
we of the Auxiliary honor our physicians in manyB
and varied ways, suiting the means to our ownl
communities. It is also the day on which, if pos-B
sible, we try to provide some personal pleasure
for our hard working husbands with dinners,
barbecues, dances or other entertainment.
The awards given at the Doctor’s Day Awards
luncheon are for the most original, outstanding
and unique observance of Doctor’s Day the past
(Continued on page 773)
"
i
ISIS
'
(Dihydrocodeinone with Homatropine Methyfbromide)
■ ?
■ Relieves cough quickly and thor-
oughly ■ Effect lasts six hours and
longer, permitting a comfortable
night’s sleep ■ Controls useless
cough without impairing expecto-
ration ■ rarely causes constipation
■ And pleasant to take
Syrup and oral tablets. Each teaspoon-
ful or tablet of Hycodan* contains 5 mg.
dihydrocodeinone bitartrate and 1.5 mg.
Mesopin.t Average adult dose: One tea-
spoonful or tablet after meals and at
bedtime. May be habit-forming. Avail-
able on your prescription.
endo Laboratories
Richmond Hill 18, New York
U. S. PAT. 2,630,400 + BRAND OF HOMATROPINE METHYL BROMIDE
Reviews of ataraxic therapy commonly divide the available tranquilizers into three
main categories: the rauwolfia derivatives; the phenothiazine compounds; and a
smaller group of agents which are lumped together for the sake of convenience
rather than because of any common characteristic.
As a result, one significant fact is often overlooked: ATARAX (hydroxyzine) does
not fit into any of these three categories. Indeed, by any logical criterion, it
belongs in a class by itself.
1. ATARAX is chemically unique. It differs from any other tranquilizer now avail'
able, not in minor molecular rearrangements but in basic structure.
2. ATARAX is therapeutically different. ATARAX is characterized by unique cerebral
specificity. On ATARAX, the patient retains full consciousness of incoming stimuli
-their nature and their intensity-but his reactions are those of a well-adjusted
person. He is neither depressed nor torpid, and his reflexes remain normal, as does
cortical function. Thus ATARAX induces a calming peace-of-mind effect without
disturbing mental alertness.
ATARAX
in any
hyperemotive
state
for childhood behavior disorders
10 mg. tablets— 3-6 years, one tab-
let t.i.d.; over 6 years, two tablets
t.i.d. Syrup -3-6 years, one tsp.
t.i.d.; over 6 years, two tsp. t.i.d.
for adult tension and anxiety
25 mg. tablets-one tablet q.i.d.
Syrup— one tbsp. q.i.d.
for severe emotional disturbances
100 mg. tablets-one tablet t.i.d.
for adult psychiatric and emotional
emergencies
Parenteral Solution-25-50 mg-
(1-2 cc.) Intramuscularly, 3-4
times daily, at 4-hour intervals.
Dosage for children under 12 not
established.
Supplied: Tablets, bottles of 100. Syrup,
pint bottles. Parenteral Solution, 10 cc.
multiple-dose vials.
3. ATARAX is, perhaps, the safest ataraxic known. It is outstandingly well tolerated.
Every clinical report confirms this fact.* After more than 150 million doses, there
has not been a single report of toxicity, blood dyscrasia, parkinsonian effect, liver
damage, or habituation.
4. ATARAX is unusually flexible. This lack of toxicity makes it possible to adjust
ATARAX dosage to virtually any patient need. In the lowest range, children respond
well to 10 mg. or one teaspoonful of syrup t.i.d., while anxious adults usually are
treated with 25 mg. q.i.d. Yet, if needed, the dosage can safely be raised: in more
severe disturbances, dosages up to 1,000 mg. daily have been administered without
adverse reactions.
In reviewing your own experience with tranquilizers, remember that ATARAX is in
a class by itself; that you cannot judge it by your results with any other drug. To get
to know ATARAX at first hand, prescribe it for the next four weeks whenever a
tranquilizer is indicated. See for yourself how it compares.
•Documentation on request 71 71 “T* 71 H 71 V/’
Fc/ILt OF MIND A \ AKA A
(brand of hydroxyzine)
Medical Director
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
J. Florida. M.A.
January, 1958
773
(Continued from page 770)
March. One award goes to the state having the
best statewide observance, one to the county of
more than 50 members, one to the county of less
than 50 members and an honorable mention in
each category. There is also the Feldner Trophy
which is awarded to the state for its county
auxiliary submitting the best total observance,
regardless of size.
There was a round of applause when Seminole
county, with 14 members, won honorable mention
in the small county group for the second suc-
cessive year; there was louder applause when
Florida Auxiliary was presented with a crisp
ten dollar bill for the best statewide observance
and then the roof was raised when Florida was
presented the Feldner Trophy, for the observance
of Dade County Auxiliary. Mrs. William P.
Smith, President of Dade County Auxiliary and
General Chairman of the Southern Convention,
and Mrs. Maurice Greenfield, President-elect of
Dade County Auxiliary, had been the Co-chair-
man for this observance. Mrs. Robert F. Dickey,
Dade Auxiliary’s President in March 1957, Mrs.
Robert F. Mikell, who had written the original
skit, and all the Dade County Auxiliary mem-
bers who had worked so hard were there to re-
ceive this honor. The only drawback was that
Mrs. Leffie M. Carlton Jr., of Tampa, and Mrs.
Scottie J. Wilson, of Ft. Lauderdale, Chairman
and President respectively last year, were not
present to accept the state award. It. was the
excellence of the county observances in each of
the 24 counties and Mrs. Carlton’s skill in re-
porting them which was the determining factor
in our winning the prizes.
So when the Auxiliary in your county has
its Doctor’s Day celebration, forget the office and
the hospital for this one night and join in the
fun with the other doctors in your society. Laugh
at the skit or the songs which poke gentle fun at
you; dance if you aren’t too tired or the music
isn’t too fast and remember the Auxiliary is try-
ing to show its pride in your chosen profession
and to provide some moments of fun and relax-
ation, where the burdens of your profession can
be set aside, to be resumed with renewed vigor
from the night’s respite.
Mrs. Perry D. Melvin
The Thirty-First Annual Meeting of the
Woman’s Auxiliary to the Florida Medical Asso-
ciation will be held in May at the Hotel Ameri-
cana, Bal Harbour, Miami Beach.
when anxiety and tension "erupts” in the G. I. tract...
ILEITIS
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay" of ileitis — without fear of barbiturate loginess, hangover or
habituation . . . wth PATHILON (25 //ig.)*!16 anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
HOOKS RECEIVED
EVERY WOMAN
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
"premarin:
widely used
natural, oral
estrogen
AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
5645
It Pays to Be Healthy. A World - Renowned
Physician Guides You to Success, Happiness, and Health
in Your Work ■ By Robert Collier Page, M.D., F.A.C.P.
Pp. 285. Price, $4.95. Englewood Cliffs, N. J., Pren-
tice-Hall, Inc., 1957.
Reminding the reader that the tensions and frustra-
tions of his job can take years off his life unless he knows
how to handle this vastly important area of his daily
living, this book shows him how to analyze his job and
his approach to his job, how to deal with people who
may annoy him, how to find the job that is right for
him, how to know himself as he really is. In short, he
learns how to meet the competition he must meet, earn
more money as he goes along, and keep himself healthy,
likeable and energetic.
As a medical consultant for management, the author
has stutlied employed persons as whole persons who have
likes and dislikes, who go home to families, who rear
rhildren, who want some of the good things that money
can buy. In this book he helps one understand the
stages of life through which all must pass, and the spe-
cial problems of each stage. He gives careful, friendly
counsel to the wife of the ambitious man. He shows
how attitudes, secret thoughts and personality can make
or break one. He also makes clear a few simple, safe
technics — not medicines — that can help anyone lead a
better life, no matter what his job may be. In addition,
he shows how executives really get results from their
staffs, how industry really looks at the worker, and the
meaning of authority. There are surprising revelations
about the worker and about American business in this
frank, comprehensive book. The reader will be rewarded
by finding a fresh approach to his job that offers him
the greatest possible reward and shows him how he holds
in his hands the key to health in everything he does.
From Sterility to Fertility. A Guide to the
Causes and Cure of Childlessness. Bv Elliot E. Philipp,
M.D., MB, B.Chir, F.R.C.S, M.R.C.O.G. Pp. 120.
Price, $4.75. New York, Philosophical Library, Pub-
lishers, 1957.
This book was written by a consultant gynecologist
and obstetrician attached to a general hospital with a
large gynecologic and maternity department to help
childless couples decide what can be done to overcome
their infertility. About one in every six couples is child-
less, and undoubtedly some of these millions can be
assisted by doctors who give advice, conduct investiga-
tions to find the causes in individual cases, and treat the
causes when they are discovered and are amenable.
The book does not and cannot replace the doctor, but
it will save doctors and patients precious hours by ex-
plaining for the lay public some of the known reasons
for infertility and how and why the investigations and
treatments are carried out. Helpful diagrams and charts
are included, and advice is given concerning the adoption
of babies through the registered societies and authorities.
The Chronically 111. By Joseph Fox, Ph D. Pp.
229. Price, $3.95. New York, Philosophical Library, Inc, I
1957.
This book attempts to survey some of the facets of
what has become a most significant demographic and
public health problem confronting the nation. This so-
ciologic approach to the problem should be of great in-
terest to the busy physician, the social worker, the hos-
pital administrator and those in labor and management
who deal with the chronically ill. The approach is first
to consider chronic disorders as they strike the individual, j
and only after they have been discussed in that setting
are the problems of organization, institutionalization, fi- I
nance and ethics discussed. The author, who has had
wide experience as administrator of a home for aged and
of a small chronic disease hospital, has devoted almost
two decades to the study and analysis of the long term
patient and the aged.
J. Florida. M A.
January, 1958
775
For Speedier Return To Normal Nutrition
u? . : =
and the Protein Need
in Renal Disease
Prevailing opinion holds that during the nephrotic
state — provided the kidneys are capable of excreting
nitrogen in a normal manner — the patient should be
given a diet high in protein (1.5 to 2 grams per kilogram
of body weight daily). The purpose of such a diet is to
replace depleted plasma protein and to increase the
colloidal osmotic pressure of the blood.
Sharp restriction of dietary salt appears indicated
only in the presence of edema, but moderate restriction
is usually recommended.
Lean meat is admirably suited for the diets pre-
scribed in most forms of renal disease. It supplies rela-
tively large amounts of high quality protein and only
small amounts of sodium and chloride. Each 100 Gm.
of unsalted cooked lean meat (except brined or smoked
types) provides approximately 30 Gm. of protein, and
only about 100 mg. of sodium and 75 mg. of chloride.
In addition to its nutritional contributions meat
fulfills another advantageous purpose: It helps make
meals attractive and tasty for the patient who must
rigidly adhere to a restricted dietary regimen.
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nutri-
tion of the American Medical Association and found
consistent with current authoritative medical opinion.
American Meat Institute
Main Office, Chicago . . . Members Throughout the United States
I
776
Voi.ume XLI\'
N UMBER 7
fitting that's proper
When the final screw is tightened and the last lens polished,
it’s proper fitting that counts. Your guild optician’s
highest standards of technical accuracy go hand in
hand with his skilled fitting to insure your patient’s
comfort. When your prescription is filled by your
GUILD optician you know that your patient will
weai his needed correction.
Guild of Prescription Opticians of Florida
777
T. Florida, M.A.
January, 1958
Management of the Patient With Headache.
By Perry S. MacNeal, M.D., F.A.C.P., Bernard J. Alpers,
vi.D., Sc.D. (Med), F.A.C.P., and William R. O’Brien,
M.D., F.A.P.A. Pp. 145. Price, $3.50. Philadelphia, Lea
k Febiger, 1957.
Probably no other symptom has such hidden meanings
is headache. In this book, the authors provide a basic,
clinical understanding of the problem and discuss causes,
differential diagnosis and treatment of the several types
i >f headache. Medical, psychologic and neurologic factors
ire considered fully in their relation to causes and to
herapeutic management. Emphasis is on treatment of
he patient and the many problems involved, as well as
in the headache itself. The authors stress the need for
! —and tell how to obtain — a detailed history of the symp-
om, a sound estimate of the patient’s personality, and
i knowledge of the social history, previous adjustments,
■motional stability, and other factors which provide the
• lasis for a personality study. Discussions of the psycho-
ogic and vascular mechanisms of head pain precede a
ound consideration of headache as a symptom of hyper-
ension and other cardiovascular disorders.
Differential diagnosis and treatment are covered from
■very phase of the subject. Under Headache in Organic
Brain Disease, are discussions of brain tumors and ab-
scesses, meningitis, vascular lesions, cough headache, sub-
dural hematoma, subarachnoid hemorrhage, post-traumat-
c headache, and cerebral aneurysms. Other forms given
iqual attention are tension, psychogenic, migraine, aller-
jic, hypertensive, premenstrual, menopausal, arterioscle-
rotic, and allergic and histamine headaches. Ocular factors,
oaranasal sinuses, the neuralgias and other extracranial
auses are taken up separately.
With the knowledge contained in this book, family
physicians, internists, psychiatrists, neurologists, and oth-
■rs can face, with confidence, any patient whose chief
omplaint is headache.
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
RADIUM
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Chysician.Radiologist)
HAROLD SWANBERG, B.S., M.D., Director
W. C. U. Bldg. Quincy, Illinois
when anxiety and tension "erupts” in the G. I. tract...
in spastic
and irritable colon
PATH I BAM ATE
*
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer. . . helps control the
emotional overlay of spastic and irritable colon — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for Tridihexethyl Iodide Ledprle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
778
Volume XLIV
Number 7
Allens Invalid Home
MILLEDGEVILLE, GA.
Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY HOOK PRINTING
PUBLICATIONS ☆ BROCHURES
Convention
PRESS ^ *
218 West Church St.
Iacksdnviuk, F i. o r i d a
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
779
IT. Florida, M.A.
[| January, 1958
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
Suburb of Atlanta
For the Treatment of
INvehinlrie Illnesses and Problems of Addiction
Psychotherapy, Convulsive Therapy, Recreational and Occupational Therapy
Modern Facilities
MEMBER
Georgia Hospital Association, American Hospital Association, National Association of
Private Psychiatric Hospitals
JAS. N. BRAWNER, JR., M.D.
Medical Director
P. O. Box 218
ALBERT F. BRAWNER, M.D.
Assistatit Director
Phone HEmlock 5-4486
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
Out-Patient Clinic and Offices
James A. Becton, M.D.
P. 0. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1 151
780
Volume XLIV
Number 7
TUCKER HOSPITAL, INC
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto-
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St, DON SAVAGE P. O. Box 10368
Telephone 61-4191 Owner and Manager Tampa 9. Florida
T. Florida. M.A.
f ANUARV, 1958
INDEX TO ADVERTISERS
781
Abbott Laboratories 7S0a, 753, 754
Allen’s Invalid Home 778
American Meat 775
Ames Co., Inc. Third Cover
Anclote Manor 782
Anderson Surgical Supply Co. 752
Appalachian Hall 781
Armour Laboratories 749
Ayerst Laboratories 774
Ballast Point Manor 780
Bayer Co 688
Brawner’s Sanitarium 779
Brayten Pharmaceutical Co. 693
Bristol Laboratories . 694, 695
Burroughs Wellcome & Co. 690, 770a
Carlton Corp 766
Convention Press 778
Cynbar Sales 740
Davies, Rose & Co 770
Drug Specialties, Inc. 769
Duvall Home 777
Eaton Laboratories 750
Endo Laboratories 771
Guild of Prescription Opticians 776
Highland Hospital, Inc 778
Hill Crest Sanitarium 779
Lakeside Laboratories 685
Ledcrle Laboratories 734, 735, 742a, 744, 747,
755, 768, 773, 777, 786
Eli Lilly & Co 698
Medical Protective Co. 742
Medical Supply Co. 746
Merck Sharp & Dohme 748, 754a
Miami Medical Center 783
Parke-Davis & Co. Second Cover, 683
Picker X-Ray Corp. 759
Quincy X-Ray & Radium Labs 777
Rich Company, Inc 741
A. H. Robins & Co. .756, 757, 764, 765
Roerig & Co. 692, 745, 772
Schering Corp. 690a, 696, 697
Julius Schmid 691
G. D. Searle Company 739
Smith-Dorsey 689
Smith, Kline & French Labs. Back Cover
E. R. Squibb & Sons 687
Surgical Supply Co 758
Tucker Hospital, Inc. 780
Upjohn Co 743
U. S. Brewers . 751
Wallace Laboratories 762a, 763
Westbrook Sanatorium 782
Winthrop Laboratories, Inc. 760, 761, 762, 767
APPALACHIAN HALL
ASHEVILLE
Established 1916
NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D.
Robert A. Griffin, M.D.
Mark A. Griffin Sr., M.D.
Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
782
Volume XLIV
Number 7
mim
' imiiii
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
• Occupational and Hobby Therapy
• Healthful Outdoor Recreation
0 Supervised Sports
• Religious Services
• Ideal Location in Sunny Florida
IFOR EMOTIONAL
READJUSTMENT
• Modern Treatment Facilities
0 Psychotherapy Emphasized
0 Large Trained Staff
0 Individual Attention
• Capacity Limited
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr„ M D
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants in Psychiatry
SAMUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M D
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
Westbrook , Sanatorium
■ t>stabtished If) 1 1 ■
RiCHMO N D
VIRGINIA
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin. psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
PAUL V. ANDERSON, M.D., President
REX BLAN KINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOM AS F. COATES, M.D., Associate
JAMES k. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and l iens Sent On Request - P. 0. Box 1514
SCHEDULE OF MEETINGS
783
_ RGANIZATION
i (edical Association
a ledical Districts
o nvest
o least
ouwest
0 least
a lecialty Societies
m of General Practice
y Society
ie ilogists, Soc. of
F s., Am. Coll., Fla. Chap.
I Syph., Assn of
1 fficers’ Society
ir and Railway Surgeons
a Medicine
icjynec. Society
ia& Otol., Soc. of
p.:c Society
li sts, Society of
r Society
c Reconstructive Surgery
>1 ic Society
is ic Society
li cal Society
o Am. Coll., Fla. Chapter
z I Society
&
iiicience Exam. Board
0 Banks, Association
e ross of Florida, Inc
e held of Florida, Inc
it Council
fcas Assn
tl Society, State
ii Association
if il Association
d 1 Examining Board
d 1 Postgraduate Course
H Anesthetists, Fla. Assn.
rs Association, State
mceutical Assoc., State
il Health Association
t u Society
1 ulosis & Health Assn
r i’s Auxiliary
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Donald F. Marion, Miami
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Reiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy..:
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax.
Howard M. DuBose, Lakeland
Judge Ernest E. Mason, Pensacola
Mrs. Perry D. Melvin, Miami
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Nathan J. Schneider, Jax.
Frank Cline Jr., Tampa
Mr. Ernest L. Abel, W. Palm Bch.
Mrs. Wendell J. Newcomb, Pensa.
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Miami Beach, May 1958
77 77 77
77 1) 77 77
>» 77 77 77
>> 77 77 77
77 77 77 77
Jan. 58
Miami Beach, May 1958
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
Miami Beach, May 11, ’58
Miami Beach, May 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
77 77 77 77
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
Jacksonville, May 18-21, ’58
Miami Beach, May 10-14, ’58
k Medical Association
[ Clinical Session
< Medical Association
i Medical Association
i Medical Assn, of
spital Conference
t tern Allergy Assn
(Item, Am. Urological Assn,
stern Surgical Congress
1 ast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City
John A. Martin, Montgomery
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala. ....
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Montgomery, Apr. 17-19, ’58
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Hollywood, Jan. 12-16, ’58
I MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones. 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin, Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Member American Hospital Association
784
Volume XLIV
Number 7
FLORIDA MEDICAL ASSOCIATION
Officers and
OFFICERS
WILLIAM C. ROBERTS, M.D., President ..Panama City
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy. -Treas. .. .Jacksonville
SHALER RICHARDSON, M.D., Editor. .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama Cilv
EUGENE G. PEEK JR., M.D...AL-58 Ocala
GEORGE S. PALMER, M.D...A-58 Tallahassee
CLYDE O. ANDERSON, M.D...C-59 Si. Petersburg
REUBEN B CHRISMAN JR., M.D. . D-60. .Coral Gables
MEREDITH MALLORY, M.D...B-61 Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D. . . PP-59 . . . . St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
t. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL-58 Brooksville
First— ALPHEUS T. KENNEDY, M.D 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D. 3-58 Jacksonville
Fourth— DON C. ROBERTSON, M.D 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D. 5-59 Sarasota
Sixth — GORDON H. McSWAIN, M.D 6-58 ..Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
FOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHF.R CHAPPELL, M.D., Chm Orlando
THOMAS H. BATES, M.D. “A” Lake Citv
FRANK L. FORT, M.D. “B” Jacksonville
ALVIN L. MILLS, M.D. "C” St. Petersburg
JOHN D. MILTON, M.D. “D” Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
LEO E. REILLY, M.D. AL 58 Panama City
ROBERT B. McIVER, M.D. B-58 Jacksonville
GRETCHEN V. SQUIRES, M.D A-59 Pensacola
DONALD W. SMITH, M.D. D-60 Miami
Committees
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm AL-58 Cainesville
III NRY I . SMITH JR., M.D. A-58 Tallahassee
JOHN J. CHELEDEN, M.D B-58 Daytona Beach
JOHN M. BUTCHER, M.D C-58 Sarasota
PAUL G. SHELL, M.D. D-58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D A-59 Pensacola
HENRY L. HARRELL, M.D. B 59 Ocala
JAMES R. BOULWARE JR., M.D C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 W. Palm Beach
Ml BRITT R. CLEMENTS, M.D A-60 Tallahassee
ROBERT E. ZELLNER, M.D B-60 Orlando
WHITMAN C. McCONNELL, M.D. C-60 St. Petersburg
RALPH S. SAPPENFIELD, M.D. D-60 Miami
HAROLD E. WAGER, M.D. A 61 Panama City
CHARLES F. McCRORY. M.D. B 61 lacksonvilh
JOHN S. STEWART, M.D C-61 Fort Myers
DONALD F. MARION, M.D I) 61 Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
BARCLEY I). RHEA, M.D A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN N'ORTWICK, M.D B 61 Jacksonville
CHILD HEALTH
WARREN W. QUII.LIAN, M.D., Chm. D 58 Coral Cables
WILLIAM F. HUMPHREYS JR., M.D. AL-58 Panama Citv
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D. A 60 Tallahassee
J. K. DAVID JR., M.D. B-61 _ Jacksonville
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm. AL-58 _ Orlando
WILLIAM W. TRICE JR., M.D C-58 Tampa
JOHN V. HANDWERKER JR., M.D I) 59 Miami
WALTER C. PAYNE JR., M.D. A-60 Pensacola
W. DEAN STEWARD, M.D B 61 Orlando
CONSERVATION OF VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orlando
HUGH E. PARSONS, M.D. C-58 Tampa
CHARLES C. GRACE, M.D. B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D D-61.._ W. Palm Beach
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D St. Petersburg
JOHN I). MILTON, M.D Miami
DUNCAN T. McFAVAN, M.D Orlando
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 W. P aim Beach
GEORGE H. GARMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
MATERNAL WELFARE
E. FRANK McCALL, M.D., Chm B-60 ... Jacksonville
WILLIAM C. FONTAINE, M.D AL-58 Panama Cits
J. LLOYD MASSEY M.D A-58 Quincy
RICHARD F. STOVER, M.D. D-59 Miami
S. L. WATSON, M.D C-61 Lakeland
Florida, M.A.
Ivnuary, 1958
MEDICAL ECONOMICS
OBERT E. ZELLNER, M.D., Chm AL.58 Orlando
EWITT C. DAUGHTRY, M.D. D-58 Miami
CARNES HARVARD, M.D. C-59 Brooksville
ERRITT R. CLEMENTS, M.D. A-60 Tallahassee
, LOYD K. HURT, M.D B-61 Jacksonville
785
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm B-60 Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD REESER JR., M.D. C-59 St. Petersburg
GRF.TC.HEN V. SQUIRES, M.D. A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
IlCK Q. CLEVELAND, M.D., Chm D-58
VUL J. COUGHLIN, M.D. AL-58
ILLIAM G. MERIWETHER, M.D. C-59
ALTER E. MURPHREE, M.D. B-60
AYMOND B. SQUIRES, M.D A 61
ibcommittee
Coral Gables
Tallahassee
Plant City
Gainesville
Pensacola
Medical Schools Liaison
■WALTER E. MURPHREE, M.D., Chm. AL-58 Gainesville
[ERRITT R. CLEMENTS, M.D., A-60 Tallahassee
ENRY H. GRAHAM, M.D. B 58 Gainesville
\M£S N. PATTERSON, M.D. C-61 - Tampa
DWARD W. CUI.LIPHER, M.D D 59 Miami
OMER E. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 Miami
EORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
pedal Assignment
. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm A 60
NELSON H. KRAEFT, M.D AL-58
WILLIAM L. MUSSER, M.D. B-58
whitman h. McConnell, m.d c-59
DONALD W. SMITH, M.D D 61
Chattahoochee
Tallahassee
Winter Park
St. Petersburg
Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. B-61.. Jacksonville
HENRY I. LANGSTON, M.D AL-58 Apalachicola
JOHN G. CHESNEY, M.D D-58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D A-60 Wewahitchka
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURSE
URNER Z. CASON, M.D., Chm B-59 Jacksonville
IEO M. WACHTEL, M.D. AL-58 Jacksonville
. FRANK CHUNN, M.D. C-58 Tampa
WILLIAM I). CAWTHON, M.D. A-60 DeFuniak Springs
MARKLIN JOHNSON, M.D D 61 VV. Palm lleach
MENTAL HEALTH
I ULLIVAN G. BEDELL, M.D., Chm B-61 Jacksonville
i VILLIAM M. C. WILHOIT, M.D AL-58 Pensacola
LLOYD MASSEY, M.D A-58 Quincy
V. TRACY HAVERFIELD, M.D D 59 Miami
1ASON TRUPP, M.D C-60 Tampa
NECROLOGY
BASIL HALL, M.D., Chm. AL-58 Tavares
I VALTER W. SACKETT JR., M.D D-58 Miami
LEO M. WACHTEL, M.D B-59 Jacksonville
jvLVIN L. STEBBINS, M.D A 60 Pensacola
(AYMOND 11. CENTER, M.D C-61 Clearwater
NURSING
THOMAS C. KENASTON, M.D., Chm B 59 Cocoa
:ARL M. HERBERT, M.D AL-58 Gainesville
IERBERT L. BRYANS, M.D. A-58 Pensacola
SORVAL M. MARK SR., M.D C-60 St. Petersburg
AMES R. SORY, M.D D 61 .... VV. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
1ICHARD G. SKINNER JR., M.D., Chm B-59. Jacksonville
OHN J. BENTON, M.D. AL-58 Panama City
1EORGE S. PALMER, M.D. A-58 Tallahassee
DWARD W. CULLIPHER, M.D. D 60 Miami
RANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
TASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
WILLIAM J. HUTCHISON, M.D AL 58 Tallahassee
-HAS. L. FARRINGTON, M.D. C-58 St. Petersburg
I'HOMAS N. RYON, M.D D 59 Miami
1IAYMOND R. KILLINGER, M.D. B-61 Jacksonville
Special Assignment
1. Industrial Health
C. W. SHACKELFORD, M.D., Chm. A-61 Panama City
FRANK V. CHAPPELL, M.D AL-58 Tampa
A. BUIST LITTERER, M.D. D-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.D B-60 Jacksonville
WOMAN’S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
JOHN H. TERRY, M.D AL-58 Jacksonville
WILEY M. SAMS, M.D D-58 Miami
G. DEKLE TAYLOR, M.D. B-59 Jacksonville
CHARLES McC. GRAY, M.D C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 Jacksonville
IULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT. M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 ..._ Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D.. 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHF.Y JR., M.D., 1951 Tampa
ROBERT B. McIVER, M.D., 1952 Jacksonville
FREDERICK K HERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M l)., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
786
Volume XLIV
Number 7
ACHROMYCIN
TETRACYCLINE
OPHTHALMIC Oil
SUSPENSION t*
no sting
no smear
no cross
contamination
...Just drop on eye ... spreads in a wink! Provides unsur I
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SUPPLIED: 4 cc. plastic squeeze, dropper bottle containin'
Achromycin Tetracycline HCI (1%) 10.0 mg., per cc., sus
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just wet... ...and read
does proteinuria occur more frequently in any type
of heart failure— myocardial hypertrophy, mitral valve,
coronary artery, aortic valve or hypertensive heart disease?
No. The incidence of proteinuria is about equal among the various
types of cardiac patients in failure.
Source— Race, G. A.; Scheifley, C. H., and Edwards, J. E.: Circulation 13: 329, 1956.
first colorimetric test for proteinuria
ALBUSTIX
Reagent Strips. Bottles of 120.
also available as:
ALBUTEST
Reagent Tablets. Bottles of 100 and 500.
AMES COMPANY, INC • ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto 45s5a
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MED J C I NE
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NEW YORK N Y 29 j c-E
in G.l. disorders
‘Compazine’ controls tension
—often brings complete relief
In such conditions as gastritis, pylor-
ospasm, peptic ulcer and spastic
colitis, ‘Compazine’ not only re-
lieves anxiety and tension, but also
controls the nausea and vomiting
which often complicate these
disorders.
Physicians who have used ‘Com-
pazine’ in gastrointestinal disorders
— often in chronic, unresponsive
cases — have had gratifying results
(87% favorable).
Compazine
the tranquilizer and antiemetic
remarkable for its freedom from
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Available: Tablets, Ampuls, Span-
sule® sustained release capsules,
Syrup and Suppositories.
*T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.P,
Smith Kline & French Laboratories , Philadelphia
FEBRUARY, 1958
Vol. XLIV
ESTABLISHED
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
In a recent report of five years’ experience involving 2,142 patients,
the authors conclude that CHLOROMYCETIN (chloramphenicol,
Parke-Davis) is a valuable and effective antibiotic in the treatment
of various acute infectious diseases.1
Other current reports of in vivo and in vitro studies agree that
CHLOROMYCETIN has maintained its effectiveness very well
against both gram-negative2'6 and gram-positive2,6'10 organisms.
CHLOROMYCETIN is a potent therapeutic agent and, because certain blood
dyscrasias have been associated with its administration, it should not be used
indiscriminately or for minor infections. Furthermore, as with certain other drugs,
adequate blood studies should be made when the patient requires prolonged
or intermittent therapy.
REFERENCES (1) Woolington, S. S.; Adler, S. J., & Bower, A. G., in Welch, H., & Marti-
Ibanez, E: Antibiotics Annual 1956-1957, New York, Medical Encyclopedia, Inc., '>1957, p. 365.
(2) Ditmore, D. C., & Lind, H. E.: Am. /. Gastroenterol. 28:378, 1957. (3) Hasenclever, H. E:
J. Iowa M. Soc. 47:136, 1957. (4) Waisbren, B. A., & Strelitzer, C. L.: Arch. Int. Med. 99:744, 1957.
(5) Holloway, W. J., & Scott, E. G.: Delaware M. J. 29:159, 1957. (6) Rhoads, P. S.: Postgrad. Med.
21:563, 1957. (7) Petersdorf, R. G.; Bennett, I. L., Jr., & Rose, M. C.: Bull. Johns Hopkins Hosp.
100:1, 1957. (8) Royer, A.: Changes in Resistance to Various Antibiotics of Staphylococci and Other
Microbes, paper presented at Fifth Ann. Symp. on Antibiotics, Washington, D. C., Oct. 2-4, 1957.
(9) Doniger, D. E., & Parenteau, Sr. C. M.: J. Maine M. A. 48:120, 1957. (10) Josephson, J. E., &
Butler, R. W: Canad. M. A. J. 77:567 (Sept. 15) 1957.
PARKE, DAVIS & COMPANY • DETROIT 32, MICHIGAN
FFICACY
♦Adapted from Ditmore and Lind.2 Organisms tested were isolated from stools of 48 patients.
Host
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
VOLUME XLIV, No. 8 ♦ Februar ; 1958
C 0 N r E N 1 S
Scien tific A r tides
Transplantation of the Ureters Into an Isolated
Ileal Loop, J. Harold Newman. M.D. 809
Clinical Management of Traumatic Hyphemia,
Thomas G. Dickinson, M.D. 815
Highlights of Second International Congress
For Psychiatry, I. Leo Fishbein, M.D. 820
Abstracts
Drs. Herbert Eichert, Nelson H. Kraeft, and Morris Waisman 826
House of Delegates
Proceedings of Called Meeting, Jacksonville, Dec. 8, 1957 827
Editorials and Commentaries
Program for Eighty-Fourth Annual Meeting 852
Association Policies on Medicare Determined at Called
Meeting of House of Delegates 853
Seminar on Cardiovascular Diseases, Jacksonville, Feb. 20-22. 1958 853
Symposium on Cardiovascular Problems of the Aging,
Miami Beach, April 12, 1958 855
Second Annual Fracture Course, Chicago, April 16-19, 1958 855
Report of Delegates to American Medical Association
1957 Clinical Meeting 855
Informational Meeting Held for Active Members of Blue Shield 861
General Features
Others Are Saying 867
Letter to The Editor 868
State News Items 868
Births, Marriages and Deaths 879
Component Society Notes 882
New Members 892
Classified 900
Obituaries 900
Books Received 908
Schedule of Meetings 923
Florida Medical Association Officers and Committees 924
County Medical Societies of Florida 926
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price S5.00 a year: single numbers. 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411, 735 Riverside Ave.. Jacksonville 3. rla. Telephone £-L 6-1571. Accepted for mail-
ing at snecial rate of Dostage Drovided for in Section 1103. Act of Congress of October 3. 1917: authorized October 16,
1918. Entered as second-class" matter under Act of Congress of March 3. 1879. at the post office at Jacksonville.
Florida. October 23, 1924
J. Florida M.A.
February, 1958
793
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796
Volume XLIV
Number 8
NOW.. .A NEW TREATMENT
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Angina Pectoris. Circulation (Jan.) 1958.
♦•Cardilate’ brand Erythrol Tetranitrate SUBLINGUAL TABLETS, 15 mg. scored
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
[. Florida M.A.
February, 1958
797
IT DOESN’T STOP THE PATIENT
.and for a nutritional buildup
plus freedom from leg cramps*
STORCAVITE’
BONADOXIN brings relief to 88.1%
of patients ... often within a few hours.
But it does not produce drowsiness, or
side effects associated with over-potent
antinauseants. With safe BONADOXIN,
"toxicity and intolerance ... [is] zero.”2
Is she blue at breakfast? Prescribe
BONADOXIN. Usually just one tablet at
bedtime stops nausea and vomiting
of pregnancy . . .
BONADOXIN"
STOPS MORNING SICKNESS... BUT
phosphate-free calcium, 10 essential
vitamins, 8 important minerals.
Bottles of 100.
•due to calcium-phosphorus Imbalance
NEW YORK 17, NEW YORK
Division, Chas. Pfizer & Co., In
and just one supplies the a
full 50 mg. of pyridoxine. N
EACH TABLET CONTAINS:
MECLIZINE HCI 25 mg.
PYRIDOXINE HCI SO mg.
Bottles of 25 and 100.
References: 1. Groskloss, H. H., et al: Clin.
Med. 2:885 (Sept.) 1955. 2. Goldsmith, J. W.:
Minnesota Med. 40:99 (Feb.) 1957.
798
Volume XLIV
Number 8
help reduce
the pressures
IN your
patients
help reduce
the pressures
ON your
patients
for total management
of your hypertensive
patients rely upon
Squibb Whole Root Rauwolfla Serpentina
Raudixin provides gradual, sustained lowering of
blood pressure in hypertensive patients, as well as
a mild bradycardia. Hence, the work load of the
heart is reduced.
. . often preferred to reserpine in private
practice because of the additional activity
of the whole root.”
Tranquilizing Raudixin helps relax the anxious
hypertensive patient so that he is better able to
cope with external pressures without being over-
whelmed by them. By reducing these anxieties and
tensions, Raudixin helps break the mental tension
—hypertension cycle.
Dosage: Two 100 mg. tablets once daily; may be adjusted
within range of 50 to 300 mg. Supply: 50 and 100 mg. tablets.
Bottles of 100, 1000 and 5000.
•JUUOWtH-* IS A SQUIBS TAAOtMASK
Corrin, K. M.: Am. Pract. & Dig. Treatment 8:721 (May) 1957.
Squibb
Squibb Quality— the Priceless Ingredient
NOW- FROM ABBOTT LABORATORIES
AN ANTIBIOTIC TRIAD
-FOR THE CONTROL OF
ALL COCCAL INFECTIONS
against staph-,
strep- and
pneumococci
Indications
erythrocin is indicated in treat-
ing infections caused by staphy-
lococci, streptococci (including
enterococci), and pneumococci.
Indicated also, in treating infec-
tions that have become resistant
to other antibiotics. May be used
for patients who are allergic to
penicillin or other antibacterials.
Dosage
Usually administered in a total
daily dose of 1 to 2 Gm., depending
on severity of infection. Suggested
dose is 250 mg. every six hours;
for severe infections, usual dose is
500 mg. every six hours.
Supplied
In bottles of 25 and 100 Filmtabs
( 100 and 250 mg. ) . Also, in tasty,
cinnamon-flavored oral suspen-
sion, in 75-cc. bottles. Each 5-cc.
teaspoonful represents 100 mg. of
erythrocin activity.
®Filmtab — Film -sealed tablets, Abbott; pat. applied for.
J. Florida M.A.
February, 1958
799
REMARKABLE EFFECTIVENESS PLUS A SAFETY RECORD
UNMATCHED IN SYSTEMIC ANTIBIOTIC THERAPY TODAY
Actually, after almost six years of extensive use, there has not been a single report
of a serious reaction to erythrocin. And, after all this time, the incidence of
resistance to erythrocin has remained exceptionally low.
You’ll find ERYTHROCIN is highly effective against the majority of coccal infec-
tions and may also be used to counteract complications from /^i on
severe viral attacks. It comes in Filmtabs and in Oral Suspension. vAaAK^IX
800
Volume XL1\
X UMBER 8
Compocillin-V
for those
penicillin-sensitive
organisms
Indications
Against all penicillin-sensitive
organisms. For prophylaxis and
treatment of complications in
viral conditions. And as a prophy-
laxis in rheumatic fever and in
rheumatic heart disease.
Dosage
Depending on the severity of the
infection, 125 to 250 mg. (200,000
to 400,000 units) every four to six
hours. For children, dosage is de-
termined by age and weight.
Supplied
Filmtabs compocillin-v (Potas-
sium Penicillin V, Abbott) come in
125 mg. (200,000 units), bottles of
50 ; and in 250 mg. (400,000 units),
bottles of 25. Oral Suspension
compocillin-v (Hydrabamine
Penicillin V, Abbott), contains 180
mg. per 5-cc. teaspoonful, in 40-cc.
and 80-cc. bottles.
802071
. Florida M.A
February, 1958 801
THE HIGHER BLOOD LEVELS OF COMPOCILLIN-V
-IN EASY-TO-SWALLOW FILMTABS AND TASTY, ORAL SUSPENSION
units/cc.
16
14
12
16
8
6
4
2
0
The chart represents a comparison of t
filmtab compocillin-v (Potassium Pei
with uncoated potassium penicillin V, i
potassium penicillin G. Bar heights sh
crossbars show medians. Note the high
ages of filmtab compocillin-v at 'A ho
he blood levels of
licillin V, Abbott)
ind with buffered
ow ranges, while
ranges and aver-
Uncoated Potassium Penicillin V
Buffered Potassium Penicillin G
Filmtab Compocillin-V
(Potassium Penicillin V, Abbott)
Doses of 400,000 units were administered before
mealtime to 40 subjects involved in this study.
Hours
V?
2
4
Now, with Filmtab compocillin-v, patients get (and within minutes) fast, high peni-
cillin concentrations. Note the blood level chart.
compocillin-v is indicated whenever penicillin therapy is desired. It comes in
two highly-acceptable forms. Filmtab compocillin-v offers two therapeutic dosages
(125 and 250 mg.). Patients find Filmtabs tasteless, odorless and easy-to-swallow.
For children, compocillin-v comes in a tasty, banana-flavored /^j fi p ,,
suspension. It’s ready-mixed — stays stable for at least 18 months. L/UjuCMX
VoLUMt XU V
.V CM BE It 8
1502
and when
coccal infections
hospitalize
the patient
(Ristocetin, Abbott)
Indications
SPONTIN is indicated for treating gram-
positive bacterial infections. Clinical
reports have indicated its effectiveness
against a wide range of staphylococcal,
streptococcal and pneumococcal infec-
tions. It can be considered a drug of
choice for the immediate treatment of
serious infections caused by organisms
resistant to other antibiotics.
Dosage
Recommended dosage depends on the
sensitivity of the microorganism and on
the severity of the disease under treat-
ment. For pneumococcal and streptococ-
cal infections, a dosage of 25 mg./Kg.
per day will usually be adequate. Major-
ity of staphylococcal infections will be
controlled by 25 to 50 mg./Kg. per day.
However, in endocarditis due to rela-
tively resistant strains or where vege-
tations or abscesses occur, dosages as
high as 75 mg./Kg. per day may be used.
It is recommended that the daily dosages
be divided into two or three equal parts
at eight- or twelve-hour intervals.
Supplied
SPONTIN is supplied as a sterile, lyophi-
lized powder, in vials representing 500
mg. of ristocetin activity.
•0207Q
J. Florida M.A
IFkbrvary, 1958
803
SPONTIN comes to the medical profession with a clinical history of dramatic results
— cases where the patients were given little chance of survival.
During these careful, clinical investigations, lives were saved after weeks (and
sometimes months) of antibiotic failures. These were the cases where the infecting
organisms had become resistant to present-day therapy. And, just as important,
were the good results found against a wide range of gram-positive coccal infections.
Essentially, SPONTIN is a drug for hospital use, for patients with potentially
dangerous infections. In its present form, SPONTIN is administered intravenously
using the drip technique. Dosage may be dissolved in 51 dextrose in water or in
any isotonic or hypotonic saline solution. Some of the important therapeutic points
of SPONTIN include:
successful short-term therapy for acute or subacute endocarditis
new antimicrobial activity — no natural resistance to spontin was found in
tests involving hundreds of coccal strains
antimicrobial action against which resistance is rare — and extremely diffi-
cult to induce
bactericidal action at effective therapeutic dosages.
SPONTIN is truly a lifesaving antibiotic. It could save the life
of one of your patients — does your hospital have it stocked?
QiUVo tt
804
Volume XMV
Number 8
... use the new transistorized Sanborn Model 300 Visette
electrocardiograph for 15 days . . . without cost or obligation
The more-than-usual interest show n by doctors in the new Sanltorn Model 800
Visette electrocardiograph is understandable: the Visette is the only instru-
ment in history to provide clinical accuracy in such a small, lightweight form.
And because it is so new, Sanborn Company expects that you, like many
doctors, may want to “know more about it” l>efore making a definite decision
to buy a Visette for your own practice. You hare that opportunity, by taking
advantage of the Sanborn Company exclusive — and long-practiced —
15-day Trial Plan.
In this way, doctor, you can use a new Visette in your office, on house and
hospital calls, wherever you wish a ’cardiogram to be run — just as your
practice actually demands. You have two weeks to thoroughly acquaint
yourself with every feature of Visette operation and performance — to let
the Visette prove itself in actual use. If you like, you can send Sanborn
Company a specimen record made on your Visette, should any technical
questions arise concering the instrument’s use.
Sanborn Company believes this is the best way — by proof in practice —
to convey the true value of the Visette's compactness, complete portability
and fine-instrument accuracy of performance. Take the 15 days, doctor —
simply address “Inquiry Director, Medical Division” for full details of the
No-Obligation Trial Plan.
The Model 51 Viso-CardieTte electrocardiograph — long a
familiar instrument in heart practices throughout the world
— is available as always, for those who prefer a larger,
heavier instrument. Price $785 del.
SANBORN COMPANY
MEDICAL DIVISION
175 Wyman Street, Waltham 54, Mass.
Miami Branch Office 1545 S. W. 8th St., Franklin 3-5493 5494
St. Petersburg Branch Office. 1221 Arlington Ave. N., St. Petersburg 7-3229
nutrition-
need not rely on "wishing”
As a comprehensive supplement to deficient natural
secretion of digestive enzymes, particularly in older
patients, ENTOZYME effectively improves nutrition by
bridging the gap between adequate ingestion and proper
digestion. Among patients of all ages, it has proved help-
ful in chronic cholecystitis, post-cholecystectomy syn-
drome, subtotal gastrectomy, pancreatitis, dyspepsia,
food intolerance, flatulence, nausea and chronic nutri-
tional disturbances.
For comprehensive digestive enzyme replacement—
ENTOZYME
Each double-layered Entozyme
tablet contains:
Pepsin, N.F 250 mg.
— released in the stomach from
gastric-soluble outer coating
of tablet.
Pancreatin, U.S.R 300 mg.
Bile Salts 150 mg.
—released in the small intestine
from enteric-coated inner
core.
A. H. ROBINS CO., INC.
Richmond 20, Virginia
Ethical Pharmaceuticals of Merit since 1878
where there’s a cold
there’s
CORICIDIN
when it’s a simple cold
CORICIDIN^TABLETS
when it’s an all-over cold
CORICIDIN FORTE
CAPSULES
when infection threatens the cold
CORICIDIN with PENICILLIN
TABLETS
when pain is a dominating factor
• CORICIDIN with CODEINE
(gr. Vi or gr. Vi) TABLETS 0
when children catch cold
CORICIDIN MEDILETS®
when cough marks the cold
CORICIDIN SYRUP*
0 Narcotic for which oral I? is permitted
© Exempt narcotic
SCHERING CORPORATION • BLOOMFIELD, NEW JERSEY
CN-JI2<
CORICIDIN FORTE
CAPSULES
on Rx only
for “get-up-and-go”
METHAMPHETAMINE
• buoys spirits • potentiates pain relief • aids
decongestive action
for stress support VITAMIN C
• supplements illness requirements • bolsters
resistance to infection
Each red and yellow Coricidin Forte
Capsule provides:
Chlor-Trimeton* Maleate . . 4 mg.
(chlorprophenpyridamine maleate)
Salicylamide 0.19 Gnu
Phenacetin 0.13 Gm.
Caffeine 30 mg.
Ascorbic acid 50 mg.
Methamphetamine
hydrochloride 1.25 mg.
On Rx and cannot be refilled without
your permission
for extra relief ANTIHISTAMINE
• higher dosage strength • optimal therapeutic
benefit • virtually no side effects
dosage
One capsule every four to six hours.
packaging
Bottles of 100 and 1000.
Coricidin,® brand of analgesic-antipyretic.
SCHERING CORPORATION • BLOOMFIELD, NEW JERSEY
ic/cA
4k
CN -J -32 a
808
Volume XLI V
Number 8
the bactericidal action
In addition to rapid clinical re-
sponse, 'Ilotycin’ provides the
important advantages only a bac-
tericidal antibiotic can give you.
'Ilotycin’ effectively eliminates
strep, carrier states, directly kills
pathogens to prevent the emer-
gence of resistant strains, and of-
fers maximum assurance against
spread of infection.
ELI LILLY AND COMPANY . IN
makes the difference
Also consider 'Ilotycin’ for safer
therapy. Allergic reactions follow-
ing systemic treatment are rare.
Bacterial flora of the intestine is
not significantly disturbed.
You can achieve more complete
antibiotic therapy with 'Ilotycin.’
Usual adult dosage is 250 mg.
every six hours.
* * I lotycin* (Erythromycin, Lilly)
DIANAPOLIS 6, INDIANA, U.S.A
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, February, 1958 No. 8
Transplantation of the Ureters Into an
Isolated Ileal Loop
J. Harold Newman, M.D.
JACKSONVILLE
In certain diseases it is necessary or desirable
to divert the urinary stream above the level of
the bladder. This operation has extremely serious
implications for the patient, and while many
procedures have been described, no entirely satis-
factory method has been worked out. Transplan-
tation of the ureters into an isolated segment of
ileum appears to offer major advantages over
previously used methods.
The simplest means of urinary diversion are
nephrostomy and cutaneous ureterostomy. Both
of these operations have disadvantages which limit
their scope. In nephrostomy, a catheter is neces-
sary, which must be periodically changed. In-
fection and calculus formation are common. With
bilateral nephrostomy, there are two widely sep-
arated openings, making their care a real chore.
In cutaneous ureterostomy, two openings are also
necessary, but they are closer together and more
conveniently located. The major drawback to
cutaneous ureterostomy has been the frequency
of serious complications with the ureteral stoma.
Up to this time, ureterosigmoidostomy has been
the most widely used method of urinary diversion.
It has the advantages that urinary and fecal con-
trol are retained and no external collecting ap-
pliance is necessary. Unfortunately, follow-up
studies show that patients with ureterosigmoid
anastomoses do not fare well.1-2 There often de-
velop severe and progressive pyelonephritis and
renal damage as well as certain electrolyte dis-
turbances.3 Efforts to improve the operation
and lessen these complications have led to a bet-
ter understanding of their mechanisms, but have
not done too much to reduce their frequency be-
cause the complications are inherent in the opera-
tion itself.4 Pyelonephritis and renal damage oc-
Read before the Florida Medical Association, Eighty-
1 hird Annual Meeting, Hollywood, May 7, 1957.
cur because the colon is loaded with bacteria
which may reach the kidney either via the lym-
phatics or by direct regurgitation because of high
intraluminal pressures developed during defeca-
tion. Electrolyte disturbances occur because of
reabsorption while urine is being retained in the
colon.
As knowledge of the causes of failure of
ureterocolic anastomosis developed, new proce-
dures were devised to overcome these shortcom-
ings. Basically, they have all followed the same
pattern. Instead of transplantation of the ureters
into the intact colon, they were placed into iso-
lated segments of either the large or small bow-
el.5-0 The advantages were that an isolated seg-
ment of bowel could be rendered sterile, the area
from which reabsorption could occur would be
smaller, and intraluminal pressures would be nil or
much lower. Of the various new operations pro-
posed, Bricker’s procedure7 has attained the
greatest popularity (fig. 1). Bricker isolates a
loop of ileum and anastomoses the ureters to the
loop after closing the proximal end. The distal end
is brought out through the abdominal wall as an
ileostomy. There are many advantages to this
operation. The ileal loop is short and isoperistal-
tic, and acts only as a conduit so that urine does
not remain long enough to permit reabsorption.
Intraluminal pressures are low, and regurgitation
does not occur even with the open mucosa to
mucosa Cordonnier type of anastomosis. The
ileum is relatively sterile and may be rendered
sterile postoperatively. There is only a single ex-
ternal opening, which is in a convenient location
for the patient. At operation, the anastomoses
are performed at skin level, permitting more ac-
curate approximation of the ureter to the ileum.
The great disadvantage is that an external urine-
collecting appliance must be worn.
810
NEWMAN: TRANSPLANTATION OF THE URETERS
Volume XI. I V
Xl'SI BEE X
Indications
The most frequent indication for ureteroileal
anastomosis is malignant disease in which the
bladder alone or together with other pelvic vis-
cera must be extirpated. Less frequently, urinary
diversion is indicated when the bladder is unable
to retain urine either because of contraction, in-
operable carcinoma, or fistula which cannot be
corrected. It is also indicated in cases of ureteral
obstruction which are not amenable to local cor-
rection. It has been used in neurogenic vesical and
ureteral dysfunction and it may provide the an-
swer to some of the difficult problems when the
bladder and ureter are unable to expel or propel
their contents.8 It is probably the procedure of
choice in exstrophy of the bladder when pyelone-
phritis and renal damage have occurred. Ureter-
oileostomy has been successfully used in cases
in which ureterosigmoidostomy was previously
performed and the patients are having trouble
with pyelonephritis or electrolyte disturbances.
The preparation of the patient is the same as
for any other elective small bowel surgery. Violent
purgation is not necessary as the ileal contents
are liquid and may easily be milked out of the
segment to be used. Neomycin alone and in combi-
nation with other antibiotics was used in the
series of cases reported herein. The surgical
technic of the operation has been described by
Bricker7 and will not be given here.
Complications
The morbidity, mortality, and complications of
ureteroileal anastomosis are difficult to assess as
this operation is often combined with other
surgery and the patients frequently have malig-
nant disease which may not be brought under con-
trol. There were no operative deaths in the pres-
ent series of five cases, and Bricker had no oper-
ative mortality in 25 cases when ileal bladder
substitution was performed without associated
pelvic surgery. In Bricker’s series of over 100
cases, hydronephrosis occurred in 15 per cent
when the pyelogram had been normal initially.0
It regressed in many cases in which it was present
in the beginning. In two cases in my series,
pyelograms initially normal have continued to be
normal. In one case, the pronounced bilateral
hydronephrosis has shown improvement. Although
there was an initially normal pyelogram in one
case, severe hydronephrosis on the left side devel-
oped which required nephrectomy. The other kid-
ney continues to have a normal pyelogram. In
r •
7„/v
Fig. 1. — An ileal segment is isolated from the main
alimentary stream. Following closure of the proximal
end. the ureters are anastomosed to the ileal segment
while the distal end is brought through the abdominal
wall as an ileostomy.
one case, a mild hydronephrosis developed on the
initially normal left side, but regression ot severe
hydronephrosis occurred on the right side.
Fig. 2. Case 1. — Preoperatively, there wras a normal
kidney on the left side and severe hydronephrosis on
the right side.
J. Florida M.A.
February, 1958
NEWMAN: TRANSPLANTATION OF THE URETERS
81 1
the bags work? Two, how do the patients react
to them? Fortunately, the answer to both ques-
tions is favorable. In this series of cases, the
Rutzen and Pierce bags were used. Both are
glued to the skin and both have been satisfac-
tory. The Rutzen bag must be made up to size for
each patient and cannot be ordered ahead of
time. The Pierce bag may be cut to size by the
patient or physician and for this reason can be
procured in advance and applied to the ileostomy
at the end of the operation. The manufacturers
of the bags recommend changing daily or twice
daily. By a process of trial and error, most pa-
tients have found it is satisfactory to change the
bag every second or third day. The patient may
bathe or shower without loosening the bag.
The reaction of the patients to ileostomy and
the bag has been gratifying. These patients
have realized that they have a serious prob-
lem and all have been willing to accept the
necessary inconvenience. The patient with a vesi-
covaginal fistula, who had been constantly wet.
considered ileostomy a decided improvement over
her former status. The patients with malignant
disease all readily accepted ileostomy when they
Fig. 3. Case 1. — Postoperatively, there has been con-
siderable improvement on the right side while mild
left hydronephrosis has developed.
Bricker reported pyelonephritis in 15 per cent
of his cases. He stated that it has been easily con-
trolled with medication. In the present series,
pyelonephritis requiring medication developed in
only one case. The single patient who has died
succumbed from urosepsis 1 7 months after oper-
ation due to the formation of urinary calculi.
Hyperchloremic acidosis and other acid base dis-
turbances did not occur in Bricker’s series and did
not occur in this series. In several cases there
was abdominal cramping in the postoperative
period, but obstruction requiring reoperation de-
veloped in none. In one case, dermatitis developed,
probably on an allergic basis, where the bag
was attached to the skin. This was corrected by
removing the bag and using a catheter in the
ileostomy until the dermatitis healed. Since that
time, the patient has worn elastoplast between
the skin and the bag, and there has been no
further trouble.
Reaction of Patients
I'he patient with the ileal bladder substitution
is permanently committed to wearing a bag. Two
questions immediately arise. One, how well do
Fig. 4. Case 2. — Pyelogram made seven months post-
operatively, showing a normal right kidney.
812
NEWMAN: TRANSPLANTATION OF THE URETERS
Volume XI. IV
Number 8
Fig. 5 Case 3. — Pyelogram made five months alter
operation showing urinary passages of normal morphol-
ogy and function.
were told it was the best way to take care of
them, and so far none have regretted it. The pa-
tients have quickly learned to use and take care
of the bags. They are able to wear their normal
clothing and resume normal activities. There has
been no odor problem.
Report of Cases
Case 1. — A 49 year old Negro woman had a large
vesicovaginal fistula following radiation for carcinoma
of the cervix. This rendered her incontinent, and the
tissues about the fistula were such that local correction
was not possible. Preoperatively, the left kidney was
normal, and the right kidney was severely hydronephrotic
(fig. 2). Ureteroileostomy was performed on April 16,
1955. The patient did well postoperatively and quickly
learned to use the bag. She was delighted at being dry'
again. Mild hydronephrosis developed on the left side
while the dilatation on the right side regressed (fig. 3).
The patient enjoyed good health until July 1956, when
she had hematuria and fever. Excretion urography showed
nothing new, and the trouble was presumed to be pye-
lonephritis, for which she received Gantrisin. In Septem-
ber 1956, renal failure and septicemia developed, and
she died on September 12. Autopsy disclosed bilateral
pyelonephritis due to renal and ureteral calculi. Unfor-
tunately, these calculi were not evident in the pyelograms.
Case 2. — A 51 year old Negro woman was subjected
to cystectomy, urethrectomy, hysterectomy and ureter-
oileostomy on Aug. 7, 1956, for carcinoma of the bladder.
The preoperative pyelogram was normal. Following sur-
gery, the pyelogram remained normal for the right side,
but there was progressive hydronephrosis on the left
side which was treated by nephrectomy on September
15. Since that time the patient has done well except
for one episode of pain in the loin on the right side and
' fever, which responded to Gantrisin. She has adapted
herself to the ileostomy and is performing her normal
household duties. The pyelogram of April 1, 1957,
showed a normal right kidney (fig. 4). Blood chemis-
try determinations have remained normal.
The hydronephrosis on the left side which
occurred in these two cases was probably due to
kinking of the ureter when it was drawn upwards
behind the sigmoid. In the hope of giving the
ureter a better blood supply, only a small opening
was made in the mesosigmoid, and dissection of
the ureter kept to a minimum. Since that time,
a larger opening has been made in the mesosig-
moid, and the entire course of the ureter visual-
ized from the retroperitoneum to the ileum. This
appears to have solved the problem, and there
has been no further difficulty with the left ureter.
Care is taken to preserve the adventitia and ves-
sels about the ureter.
Case 3. — A 63 year old white man underwent cys-
tectomy and ureteroileostomy on Sept. 1, 1956, for car-
cinoma of the bladder. The pyelograms were normal
before surgery. Mild hydronephrosis was demonstrated
roentgenographicallv on the eighteenth postoperative day,
but the pyelograms have returned to normal (fig. 5).
There was no pain in the loin following surgery, and
Fig. 6. Case 4. — Pyelogram made six months aft'
operation showing normal kidneys and ureters.
J. Florida M.A.
February, 1958
NEWMAN: TRANSPLANTATION OF THE URETERS
813
the blood chemistry determinations have remained nor-
mal. The patient quickly learned to use the bag and has
resumed his normal activities.
Case 4. — A 57 year old white man was subjected to
cystectomy and ureteroileostomy on Oct. 5, 1956, for
carcinoma of the bladder. The preoperative excretory
urogram was normal. Urograms made on the eleventh
postoperative day and again on April 9, 1957, showed
normal unobstructed kidneys and ureters (fig. 6). There
has been no backache or fever. Blood chemistry deter-
minations have remained normal. The patient manages
the bag without difficulty and is able to conduct his
normal activities.
Case 5. — In a 67 year old white man with carcinoma
of the prostate bilateral hydronephrosis developed due
to invasion of the distal ureters by the prostatic growth
(fig. 7). The ureters were transplanted to an isolated
ileal loop on March 22, 1957. The constant preopera-
tive pain in the loin was relieved. Before surgery, the
nonprotein nitrogen was 65 mg. per hundred cubic cen-
timeters. It fell to 38 mg. on the fourth postoperative
day. Other blood chemistry determinations have re-
mained normal. Intravenous urography on the thirteenth
postoperative day showed more rapid appearance of dye
and slight shrinkage of the renal pelves (fig. 8). The
patient was discharged on April 6, 1957, and is now at
home learning to use the bag.
Summary
A series of five cases is reported in which
urinary diversion was accomplished by ureteroileal
anastomosis and ileostomy. This appears to be
the safest and most satisfactory type of urinary
www
Fig. 7. Case 5. — Preoperative pyelogram showing ad-
vanced bilateral hydronephrosis.
Fig. 8. Case 5. — Pyelogram made on thirteenth post-
operative day already shows some shrinkage of the
renal pelves.
diversion available at the present time. With the
possible exception of pyelonephritis, the compli-
cations which occur are not inherent in the oper-
ation and can be eliminated. External drainage
is a disadvantage but not a contraindication. The
patients do not feel that they are severely handi-
capped and quickly adjust to the new method of
micturition. They have been able to resume most
of their normal activities and lead relatively
normal lives. There have been no odor or esthetic
problems.
References
1. Cordonnier, J. J., and Lage, W. J. : Evaluation of Ure-
terosigmoid Anastomosis by Mucosa-to-Mucosa Method After
Two and One Half Years’ Experience, J. Urol. 66:565-570
(Oct.) 1951.
2. Harvard, B. M., and Thompson, G. J.: Congenital Ex-
strophy of Urinary Bladder: Late Results of Treatment
by Coffey-Mayo Method of Uretero-Intestinal Anastomosis,
.1. Urol. 65:223-234 (Feb.) 1951.
3. Ferris, D. O., and Odel, H. M.: Electrolyte Pattern of
Blood After Bilateral Ureterosigmoidostomy, J. A. M. A.
142:634-640 (Mar. 4) 1950.
4. Lapides, J.: Mechanism of Electrolyte Imbalance Following
Ureterosigmoid Transplantation, Surg., Gynec., & Obst. 93:
691-704 (Dec.) 1951.
5. Bricker, E. M., and Eiseman, B. : Bladder Reconstruction
from Cecum and Ascending Colon Following Resection of
Pelvic Viscera, Ann. Surg. 132:77-84, (July) 1950.
6. Gilchrist. R. K.; Merricks, J. W. : Hamlin, H. H., and
Rieger, 1. T. : Construction of Substitute Bladder and
Urethra. Sun?., Gynec., &* Obst. 90:752-760 (June) 1950.
7. Bricker, E. M. : Substitution for Urinary Bladder by Use
of Isolated Ileal Segments, S. Clin. North America 36:
1117-1130 (Aug.) 1956.
814
NEWMAN: TRANSPLANTATION OF THE URETERS
Volume XMV
Number 8
8. Jensen, O. J. Jr.; Eggers, H. E. ; Bill, A. H., and Dillard,
D. R. : Urinary and Fecal Incontinence Due to Congenital
Abnormalities in Children; Management by Transplanta-
tion of Ureters to Isolated Ileostomy, J. Urol. 72:322-328
(Feb.) 195 5.
9. Bricker, E. M.; Butcher, H. R., and McAfee, C. A.: Late
Results of Bladder Substitution with Isolated Ileal Seg-
ments, Surg., Gynec., & Obst. 99:469-482 (Oct.) 1954.
427 West Duval Street.
Discussion
Dr. C. Burling Roesch, Jacksonville: It is per-
haps apropos and quite characteristic that a general
surgeon be asked to discuss this fine paper by Dr. New-
man, since it has been the impetus of the general sur-
geon which has brought about a continuing search for an
acceptable method to use as a urinary bladder substi-
tution. It would be presumptuous of me to discuss this
procedure from personal experience since I have but
four cases personally. I have, however, followed Dr.
Newman’s cases and those of others in our community,
and consequently have some familiarity with the prob-
lem and this method of the solution of the problem.
Dr. Newman has brought out beautifully the scientif-
ic and technical aspects of this operation. I should
like to dwell a little on the human aspect of the problem;
the art of medicine, if you will, rather than the science of
medicine.
In my early years in surgery, I had the good fortune
to work under Dr. C. D. Creevy, who was most interested
in radical extirpation of the bladder for carcinoma and
utilized bilateral cutaneous ureterostomies for urinarv di-
version. It was from this experience and other con-
tacts with this procedure that I have developed a deep-
seated antipathy toward cutaneous ureterostomy and the
continuing postoperative complications which this opera-
tion, in general, presents. This is particularly true when
one has repeated contact with the patient who is hav-
ing intermittent pyuria with fever and leakage of urine
when the catheter plugs, when the patient lies down and
there is no siphonage from the ureteral stoma, when
granulation constricts the orifice, or when numerous other
complications occur, all of which disturb profoundly
even those patients who are not of a fastidious nature.
Certainly, those patients with tender sensibilities are
markedly depressed by the care of a bilateral cutaneous
ureterostomy. It is here, I think, that this procedure
offers its greatest help.
More and more people are being submitted to more
radical extirpative surgery as the result of our con-
tinued attack on cancer. Of the ISO operations performed
by Bricker and his associates since the inception of this
method in 1950, 118 operations were performed for
patients undergoing exenteration of the pelvic viscera, and
only 32 for those in whom bladder substitution was in-
stituted for other reasons. The rapid adoption of this
operation is good testimony to its efficacy. I am sur-
prised that it has not been more generally seized upon
by the urologic members of our group, but rather that
the general surgeons have pressed for its adoption.
Recently, I attended a reunion at the Cornell Uni-
versity-New York Hospital Medical Center and was
surprised to hear the Chief of Urology, Dr. Marshall,
state that he had not performed this operation. In the
Surgical Department, however, Dr. William Barnes, a
classmate of mine, has done so in many cases with great
satisfaction, and is even now attempting to develop a
water-tight connection to obviate the necessity of epi-
dermal cement.
Patients subjected to this procedure are happy pa-
tients. They are relieved of the pain, the constant ne-
cessity to void, getting up five, six, a dozen times a night
to pass a few drops of urine or to leak constantly
through a vaginal fistula. One has but to talk to patients
in whom other procedures have been tried, and as a
secondary measure have had the ureters placed in the
isolated loop to realize what a boon this is to any
patient who needs a substitution for the urinary bladder.
Even the most uneducated person can be instructed in
the simple care of this isolated loop, and thus far, the
complications have been minimal in our experience and
in that recorded in the literature.
I have certainly enjoyed Dr. Newman’s fine presenta-
tion and the opportunity to reiterate his recommenda-
tion of the procedure for more widespread use.
T. Florida M.A.
February, 1958
815
Clinical Management of Traumatic Hyphemia
Thomas G. Dickinson. M.D.
SARASOTA
The management of traumatic hyphemia
presents one of the most serious of ophthalmo-
logic problems to the physician. Many eyes have
been lost or have suffered serious functional im-
pairment when a seemingly trivial contusion was
complicated by late bleeding and secondary glau-
; coma. That many therapeutic approaches to
this problem have been advanced over the years
is tacit evidence that as yet no ideal cure has
i been achieved.
Most hyphemias are small, and the bleeding
is transient and spontaneously controlled by an
equilibration between vascular and intraocular
■ pressure, and by the contracture of the lacerated
vessel. With the more severe hyphemias, how-
ever, seen when a vessel of arterial size is dam-
aged, particularly those near the root of the iris,
the possibility of secondary hemorrhage occur-
ring on the second to the fifth post-traumatic day
is increased. The source of the secondary bleed-
ing is probably from damage to the ciliary body
rather than an iris vessel.1 The slit lamp ap-
pearance of the impaired eye often will not reveal
the true nature of the injury, but if an iridodialy-
sis is present or a gross rent in the iris, then one
■ should be more expectant of complications. Sec-
ondary hemorrhage is more common in adults
than in children. Secondary hemorrhages also
tend to be more profuse than the primary bleed-
ing. Absorption of the blood takes place mainly
from the anterior surface of the iris, and most
uncomplicated hyphemias will be absorbed in
from one to seven days, leaving no trace.
The common early complications of traumatic
hyphemia are secondary bleeding, secondary glau-
coma and blood staining of the cornea. When the
tension rises from secondary hemorrhage, the
color of the blood turns from red to almost black.
It is because of this appearance that the classi-
cal term “eight-ball hemorrhage” has been ap-
plied. Long term complications are posterior
synechia; heterochromia of the iris, when the iris
of the injured eye becomes darker because of
hematogenous pigmentation; and more rarely,
Read before the Florida Society of Opthalmology and
Otolaryngology, Seventeenth Annual Meeting, Miami Beach,
May 13. 1956.
hemo-ophthalmitis. when breakdown products of
blood pigment are noted in the aqueous and
chronic degenerative changes spread throughout
the globe. This late complication is rather rare,
but, when present, often leads to a chronic, ir-
ritable eye, ending in a sightless, hard, painful
globe requiring removal. By far the most com-
mon and the most serious of these complications
is secondary glaucoma.
Observations in Ten Cases of Hyphemia
Ten cases of hyphemia have been studied.
While this series is far too small for valid statis-
tical analysis, some interesting observations may
be noted.
Table 1 indicates the pertinent clinical data
of the 10 cases studied to show age, agent that
caused the damage, visual acuity of the patient
when first seen and at the time of discharge,
complications, associated ocular lesions, and the
day on which the hyphemia finally cleared from
the anterior chamber. This table further sug-
gests that the poorest visual results occurred in
cases that were complicated with secondary
bleeding accompanied by glaucoma. This finding
is in keeping with the observations of other
investigators.
It will be noted that in four cases there were
serious complications, not inclusive of the asso-
ciated ocular lesions. All cases were managed by
the methods outlined herein. The uncomplicated
cases need no further mention. The cases in
which complications required additional therapy
are discussed.
Case 3 was that of an eight year old Negro
boy who had been struck in the eye with a base-
Il3.il bat. He was not seen until eight days after
the injury and. stated that the eye had become
acutely painful two days after the injury and
had remained so. Atropine drops had been in-
stilled shortly after the injury, and the child re-
mained ambulatory. When first examined, the
eye was hard and the anterior chamber entirely
black with hemorrhage. The anterior chamber
was opened on the eighth day after the injury,
and the clot was removed with a forceps. The
pupil was found to be widely dilated and ad-
Table 1. — Summary of Ten Cases of Hyphemia
816
DICKINSON: TRAUMATIC HYPHEMIA
Volume XI. IV
Number 8
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T. Florida M.A.
February, 1958
DICKINSON: TRAUMATIC HYPHEMIA
817
lierent in that position. Air was instilled into the
anterior chamber, and no further bleeding was
encountered after the surgery. The pupil has at
no time responded to miotics. There was a dense
vitreous hemorrhage, which has cleared over the
course of eight months. Optic atrophy is now
present. The intraocular tension is now normal.
The eye is painless but blind.
In case 7, a severe secondary glaucoma de-
veloped on the third post-traumatic day, unac-
companied by a secondary hemorrhage. The
glaucoma responded in four hours to intensive
miotic therapy of Mecholyl and Prostigmine com-
bined with Diamox, and remained controlled on
Diamox alone. The eye effected an otherwise un-
eventful recovery by the fifth day after the in-
jury without surgical intervention.
In case 9, in which there was a severe
iridodialysis along with hyphemia, an episode of
acute pain occurred in the eye on the third day,
accompanied by secondary hemorrhage. The
hemorrhage, however, did not fill the anterior
chamber. Two to 3 mm. of iris was visible su-
periorly at all times. There was no increase in
intraocular tension. Slight additional bleeding
occurred on the fourth day, but there was com-
plete clearing of the chamber by the seventh day.
There was no surgical intervention.
In case 10, a tear in the iris was present near
the pupillary border, and a severe secondary
hemorrhage on the third post-traumatic day filled
the anterior chamber with blood. This was ac-
companied by secondary glaucoma that did not
respond to miotics or Diamox. A paracentesis
with irrigation was performed 10 hours after the
secondary hemorrhage occurred. A large amount
of black fluid blood and several clots were re-
moved. Air was instilled, and the patient was
returned to bed rest. Slow oozing continued from
the area of the iris tear, but at no time was the
anterior chamber filled with blood following sur-
gery. Tension remained slightly elevated for 10
post-operative days. By the twelfth postoperative
day, the chamber had cleared, and the tension
was normal. The postoperative management was
identical to that of the uncomplicated cases in
this series except for the addition of Diamox.
Discussion of Treatment
Duke-Elder2 stated that in most cases of
traumatic hyphemia absorption takes place satis-
factorily with no treatment other than bed rest,
sedation and bandaging. While this is certainly
true, I believe it important for the physician to
be expectant of complications, at least through
the treacherous first five post-traumatic days, and
to keep a guarded prognosis. In this series the
patients were hospitalized whenever possible and
put at complete bed rest. Adequate sedation was
given to minimize general bodily activity. Cer-
tainly, temporary elevation of the vascular pres-
sure brought about by activity would tend to
increase the chance of secondary hemorrhage.
Systemic sedation in children was heavy and was
continued until adequate inactivity was obtained.
The head of the bed was elevated 15 to 20 de-
grees to promote settling of the blood interiorly
in the anterior chamber. Theoretically, this
measure should help prevent posterior synechia
unless the fluid level of the blood remains above
the pupillary border. A binocular dressing was
used on all patients in order to remove the incen-
tive for ocular rotations and to decrease pupillary
and ciliary activity by removing the stimuli of
light and accommodation. In the very young,
however, the fear engendered by binocular patch-
ing, in spite of heavy sedation, often led to more
thrashing and general activity than when the eye
was left unpatched. Sand bags or rolled pillows
were used on either side of the head to prevent
the patient from turning to a facedown position.
The question of the use of cycloplegics, such
as atropine or homatropine, or miotics such as
pilocarpine, or the use of no drops to alter the
pupillary size gives rise to controversy. My-
driasis, as recommended by Thygeson and Beard,1
stops all movement of the uveal tract and im-
mobilizes the edge of the laceration. Miosis, as
advocated by Rychener,-'5 opens the filtration
angle and increases the iris surface for absorp-
tion of the blood. It also partially immobilizes
the edges of the wound, but it will cause some
congestion of the uveal tract and theoretically
could put the edges of the wound on a pull or
stretch, thus promoting bleeding. In this small
series, neither miotics nor mydriatics were used,
except in case 3, in which atropine had been in-
stilled prior to referral. It is thought that one
can partially accomplish immobility of the uveal
tract by binocular patching, while still preserving
the larger iris absorption surface and a relatively
open chamber angle. Certainly, if a mydriatic is
thought to be indicated, and I believe that it is
not, it should not be atropine but rather homat-
ropine, the action of which can be reversed more
easily.
Regarding hot or cold compresses, hot com-
presses would be contraindicated because of the
818
DICKINSON: TRAUMATIC HYPHEMIA
Volume XLI V
Number 8
possibility of effecting a vasodilatation that
might promote secondary bleeding.1 It is ques-
tionable if cold compresses actually are of bene-
fit. and it would seem that the danger of the mild
trauma incident to pressing on the eye while ap-
plying the compress would more than offset the
slight advantage of any vasoconstriction that
might be effected.
The benefit of vitamin K for bleeding in pa-
tients with normal bleeding, clotting and pro-
thrombin times has never been proved. It is not
believed indicated unless there is an abnormality
in the prothrombin time. Salicylates, however,
tend to depress prothrombin production and
should not be used for analgesia in these cases.
Capillary fragility may play a role in sec-
ondary hyphemia. New vessels are forming by
the first, second or third day after the injury.
Theoretically, then, vitamin C should be given
prophylacticallv because of its role in the for-
mation of intracellular cement. Theoretically,
also, rutin or Quertine might be of value. Evi-
dence has been presented by Schiller1 that rutin,
in doses of 50 to 75 mg. per kilogram, acts as
a strong cutaneous vasoconstrictor.
It is possible, therefore, that the effect of the
vitamin P flavonoids on capillary fragility may
be related to their ability to constrict minute
blood vessels strongly. Quertine has the same
physiologic effects as rutin.5 On this basis, 60
mg. of rutin was given three times a day. along
with 300 mg. of vitamin C.
Control studies with carbazochrome (Adre-
nosem) have failed to demonstrate any effect on
diabetic retinopathy, capillary counts or capillary
mobilization.0 No studies of its use in hyphemia
have been reported. Peele’s studies7 in post-
tonsillectomy bleedings, however, suggested there
may be some hemostatic activity.
It is probable that no systemic hemostatic
agents have any beneficial effect, but since Adre-
nosem is without harmful side effects, I have
elected to use it on an empiric basis in a dosage
of 5 mg. three times a day for five days.
Steroids, such as cortisone and ACTH.
theoretically will cause a lowering of the clot-
ting time and a delayed absorption time; hence,
they are contraindicated. The mechanism of
hyphemia is not that of the pathologic process
of inflammation and would not be an indication
for the steroids.
Streptokinase and streptodornase (Varidase)
and their role in the clearing of clots in the an-
terior chamber have received some enthusiastic
reports in the literature.8 Doses of 15,000 units
and over, however, have been shown to produce
toxic sequelae in the anterior chamber of rab-
bits. Further, in the rabbit there is no reported
difference between the untreated and the treated
eye with tolerated doses of Varidase.0 These
data suggest that in the light of present knowl-
edge Varidase is not indicated in the treatment
of hyphemia.
In those cases complicated by secondary
bleeding, the prognosis becomes poor. If the in-
traocular tension rises, but the chamber is not
completely filled with blood (that is, there is iris
visible), one is justified in a trial of miotics,
such as pilocarpine and eserine or Mecholyl and
Prostigmine, along with Diamox systemically.
When employing Diamox to lower the intraocular
tension in these cases, one must consider the pos-
sibility that Diamox. by decreasing intraocular
fluid formation, may lessen the amount of blood
washed out of the chamber per unit of time, and
hence could theoretically slow up absorption of
the hyphemia. DFP (Floropryl) should not be
used because of the pronounced congestion it will
cause. If the tension is not controlled within 12
to 24 hours, irreversible blood staining of the
cornea may develop. Early surgery is indicated,
and I believe 10 hours should be the limit of con-
servative effort. If the chamber is completely
filled with blood and the tension is elevated, con-
servative measures will probably not be effec-
tive. and surgical delay would not seem justified.
The eyes that suffer secondary hemorrhage
usually have some resultant loss in vision, but
often early surgical intervention will prevent loss
of the eye.
Simple paracentesis with gentle irrigation, re-
peated often enough to control intraocular ten-
sion until the blood begins to be absorbed, will
often suffice to control the secondary hemorrhage.
Irrigation should be minimal and it should not
attempt to dislodge small tenacious clots on the
iris, as to do so may reopen a bleeding vessel.
The injection of an air bubble into the anterior
chamber at the time of paracentesis will tend to
promote clotting.
Wilson and his co-workers10 advocated the
routine use of air injection into the anterior
chamber in all cases of traumatic hyphemia as
a prophylactic procedure against secondary hem-
orrhage.
The air bubble acts as a cushion in the event
of secondary glaucoma and helps keep the blood
from actual contact with the corneal endothe-
J. Florida M.A.
February, 1958
DICKINSON: TRAUMATIC HYPHEMIA
819
lium. If this is to be done in a child, a general
anesthetic would be required, and one must
weigh carefully the suggested value of the pro-
cedure against the dangers of possible post-
anesthetic excitement or nausea and vomiting
with their concomitant increase in intravascular
pressure. One must also consider that in order
to inject air in-to the anterior chamber in such
cases one must of necessity disturb the balance
between the intraocular pressure and intravascu-
lar pressure. This disturbance could theoretically
initiate secondary bleeding which might not
otherwise have occurred. I would, therefore, not
elect to use this procedure routinely.
Hopen and Campagna11 reported some bene-
ficial results with the use of trypsin intramus-
cularly. The cases of hyphemia reported in their
series were postoperative rather than traumatic.
Their studies suggested that this enzyme may
have a beneficial fibrinolysin-like effect on an-
terior chamber hemorrhages, and is worthy of
further investigation. It was not used in this
series.
If there is evidence of continued fresh bleed-
ing at the time of paracentesis that does not
cease within five minutes. Hughes1- and Savory1'’
advocated thrombin irrigation of the anterior
chamber. Human thrombin is used in a dosage
of 5 to 10 units per milliliter. Bovine thrombin
should not be used because of the danger of
foreign protein reaction.14 After the clot and the
fluid blood are irrigated out, the anterior chamber
is gently irrigated with the thrombin mixture for
about one minute, until the bleeding vessel has
clotted. I have had no firsthand experience with
this procedure, but I believe that it is a logical
adjunct to our “pharmamentarium” at the time
of surgery, and worthy of trial.
If there is a large clot in the anterior cham-
ber, often paracentesis and irrigation will not
dislodge or remove it. If allowed to remain, it
may lead to posterior synechia formation and
possibly even a late iris bombe, especially if the
entire pupil is covered. In such cases, the clot
may be removed by opening the anterior cham-
ber. A small Graefe knife incision is made at 12
o'clock. A knife is used rather than a keratome
to avoid damaging the lens or the iris. This inci-
sion can be enlarged with scissors. Postplaced
corneoscleral sutures, three to four in number,
are put in. The corneal flap is then held up and
the clot grasped with a capsule forceps without
teeth and removed. Any remaining blood is then
irrigated out. The sutures are closed, and an air
bubble is instilled. This method has been most
satisfactory in the removal of large clots.
Summary and Conclusion
Traumatic hyphemia is an extremely serious
ocular condition. There is no general agreement
in the literature regarding its management.
Observations are made on a series of 10 cases,
and various forms of treatment are discussed.
The cases in this study were managed by the
following routine for the first five post-traumatic
days, except when complications indicated a
change:
( 1 ) Hospitalization at complete bed rest.
(2) Sand bags to the side of the head, and the
bed elevated 15 to 20 degrees. (3) Adequate
sedation to prevent general bodily activity. (4)
Rutin, 60 mg., and vitamin C., 300 mg., three
times a day. (5) Binocular occlusive patching,
unless the patient is tco young to make this prac-
tical. (6) Adrenosem, 5 mg., three times a day.
(7) No drops in the eyes.
If secondary hemorrhage occurs, strong miotics
are indicated accompanied by systemic adminis-
tration of Diamox. If the anterior chamber is
completely filled with blood, immediate surgery
is indicated.
Paracentesis with gentle irrigation and air in-
stillation is the preferred primary procedure. If
this is unsuccessful, corneal section with mechani-
cal removal of the clot may be employed. Throm-
bin irrigation is worthy of consideration.
After the direct effects of injury have quieted
down and the danger of further hemorrhage has
passed, the pupil should be dilated and the fundus
carefully inspected for evidence of retinal detach-
ment or other residual damage to the fundus.
I am indebted to Dr. Irving H. Leopold for his critical
leview of this paper before publication.
References
1. Thygeson, P., and Beard, C.: Observations on Traumatic
Hyphemia, A. M. A. Arch. Ophth. 35:977-985 (July) 1952.
2. Duke-Elder, William Stewart: Textbook of Ophthalmology,
Vol. 6: Injuries, St. I.ouis, C. V. Mosby Company, 195-1.
pp. 5 778-5781.
3. Rychener, R. O.: Management of Traumatic Hyphemia,
J. A. M. A. 126:763-765 (Nov. 18) 1944.
4. Schiller, A. A.: Mechanism of Action of Vitamin P Flava-
noid (rutin) on Cutaneous Circulation, Am. 1. Physiol.
165:293-305 (May) 1951.
5. Leopold, 1. II. : Pharmacology and Toxicology, A. M. A.
Arch. Ophth. 48:163-261 (Aug.) 1952.
6. Keeney. A. H., and Mody, M. V.: Adrenosem (Carbazo-
chrome) in Primary Glaucoma and Diabetic Retinopathy.
Arch. Ophth. 54:665-669 (Nov.) 1955.
7. Peele, J. C. : Adrenosem in Control of Hemorrhage from
Nose and Throat; A Preliminary Report, A M. A Arch
Otolaryng. 61:450-464 (April) 1955.
8. Jukofsky, S. L.: New Technique in Treatment of Hyphe-
mia; Preliminary Report. Am. [. Ophth. 34:1692-1696
(Dec.) 1951.
9. Smillie, J. W.: Effect of Streptokinase on Simulated
Hyphemia; With Study of Its Toxicity to Anterior Cham-
bers of Rabbits, A. M. A. Arch. Ophth. 37:911-917 (June)
1954.
10. Wilson, J. M., and others: Air Injection in Treatment of
Traumatic Hyphemia, A M. A. Arch. Ophth. 37:409-411
(March) 1954
820
FISHBE1X: SECOND INTERNATIONAL CONGRESS EOR PSYCHIATRY
Volume Xl.i V
Number s
11. Hopen, J. M., and Campagna, F. N.: Use of Intramuscu-
lar Trypsin in Traumatic, Inflammatory, and Hemorrhagic
Ocular Disturbances, Am. J. Ophth. 40:209-214 (Aug.)
1955.
12. Hughes, W. L. : Use of Thrombin in Anterior Chamber to
Control Hemorrhage, Acta XVI, Intern. Cong. Ophth.
2:1299, London, British Med. Assn., 1950.
13. Savory, M. : Some Uses of Thrombin and Fibrinogen in
Ophthalmic Surgery, Tr. Ophth. Soc., U. Kingdom <> 7:323,
1947.
14. Sorsby, A., editor: Modern Trends in Ophthalmology, Vol.
3, New York, Paul B. Hoeber, Inc., 1955, pp. 302-304.
1950 Arlington Street.
Highlights of Second International
Congress for Psychiatry
Zurich. Switzerland. Sept. 1-7. 1957
I. Leo Fishbein, M.D.
MIAMI
After a long interim of seven years since the
First International Congress was held in Paris in
September 1950, the Second Congress began its
serious work in the cultured and friendly climate
of cosmopolitan Zurich, which has been, since the
Bronze Age, a center for civilized man in the arts
and sciences. It remains today a great city de-
voted to the liberal spirit and welfare of its citi-
zens-and attuned to its many visitors from all over
the world.
In this cheerful and dedicated atmosphere
the Second Congress began its stimulating delib-
erations. About 3,000 members from 64 countries
were there, most of them coming from Europe
and the Americas. Every continent was repre-
sented, from Iceland to South Africa and from
Israel to Australia. Russian colleagues were con-
spicuous by their absence. Polish, Bulgarian,
Czech and Yugoslav psychiatrists were present
and active in the seminars.
One hundred and thirty papers were read at
the plenary sessions. Forty symposiums, besides
section sessions and discussion groups, were in-
corporated in the proceedings. Five official lan-
guages were employed: German, French, English,
Spanish and Italian. More than half of the
speakers spoke in several of these languages. Some
simultaneous translations were available.
Theme and Aims of the Congress
Wisely and judiciously, the Congress chose
one main theme, “The Present Status of Our
Knowledge About the Group of Schizophrenias.”
Many organizations and individuals helped in the
financial and supportive activities so necessary
From the Departments of Psychiatry, Jackson Memorial Hos-
pital, Miami, Veterans Administration Mental Hygiene Clinic,
Miami, and Mt. Sinai Hospital, Miami Beach.
BEACH
for such a great international undertaking. Many
sponsors shared in the expenses, among them
American firms and foundations such as the
Aquinas Fund. Schering Corporation, Scottish
Rite Masons, Smith. Kline & French Laboratories,
Squibb Institute for Medical Research, Wallace
Laboratories, Wyeth Laboratories, and Burroughs
Wellcome & Co.
Dr. Manfred Bleuler, son of the late esteemed
Swiss psychiatrist, Eugene Bleuler, delivered an
inspiring and forceful address on the aims and
theme of this Congress. He emphasized the great
responsibilities psychiatrists have in trying to
solve one profound problem of mental illness,
schizophrenia. He pointed out that this regressive,
destructive process, disintegrating the personality
and distorting reality relationships, afflicts one
per cent of the human race, respecting neither'
class, position nor national boundaries; that the
etiology, terminology and therapeutic procedures
in different areas of the wrorld are still in dispute,
because of the magnitude of the problem as wrell
as differences of communication in the various
languages. This Congress, he said, needed great
courage in absorbing the knowledge and under-
standing of the bewildering enigma loaded with
psychopathologic, physiologic and hereditary in-
tricacies that seem so inaccessible.
Dr. Bleuler deplored the tragic negligence of
the treatment of schizophrenic patients of all
ages. He lamented society’s terror of the malady
by wishing it away or condemning the afflicted
because they became sick. “Reflect and do not
doubt; we are proud to obtain comprehension of
this dread disease and a treatment does exist!
We are constantly present at their suffering! Our
common task is the heroic effort to aid all schiz-
J. Florida M.A.
February, 1958
FISHBEIN: SECOND INTERNATIONAL CONGRESS FOR PSYCHIATRY
821
ophrenics everywhere, not only those in favor-
able clinics!”
Dr. Bleuler found recompense in sharing the
common language of psychiatric colleagues dedi-
cated with determination, audacity and sacrifice
to wipe out this scourge of humanity. This Con-
gress was united in rendering understanding and
encouragement in the great battles ahead, in mo-
bilizing society to take its full responsibilities to-
ward the mentally ill.
His stirring remarks were profound. “The
schizophrenics are like ourselves, with all the
human aspirations and hopes! Their poignant
experiences need to be shared and evaluated. Their
dissociative personalities need to be restored to
sanity. We must demand more from society
which must not now close its eyes with indiffer-
ence, ignorance, mockery, or contempt!”
In continuing, he explained that the life his-
tory of the schizophrenic is as important in ther-
apy as the detailed study of the family back-
ground. Re-education of those associated in the
familial setting is imperative. The illness has
either an hereditary predisposition on a psychody-
namic development of the personality and a spe-
Icific release situation. It is not enough to provide
big institutional buildings and smother the sick
by their structural magnitude. The tragic ac-
cumulation of events needs to be analyzed and
understood, and unfavorable human relationships
need to be changed. Metabolic disturbances do
not often play an important role in the develop-
ment of schizophrenia, which manifests a severe
alteration of the psyche with depersonalization,
dissociation, regression, hallucination and delu-
sions. Resignation about this illness has a de-
moralizing effect on humanity everywhere. Each
human personality is different and needs to be
understood. The myriad problems of human
growth development and relationships need clarity
and equanimity. Integrated research is a must.
The newer chemicals are ancillary in the total
aspect of restoring the mentally sick to good
health and further usefulness as individuals. Fi-
nally, he stated, the unanimity of purpose of this
Congress transcends boundaries of languages, na-
tions and people. The personality needs a more
favorable soil for proper development.
Dr. Jean Delay, of Paris, on behalf of the In-
ternational Organization of World Congresses
for Psychiatry, spoke of the great liberation of the
u mentally ill which began in the seventeenth and
it eighteenth centuries and of the great work done
by Swiss psychiatrists.
A great leader, himself, in modern French
psychiatry and a prominent organizer of the first
psychiatric congress in 1950, he praised the mem-
ory of Eugene Bleuler and the fruitful work done
by various groups in many countries. “Your
presence here as men of science, dedicated to
human suffering everywhere, with all points of
view and new enriched directions, is further evi-
dence of the unified success of this congress.” He
anticipated for all of us rich memories of Zurich
as we had experienced in the Paris meeting.
World Mental Health Year — 1960
Dr. A. Repond of Malenoz, Switzerland, a
great devoted friend of world psychiatry and a
frequent visitor to Florida and American psychiat-
ric group meetings, was proud to have his native
land serve as host to such a distinguished array
of psychiatrists gathered in Zurich. He sincerely
felt psychiatry had progressed faster in the last
50 years than at any other time in human history.
He had a word of caution for those living in a
period of elation with new chemical discoveries
that were promising much for the mentally ill. He
requested that some consideration be given to
the inside world of human beings, while the world
was going through the geophysical era. He fer-
vently hoped that the psychiatrists, in all coun-
tries, would take leading roles to make 1960, the
World Mental Health Year, a great success. This
fascinating and powerful project, he said, is being
sponsored by the World Federation of Mental
Health.
Welcome to Switzerland
Dr. W. Konig, Lord Mayor of Zurich, in wel-
coming the distinguished assemblage in his charm-
ingly official manner, sounded the keynote. “The
more that is done, the more there is to be done!
My greatest wish is that you help sick human be-
ings become well again!” His city had for many
long years accepted the great challenge and re-
sponsibilities of its citizens in need of psychiatric
help. Everywhere one went in Zurich, there were
interesting signs, “Die ruhige Stadt hat weniger
Kranke” — “The quiet city has fewer sick people.”
It could serve as a beacon for all metropolitan
centers. Noise, discord, ignorance and poverty
were disharmonies civilized man could do with-
out. The Zurich Chamber Orchestra conducted
by Edmond deStantz, enhanced the opening ses-
sion.
Dr. J. Wyrsch of Stans, Switzerland, welcomed
the delegates in his excellent Spanish, commenting
822
FISHBEIN: SECOND INTERNATIONAL CONGRESS FOR PSYCHIATRY
Volume XLIV
XumberS
that Switzerland had four official languages: Ger-
man, French, Italian and Romansch. Yet in such
a possible Tower of Babel confusion, there were
unity and equilibrium in the tremendous tasks to
improve psychiatric procedures on an international
scope.
Dr. E. Gobbi of Mendrisio, Switzerland, for
the organizing committee, welcomed the Italian
colleagues in their native tongue, hoping that the
delegates would come closer to the comprehen-
sion of the dynamics of the psyche and apply
them to the benefit of mankind. He declared
that Switzerland wanted tourists to come and
share the bounties nature had bestowed on his
homeland.
In Commemoration
The commemorative session of September 1.
1957, will long be cherished by those who heard
the distinguished addresses by Dr. Hans Hoff and
Dr. E. Stransky, both of Vienna, Austria. They
reminisced about their associations as assistants
under the great Julius Wagner Ritter Von Jau-
regg. His centenary was now being celebrated
with that of Eugene Bleuler.
Four distinguished and beloved colleagues,
very active in world psychiatry, were given a me-
morial tribute: Dr. E. Koffsky of Poland, Dr.
F. Fromm-Reichman of Washington. D. C., Dr.
Braumel of Germany, and Dr. F. Morel of Gene-
va, Switzerland.
Dr. Hoff, in his erudite scholarly fashion, re-
called historical details of the eminent professor
and humanist. Von Jauregg. He was one of the
first experimenters in general metabolism and
thyroid disturbances. In 1835, in Austria, this
great physician presented excellent results with
thyroid medication in cretinism and myxedema,
in spite of the adverse criticisms of his colleagues.
He received the Nobel Prize in 1927 for his work
in freeing many patients from progressive paral-
yses with typhoid and malaria fever treatment.
His devotion to the sick was phenomenal. “His
inner life was vivid and warm. All science to him
had one direction, to help all people!”
Dr. Stransky, a young and enthusiastic octo-
genarian, presented an intimate personal picture
of the fascinating Von Jauregg, who was more
than a professor. He was an original character,
great and spiritual. Von Jauregg looked like a
woodcutter, rustic and sportsmanlike. He spoke
his languages in brogue. He was tolerant and
generous and guided his students and assistants.
He was too noble to elevate himself by lowering
the prestige of others. He cared little for publicity,
preferring to share the goodness for its own re-
wards and achievements. Even though he dif-
fered from Freud about certain views, he gave
Freud a professorship at his university. Only re-
cently have his originality and greatness been rec-
ognized. “Jauregg will never have a rival! He
was one of the last, and we shall never see the
like!” The spirit of Jauregg is fully embodied in
rich fragrance and warm devotion in these two ,
distinguished orators who have presented ein
Mensch!
Dr. Klaesi presented Eugene Bleuler as a
man who had a remarkable attitude and admira- )
tion for working with sick people. He had respect
for all and was always ready to learn something .
from everyone, from the simple to the profound. •
He was never fully satisfied, sought the truth in
all matters and avoided partisanship. He culled j
ideas constantly on little cards, any time of the ;
day or night. “He was a great teacher and educa- i
tor and was fully aware of all the enigmas of his 1
time.” His distinguished son, Manfred Bleuler, I
of Zurich, is endeared to world psychiatry in the •
revered footsteps of his illustrious father. It is a •
proud heritage of devoted service to humanity.
Three distinguished colleagues, J. Delay, H.
Ey of Paris, and O. Diethelm of New York, were
presented honorary degrees of Doctor Honoris P
Causa by Dean Rossier of the Zurich University I
Faculty' of Medicine for their prodigious efforts in
organizing and handling the affairs of the first
Congress in Paris. The assembled members warm-
ly applauded such a gracious honor given to psy-
chiatry by our host city.
Dr. Ludwig Binswanger of Kreuzlingen, Switz-
erland. discussed existential analytic interpreta-
tion with special reference to schizophrenia and
its victims. He reminded his colleagues that these
sick people had misguided ideals and that they
were not able to handle themselves. They lacked
the feeling of personal worth; their lives were full
of the inadequacies and inabilities to cope with
responsibilities inherent in the growth pattern of
maturity. His therapy was directed toward guid-
ing the patient back to new roles once again in
adapting methods that could efficiently deal with
reality without excess anxieties. Man could better
learn to understand himself as well as his environ-
ment.
Dr. H. C. Ruemke of Utrecht, Holland, gave
a clinical differentiation within the group of
J. Florida M.A.
Fp.brvary, 1958
FISHBEIN: SECOND INTERNATIONAL CONGRESS FOR PSYCHIATRY
823
schizophrenia. He emphasized the impaired judg-
ment and the reduced mental powers of the sick.
He was optimistic about getting these patients
well, and felt confident there was no obsolete or
secret cure. The intuitive feelings and helpfulness
of the psychiatrist could make the difference be-
tween success and failure. The hopeful goals lay
in clinical psychiatry.
Views of Schizophrenic Treatment
Drs. E. Stroemgren, V. Lunn and T. Vangaard
of Denmark presented the varied views of schiz-
ooh^enic treatment in various clinics involving
details of the delicate doctor-patient relation-
ships. They were emphatic about the importance
of the doctor’s subjective judgment and com-
prehension about the mentally ill. Introspection
of his own reactions in dealing with the difficult
emotional manifestations was essential as the
needs for gratification, proper object relationships,
feelings of identity, and narcissistic proclivities
manifested even in the normal. The regressive
and often infantile distortions, the withdrawal
patterns, the unusual cravings, the hostilities and
bitterness — all needed proper evaluation.
Dr. Charles Savage of Bethesda, Maryland,
delivered an excellent and stimulating treatise con-
cerning analytic treatment of the schizophrenic.
The earlier the patient was seen, the better was the
prognosis. Countertransference was a legitimate
important area of inquiry in therapy since identi-
fication had to be more intense. The therapist
would experience the patient’s anxiety as his own.
perhaps also showing primitive or controlling de-
fenses. Alert observations of every description
needed to be evaluated. Unresolved unconscious
conflicts of the therapist, his infantile and magic
omnipotence, his guilt and sensitivities — all these
needed to be handled, in the slow, erratic and often
nonapparent progress shown in handling the schiz-
ophrenic, toward achieving sufficient ego strength
and identity, and giving him the gratifications
he probably never had.
Drs. D. W. Abse and J. A. Ewing of Chapel
Hill, N. C., presented some of the lessons learned
in treating schizophrenics. The patients resisted
reality-proving methods since they had become
overwhelmed by their own inabilities to cope with
reality. Uncovering and interpreting the uncon-
scious motivations gave support and relief to
these patients. The distorted object-world became
a bit clearer. Repressed instinctual impulses were
allowed to flow more freely in socially directed
channels. The therapist was the patient’s repre-
sentative of reality, and needed to follow with
freedom from anxiety the swinging back and forth
of the inner defenses that the patient presented.
Treating Schizophrenic Children
Drs. Mildred Creak of London, England, and
Lauretta Bender of New7 York City shared in the
erudite symposium of childhood psychoses. Dr.
Bender reiterated it was difficult to make decisions
about the maturation of children by two years of
age. or perhaps even up to five years of age.
Quite often the child might be able to overcome
his provocative behavior deviations in these early
years. After five it might be a question of accel-
eration or regression of the developing processes.
The difficulty often came in either the normal de-
fective lag seen at all levels or in the general back-
wardness. “Was the boy dim because he was mad
or mad because he was dim?” Was his vulner-
ability of genetic origin or environmentally pro-
duced? Both emphasized that a backward child
was not necessarily a regressed child. Hasty ex-
planations could cause untold misery for those
intimately associated. Children who had fear of
space and object-relationships, rigidity, inappro-
priate emotional reactions, incoordinations, re-
gressions, severe anxieties, and reluctance to leave
each maturation phase for the next needed to be
carefully studied for evidences of personality frag-
mentation and dissociative relationships.
Other Treatment
Various discussants gave their experiences with
insulin and convulsive therapy in treating schiz-
ophrenic children in their hospitals and clinics.
Many emphasized the terrible home environment
of these children. Insulin seemed to make many
of them more accessible for therapy. Ancillary
training methods were so necessary in the total
aspect of therapy. The speakers lamented the old
refrain. “Leave him alone and he’ll grow out of
it.” Too often such delays have made permanent
cripples out of those who could have been restored
to full health. Blindness was not only reserved
for good parents and well-wishing friends, but of-
ten iatrogenic neglect was costly in later years.
Drs. D. E. Cameron and S. K. l’raude of Mon-
treal, Canada, presented case material of chronic
paranoid schizophrenics who were treated with
prolonged chemical sleep, from 30 to 60 days,
using chlorpromazine and barbiturates. They
were accompanied by extensive use of shock treat-
824
FISHBEIN: SECOND INTERNATIONAL CONGRESS FOR PSYCHIATRY
Volume XLIV
Number 8
merits which were gradually reduced as rehabili-
tation methods were instituted. After the patient
was transferred to ambulant service, he was given
one shock treatment a week for the first month,
and then one a month for the next two years. At
this time his progress was reviewed and if good,
treatment was ended. During the two year period
psychotherapy was continued on a limited rela-
tionship basis. If relapses did occur, shock treat-
ments were administered on an ambulant basis.
They agreed that results were less favorable for
chronic cases than for early cases.
Dr. O. Diethelm of New York City reviewed
the course of schizophrenics whose illnesses were
followed in and outside of hospitals for 30 years.
Some began with an acute paranoid excitement
in the form of a panic followed by a hebephrenic
picture and terminated in simple deterioration.
Others started with depression or catatonic excite-
ment. Clinical observation and psychologic studies
indicated the far reaching effect of the monotony
of the well regimented hospital life. Deteriorated
apathetic schizophrenics responded positively to
those who were more socially active.
Dr. C. G. Jung of Kusnacht. Switzerland,
presented a paper on schizophrenia emphasizing
the disintegration of perception, the compensatory
character of pathologic content, the loss of com-
pactness, the distorted relationships, the frequent
regression to archaic association forms, the lower-
ing of the conscious threshold and the discon-
tinuity of apperception. He was warmly applaud-
ed as an Elder of psychiatry. He looked vigorous
at eighty.
Drs. N. S. Kline and J. S. Saunders of Or-
angeburg, N. Y., indicated that the newer group
of pharmaceuticals, the tranquilizers, were being
used during the last several years with amazing
results in reducing the hospital stay of patients
as well as preventing many from coming into the
institutions. It was a small but important step
in dealing with the problem of almost 750,000
hospitalized mental patients. Sedatives, hypnotics,
muscle relaxants, and ataractics of many forms
were producing results that needed further re-
search evaluation.
Social Therapy of Schizophrenia
Dr. E. E. Krapf, long an ardent worker for
world psychiatry and now with the Emited Na-
tions Organization in Geneva. Switzerland, demon-
strated the social therapy of schizophrenia. The
therapeutic goal was either to modify the sick
person to a better contact with the world of real-
ity, or to introduce beneficial changes in the family
and work environment so that the patient could
develop a greater adaptability of usefulness in
society. The modification of certain primitive be-
havior patterns needed further elaboration.
Changes in social behavior depended on social
experiences. The therapist and the patient con-
stituted always a “society of two.” Social be-
havior changed as social confidence improved.
Society could well look into its own mirror and
see what could be done to lessen stress and
struggle and competition among its groups.
Schizophrenia Among Primitive Peoples
Dr. T. A. Lambo of Abeokuta, Nigeria, made
observations of schizophrenia among primitive
people who first presented psychoneurotic-psy-
chotic overlays, such as confused episodes, twi-
light states, affective exaggerations with impo-
tence. sexual aversion and homosexual wish-fan-
tasy dreams. In most primitive cultures latent
manifestations were usually overlooked, especially
when abnormal behavior was devoid of aggression
and antisocial trends. Those patients who were
brought to town clinics showed clearcut schizo-
phrenic features.
Dr. L. Mars’ paper on schizophrenia in Haiti
was received with great interest since Dr. Mars
has been studying the problem of ethnopsychiatry
for many years in his own country. It was my
great privilege in visit him in Port au Prince in
1953 and discuss with him many facets of his j
research. The peasants who formed 80 per cent
of the population showed in their delusions a
cultural African content with gods and devils, j
The urban people evoked the Christian God, j
electricity, radio and other western civilization
elements. Schizophrenia was widespread in the
economically and culturally unstable middle class
and accounted for one third of all mental illnesses .
there.
It is impossible to elaborate further upon the
other excellent speakers and their illuminating
discussions for lack of space. A short historical
background of psychiatric progress in the last
several hundred years is presented to help reac- |
quaint the reader with the constant march of
various medical disciplines in healing the sick.
The guided tour through the Zurich University
Medico-Historial Collection, arranged and con- :
ducted by a former University of Wisconsin pro-
fessor, Dr. E. H. Ackerknecht, provided a memor-
J. Florida M.A.
February, 1958
FISHBE1N: SECOND INTERNATIONAL CONGRESS FOR PSYCHIATRY
825
able afternoon. It was interesting to learn that
a Zurich general practitioner, Dr. G. A. Wehrle,
had, as a hobby, collected medical curiosities all
his life. The University of Zurich purchased his
collection in 1932 and housed it in the Tower of
the University where it was now seen by the dele-
gates with warm enthusiasm. In 1951, the Insti-
tute for Medical History was established in Zurich.
This collection was unique for the German part of
Europe and similar collections could be seen in
London and Copenhagen. I am indebted to Dr.
Ackerknecht and his able staff for much of the
historical material reviewed.
History of World Psychiatric Progress
1. Celsus, Aretaeus and Soranus wrote extensi-
vely of psychiatric disorders in Latin.
2. Jan Wier, Paracelsus and Felix Platter began
the renaissance of psychiatry in the sixteenth
century, attacking the witch delusions of the
Middle Ages.
3. Sydenham and Willis wrote mostly in the
field of neuroses hysteria in the seventeenth
century.
4. Prefect and Benjamin Rush influenced the
philosophy of enlightenment of the mentally
ill in the eighteenth century. Others promi-
nent during this period of liberating the in-
sane from their chains were the following dis-
tinguished psychiatrists:
Abraham Joly — Genf, 1787
Vincenzo Chiarugi — Toskana, 1788
Philippe Pinel — Paris, 1793
William Tuke — York, 1796
Johann Langermann — Bayreuth, 1805
5. The French School, founded by Pinel, domi-
nated treatment in the first half of the nine-
teenth century. It was continued by his
pupils, Ferrus and Esquirol. The pupils of
Esquirol — Geroget, Leuret, Falret, Voisin.
Foville, Calmeil Baillarger, and Moreau de
Tours — all shared in furthering the humani-
tarian aims of their predecessors.
6. Antoine Laurent Boyle (1799-1858) was the
first to describe general paresis as a distinct
entity in 1822.
7. Benedict Augustin Morel (1809-1873), a
friend of Claude Bernard and a pupil of
Falret, was the creator of the influential “de-
generation-hypothesis of mental disease” in
1857.
8. Johann Christian Reil ( 1759-1813) was one
of the pioneers in German psychiatry. In the
first half of the nineteenth century this psy-
chiatry was divided into the two schools of
“psychism” represented by J. Heinroth
(1773-1843) and “somaticism” represented
by M. Jacobi ( 1775-1858) Wilhelm Grie-
singer (1817-1869), of the University of Zu-
rich, received his fame for clinical studies
of the somatic and psychologic syntheses in
mental illness.
9. Eugene Bleuler (1857-1939), professor of
psychiatry from 1897 to 1927, created the
term schizophrenia.
10. Karl Ludwig Kohlbaum (1828-1894) and his
protagonist, Emil Kraepelin (1856-1926),
were pioneers in the modern clinical classifi-
cation of psychoses. Both showed keen in-
sight into mental diseases.
11. Julius Wagner von Jauregg (1857-1940)
opened up a new era of somatic treatments
for mental diseases through his malaria fever
treatment of general paresis.
12. J. M. Charcot (1825-1893) and H. M. Bern-
heim (1873-1919) opened up new research
studies of neuroses, hysteria, and hypnosis.
Pierre Janet (1859-1947) and Sigmund Freud
(1856-1936), both strongly influenced by
Charcot, were the leaders of the two modern
schools of psychotherapy.
13. G. M. Beard (1839-1922) coined the term
“neurasthenia” and was one of the foremost
students of neurasthenia in the nineteenth
century.
14. Joseph Breuer (1842-1925) aided in the crea-
tion of psychoanalysis, which will always be
associated with the names of Freud, Adler,
Jung, Abraham and others intimately asso-
ciated with this movement.
I look forward with much enthusiasm to the
next international psychiatric congress, perhaps
in the Americas in 1962. My psychiatric col-
leagues all over the world will again get together
at that time and share in the total experiences of
their own lives one common task — to help make
mentally sick people well and create a better
world for all of us. To this goal, psychiatrists and
all men of science must devote their energies and
lives in harnessing the good of science to con-
struct a better world and not to destroy it.
420 Lincoln Road.
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826
ABSTRACTS
Volume XLIV
Number 8
Molar Sodium Lactate Compared with
Electrical Stimulation in Cardiac Arrest.
By Leonard M. Silverman, M.D., and Herbert
Eichert, M.D. J. A. M. A. 164: 1209-121 1 ( July
13) 1957.
A case is reported which presents a unique
instance of successful restoration of ventricular
rhythm by the use of molar sodium lactate in a
patient with ventricular arrest who was being
kept alive by means of artificial electrical stimu-
lation. Relatively small doses of molar sodium
lactate solution were completely ineffective as a
substitute for the artificial pacemaker in main-
taining ventricular activity. Large amounts of
molar sodium lactate solution, however, were
found to be equally good if not better than the
artificial pacemaker in maintaining a durable
rhythm. General clinical improvement was much
more striking with molar sodium lactate solution
than with the pacemaker. It would appear that
molar sodium lactate may be an adjunct to or
may be used instead of electrical stimulation to re-
store idioventricular beating.
Surgery in Pulmonary Tuberculosis: The
Problem of the Poor-Risk Patient. By Nelson
H. Kraeft, M.D., and L. Ovelia Linton. M.D.
Am. Surgeon 22:1207-1214 (Dec.) 1956.
A significant and increasing number of pa-
tients with pulmonary tuberculosis are encoun-
tered in whom the application of surgical treat-
ment must often be compromised because of fac-
tors which increase the individual surgical risk.
Such factors as ( 1 ) the increasing incidence of
pulmonary tuberculosis in older people, (2) ef-
fective chemotherapy which permits survival with
extensive disease residua of patients previously
doomed, and (3) the significant number of pa-
tients with associated but unrelated pathologic
processes necessarily indicate groups presenting
increased surgical risk. The use in these groups
of surgical measures less precise than excision but
offering considerable hope of salvage from a pre-
carious balance of chronic invalidism is here
discussed.
Experiences with patients presenting poor
operative risk in a series of 170 cases are con-
sidered. The use of bilateral resection, thoraco-
plasty with and without cavitary drainage and
subcostal plombage in selected cases is discussed.
The minimal disturbance of respiratory function
in the last group was striking. The results gener-
ally were encouraging except in the group treated
by subcostal plombage. Since these were mainly
salvage procedures, the successes warrant further
trial of the procedure in similar patients in the
future in the opinion of the authors. They con-
clude that the problem of the poor risk patient
with pulmonary tuberculosis will be solved by
earlier recognition of the disease with its occur-
rence in the older patient kept in mind, by better
and continued therapy, and by closer attention
to the patient’s socioeconomic problems involved
by the disease. They conclude further that when
pulmonary excision is not deemed feasible, per-
manent collapse measures are worthy of trial.
A prerequisite for success is a patient with rea-
sonably good resistance to the disease and one
who will adhere to the therapeutic regimen.
Cutaneous Papillomas of the Neck.
Papillomatous Seborrheic Keratoses. By
Morris Waisman. M.D. South. M. J. 50:725-732
(June) 1957.
The histopathologic findings in a common skin
lesion about which there is varying opinion as to
etiology and classification are here described.
Clinical and histopathologic features of the com-
mon cutaneous papillomas, or tags, of the neck,
chest and eyelids are reviewed. The frequent
association of seborrheic keratosis and cutaneous
papillomas and the suggestive transitions of one
form into the other prompt the impression that
the papillomas are modified seborrheic keratoses.
Histopathologic alterations of small papillomas
resemble those of early lesions of seborrheic kera-
tosis. There is a dichotomy of larger cutaneous
papillomas into epidermal and fibrous forms, de-
pending upon which tissue element predominates.
It is suggested that possibly hormonal factors,
such as those attributable to physiologic over-
activity of the anterior lobe of the pituitary-
gland and the adrenal cortex, play a role in this
formation.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
827
. Florida M.A.
February, 1958
House of Delegates
Proceedings of Called Meeting
George Washington Hotel, Jacksonville,
December 8, 1957
A called meeting of the House of Delegates
of the Florida Medical Association convened in
the Ballroom of the George Washington Hotel,
Jacksonville, at 9:25 a.m. on Sunday, December
8, 1957, with President William C. Roberts pre-
siding.
Dr. Ralph W. Jack, Chairman of the Cre-
dentials Committee, announced that a quorum
was present, 95 delegates being registered. (Sub-
sequent report of the Credentials Committee
showed 101 delegates registered.)
Delegates
ALACHUA — Henry J. Babers Jr., Walter E. Murphree
(Absent — F. Emory Bell).
BAY — (Absent — Harold E. Wager)
BREVARD — -Thomas C. Kenaston, Arthur C. Tedford
BROWARD— Julius F. Boettner, Burns A. Dobbins Jr.,
Anthony C. Gzlluccio, John H. Mickley (Absent —
Norris M. Beasley, Richard A. Mills, Paid G.
Shell)
COLLIER — (Absent — Daniel B. Langley)
COLUMBIA — Louis G. Landrum
DADE — James L. Anderson, Edward R. Annis, Jack Q.
Cleveland, L. Washington Dowlen, James J. Hutson,
Ralph W. Jack, Donald F. Marion, John D. Milton,
Warren W. Quillian, Hunter B. Rogers, Walter W.
Sackett Jr., William M. Straight, Jack L. Wright
(Absent — Morris H. Blau, Reuben B. Chrisman Jr.,
Francis N. Cooke, Vincent P. Corso, Edward W.
Cullipher, Robert E. Dickey, M. Jay Flipse, Milton
S. Goldman, Maurice M. Greenfield, W. Tracy
Haver field, James W. Holmes, R. Spencer Howell,
Joseph T. Jana Jr., Walter C. Jones, David Kirsh,
Alfred G. Levin, T. D. Sandberg, Ralph S. Sappen-
field, George F. Schmitt Jr., Donald W. Smith, Joseph
S. Stewart, Oliver P. Winslow Jr., Corren P. You-
nt ans, Nelson Zivitz)
DESOTO-HARDEE-
H'GHLANDS-GLADES — (Absent — Carl J. Larsen)
DUVAL — Frederick H. Bowen, Hugh A. Carithers, Tur-
ner Z. Cason, A. Judson Graves, Karl B. Hanson,
Gordon H. Ira, Edward Jelks, F. Gordon King,
Raymond H. King, Charles F. McCrory, Richard G.
Skinner Jr., John T. Stage, Sidney Stillman, Leo
M. Wachtel, Ashbel C. Williams (Absent — Frank
L. Fort)
ESCAMBIA — Paul F. Baranco, Herbert L. Bryans,
Joseph W. Douglas, Gretchen V. Squires (Absent —
Alpheus T. Kennedy)
FRANKLIN-GULF — John W. Hendrix
HILLSBOROUGH — Samuel H. Adams, William C. Blake,
Herschel G. Cole, H. Phillip Hampton, Madison R.
Pope (Absent — Efrain C. Azmitia, C. Frank Chunn,
David R. Murphey Jr., James N. Patterson, Wil-
liam M. Rowlett, Wesley W Wilson)
INDIAN RIVER— William L. Fitts 3rd
JACKSON-CALHOUN— Grayson C. Snyder
LAKE — George E. Engelhard
LEE-CHARLOTTE-HENDRY— John S. Stewart (Ab-
sent— William H. Grace)
LEON-GADSDEN-LIBERTY-
WAKULLA-JEFFERSON— Francis T. Holland, Robert
H. Mickler, George S. Palmer
MADISON — (Absent — Wilmer J. Coggins)
MANATEE — Richard V. Meaney
MARION — Henrv L. Harrell, Eugene G. Peek Jr.
MONROE— William R. Ploss
NASSAU — (Absent — Cecil B. Brewton)
ORANGE— Frank C. Bone, Chas. J. Collins, Harry H.
Ferran, Fred Mathers, Frank J. Pyle, Charles R.
Sias, W. Dean Steward, Robert L. Tolle, Miles W.
Thomley, Robert E. Zellner
PALM BEACH— Willard F. Ande, Edwin W. Brown,
Clarence L. Brumback, V. Marklin Johnson, Walter
R. Newbern, Ralph M. Overstreet Jr., W. Lawson
Shackelford, Edward W. Wood
PASCO-HERNANDO-CITRUS— S. Carnes Harvard
PINELLAS — Clyde O. Anderson, Harry R. Cushman, N.
Worth Gable, Norval M. Marr Sr., George H. Schoet-
ker, Walter H. Winchester, Rowland E. Wood ( Ab-
sent— M. Eldridge Black, Willliam D. Futch, Percy
H . Guinand, Joseph W. Pilkington, James E. Thomp-
son)
POLK — Jere W. Annis, James R. Boulware Jr., Marion
YV. Hester, Charles Larsen Jr. CAbsent — Samuel ].
Clark)
PUTNAM — (Absent — Lawrence G. Hebei)
ST. JOHNS— Herbert E. White
ST. LUCIE-OKEECHOBEE-MARTIN-Richard F. Sin-
nott
SARASOTA — John M. Butcher, Karl R. Rolls, Melvin
M. Simmons
SEMINOLE — Daniel H. Mathers
SITWANNEE — (Absent — Edward G. Haskell Jr.)
TAYLOR — (Absent — John H. Parker Jr.)
VOLUSIA — C. Robert DeArmas, Alphonsus M. McCarthy
(Absent — William R. Hutchinson, Arthur Schwartz)
WALTON - OKALOOSA - SANTA ROSA — (A b s e n t—
Frederic E. Caldwell)
WASHINGTON-HOLMES — (Absent — Walter H. Shehee)
STATE OFFICERS — Samuel M. Day, James T. Cook
Jr., Francis H. Langley, Cecil M. Peek, Shaler
Richardson, William C. Roberts (Absent — Meredith
Mallory, Kenneth A. Morris)
Dr. Leo Wachtel gave the invocation.
Dr. Jere W. Annis moved that the delegates
be seated.
Seconded by Dr. Milton.
Motion carried.
President Roberts introduced several guests:
Dr. William J. Kennard. Assistant Director A.M.
A. Washington Office; Major General Paul I.
Robinson. Executive Director, Office for Depen-
dents’ Medical Care; Mr. John D. Arndt, Medi-
care Administrator, Medical Association of Geor-
gia: Dr. Russell B. Carson, President, Mr. H. A.
Schroder, Executive Director, and Mr. X. G.
Johnson. Medicare Coordinator, of Blue Shield
828
HOUSE OF DELEGATES
Volume XLI V
Number 8
of Florida; Mr. Harry T. Gray, the Association’s
Attorney; Mr. Marshall Brainard, Executive Sec-
retary, Duval County Medical Society, and Mrs.
Berneice T. Mathis, Executive Secretary, Orange
County Medical Society.
Dr. Roberts announced that this meeting had
been called for the purpose of deciding the future
of Medicare in Florida and only that subject
could be discussed.
Dr. John D. Milton, Chairman, Medicare
Mediation Committee, gave an excellent illustrat-
ed address on the history, scope and present sta-
tus of the Medicare Program in Florida.
Medicare in Florida
John D. Milton, M.D.
Chairman, Florida Medical Association Medicare Mediation
Committee, Miami.
In a period of some twenty minutes. I shall
endeavor to cover Medicare prior to July 1, 1957,
and to present some of the problems that have
been causing difficulties since that date.
The Association’s Mediation Committee and
Blue Shield of Florida have worked with Medi-
care for months, but we still find it necessary to
move slowly and to feel our way along. I am cer-
tain that the physicians who are providing serv-
ices to eligible dependents are finding this true
also.
Your Mediation Committee is strictly profes-
sional and has nothing to do with the adminis-
tration of Medicare. There are so many ramifica-
tions that it is unusually hard to interpret prop-
erly any given claim.
This (Slide Xo. 1) is an attempt to summarize
concisely for you the types of care that are
authorized under the program. You will note
that this is primarily an in-hospitalization plan
and only during hospitalization will Medicare pay
for (1) the treatment of acute medical conditions
including exacerbations or acute complications of
chronic diseases, (2) the treatment of surgical
conditions, and (3) the treatment of contagious
diseases.
Medicare does provide complete obstetric and
maternity care. This is the one instance where no
restriction is placed regarding hospitalization.
The care may be provided in the hospital, home or
office.
Medicare also provides up to 365 days hospi-
talization in semiprivate accommodations for each
admission.
Jt also provides care in a hospital for bodily
injury (Slide Xo. 2) and treatment in a hospital
of acute emergencies of any nature.
Payment for diagnostic tests and procedures
is authorized only during hospitalization except
that ( 1 ) payment is authorized in an amount
not to exceed $75 for necessary diagnostic tests
and procedures performed or authorized by the
attending physician prior to hospitalization for
the same bodily injury nr surgical procedure jor
which the patient is hospitalized, and (2) pay-
ment is authorized in an amount not to exceed
$50 for necessary diagnostic tests and procedures
performed for proper after-care of the same bodily
injury or surgical procedure.
As previously stated, Medicare is essentially
an inpatient program, providing for outpatient
care in the following areas: (Slide Xo. 3) (1 ) ob-
stetric and maternity services, which have the
greatest utilization of any of the services provided
under Medicare and provide the one exception to
limitation on where the services shall be perform-
ed; (2) bodily injuries, limited to the treatment
of fractures, dislocations, lacerations and other
wounds; (3) diagnostic tests and procedures
prior to and/or following hospitalization for the
same bodily injury or surgical procedure jor which
the patient is hospitalized, and (4) radiotherapy
prescribed during a period of hospitalization and
continued or carried out on an outpatient status,
as directed by the attending physician.
Emergency Care. — As you have noted in
the information just presented. (Slide Xo. 4)
emergency care, to be payable by the government
under the Dependents’ Medical Care Program,
must be either: (1) outpatient care as stated pre-
viously, which is normally provided for under the
program: or (2) care furnished to the patient
who is admitted to a hospital as an inpatient ir-
respective of whether the hospital meets the defini-
tion of a hospital as defined in the Joint Directive.
Thus, emergency care performed in a doctor’s
office or clinic, which is not related to an obstetric
or injury case, is not compensable under the pro-
gram.
Your Association participates jointly in a
three way contract (Slide Xo. 5) with the Con-
tracting Officer of the Office for Dependents’
Medical Care, representing the government, and
Blue Shield of Florida, the fiscal agent, the As-
sociation operating in a capacity primarily of
professional mediation.
The original contract is still in effect (Slide
Xo. 6). It was not changed by the action of the
T. Florida M.A.
February, 1958
HOUSE OF DELEGATES
829
House of Delegates in May 1957, as will be ex-
plained in greater detail later. The changes pro-
duced by the decisions of the House were those of
implementation and in no way altered the existing
contract.
The contract spells out the responsibility of
the three participants. ( 1 ) It is the responsibility
of the government, that is, the Office for De-
pendents’ Medical Care, to be the final authority
in the payment of claims which deal with special
reports and special procedures. (2) Blue Shield,
the fiscal agent, deals merely w’ith the processing
of claims. When a claim is received by Blue
Shield, it must check the service information on
the dependent and the sponsor, and it must de-
termine whether the procedure is allowable un-
der Public Law 569, whether it comes within the
maximum allowances, and whether it is properly
certified. If all these are in order, then the pay-
ment of the claim is made immediately to the
physician by Blue Shield.
It is the duty and responsibility of the Florida
Medical Association to encourage physicians to
provide services to eligible dependents and to
maintain appropriate committees to review and
consider cases involving complaints, differences of
professional opinion and misunderstandings. (Slide
No. 7 -a continuation of the original contract).
Fees. — Under the original contract, fees
were paid according to the Schedule of Allow-
ances which the Association had negotiated with
the Office for Dependents’ Medical Care. In case
the particular procedure on the claim was not
listed in the Schedule, or in involved cases, a
special report was required to be submitted with
the claim. It was the Association's duty to review
these to determine the tentative fee, which then
had to be approved by the Contracting Officer.
The tentative determination of the committee be-
came final unless rejected by the Contracting
Officer within 20 days.
Also, under the original contract, any item
in the Schedule which was deemed inequitable
could be increased or decreased at any time after
adequate review. The period of that original con-
tract extended from December 10, 1956 to June
30, 1957. December 10 is the actual date of the
beginning of the contract, but payment for
authorized care under the program was permitted
from the date the law went into effect, Decem-
ber 7, 1956. (Slides No. 8 and 9 - The Beginning
of a New Era).
The action of the House of Delegates, May 8,
1957.
Resolution
WHEREAS, the Florida Medical Association de-
sires that the Medicare program be carried out on the
American principle of freedom of choice of physician
and the freedom of the physician to set his own fees,
based, not on a standardized formula or fixed fee
schedule, but on the usual fee charged for such serv-
ices, and
WHEREAS’ we have a firm conviction that better
medical care for the dependents will be provided, at
lower cost to the taxpayer; the present satisfactory
physician-patient relationship continued and incentive
for advancement in medical training and practices
maintained, if military dependents are cared for on
the same basis as other citizens,
BE IT THEREFORE RESOLVED:
1. That the fixed fee schedule contract now in
effect NOT be extended beyond the termina-
tion date of June 30, 1957.
2. That the Florida Medical Association Board of
Governors devise a mechanism to provide de-
pendents with medical care under the provi-
sions authorized by law until a new contract
has been consummated.
3. That the Florida Medical Association negotiate
a new contract carrying out the principles of
this resolution.
4. That the Florida Medical Association and each
County Medical Society establish a committee
to evaluate and recommend the disposition of
problems related to the Medicare program.
5. That a copy of this resolution be forwarded to
the Secretary and General Manager of the
American Medical Association.
(Slide No. 10 — Action of the Board of
Governors, May 26, 1957).
The action of the House of Delegates directed
the Board of Governors to carry out the mandate
of the House and to devise a mechanism to pro-
vide dependents with medical care under the pro-
visions authorized by law until a new contract
was consummated.
In accordance with these instructions, the
Board of Governors on May 26, 1957. approved
the following actions with reference to Medicare:
1. The Florida Medical Association and its
fiscal administrator jointly announce that
no fixed fee schedule on the Medicare pro-
gram exists after July 1, 1957.
2. Physicians will henceforth submit to Blue
Shield of Florida their usual fees with due
reference to the income level of service
men and the special groups receiving those
services.
3. The Florida Medical Association will pro-
cess fees submitted and decide whether
they are equitable under the circumstances
in each case.
4. This contract will be extended until Janu-
ary 1958 at which time a new contract will
be negotiated and annually thereafter.
I should like to ask that you take specific
note that these actions of the Board of Governors
830
HOUSE OF DELEGATES
Volume XU V
N ' M BF.R 8
were transmitted to the Office for Dependents’
Medical Care in a letter dated June 17, and at
General Robinson’s insistence, the following sen-
tence was added: (Slide No. 11 ) “This resolution
will in no wise abrogate our present contract but
will merely change the implementation of same,
and further, it is to be understood that this change
in process or implementation will not increase the
cost to the Government.”
You will recall that earlier in my remarks, I
stated that there was no change in the contract,
merely in the implementation of it.
General Robinson replied on June 27, 1957: (Slide
No. 12).
“We agree with the point you made
that your letter in no way abrogates the
Contract as extended through 31 January
1958. We feel that the Contract speaks for
itself. To incorporate the contents of this
letter into the Contract could very well
result in a misunderstanding as to the terms
of the Contract. The Contracting Officer
in executing this extension of the Contract
is doing so with the understanding that
the contents of the above referenced letter
are not incorporated into the Contract, and
in no wise abrogates the Contract.
“Since the fees, in the Schedule of Al-
lowances for Physicians’ Fees, set forth
in the Contract are ‘maximum fees’, we feel
that your association has acted wisely in
discontinuing publishing fees to physicians,
requesting physicians to bill their normal
charges, and with your association and its
counterparts at the local level acting as
a leveling influence.”
Slides 13 and 14 deal with that portion of
I)A Form 1863, the Medicare claim reporting
form, which has to do with certification. Im-
proper certification or lack of certification has
caused considerable difficulty in the processing
of some claims and probably has created as much
misunderstanding as any one item.
Slide 14 is a blown-up version of that portion
of DA Form 1863 which provides for certification
by the attending physician. It is necessary that
you check either “A” or “B ". You will note
that if you check “A", you agree to accept the
allowances listed in the Dependents’ Medical Care
Program Schedule of Allowances or the amount
which you have shown in Item 24. whichever is
less. As you will see on subsequent slides, if you
check in this block and your claim does not
exceed the current Schedule of Allowances, the
processing of the claim is simple and payment
will reach you in a minimum of time. If, how-
ever, you check “B” and the amount is higher
than the Schedule of Allowances for that proce-
dure, it must be sent to ODMC for approval and
must be accompanied by a special report justify-
ing the additional charges.
The routing of a claim form prior to July 1,
1957 is shown in Slide No. 15. You will note
the relatively simple procedure if you checked “A”
and the amount did not exceed that in the Sche-
dule of Allowances; your claim went to Blue
Shield, and if it was filled out properly and was an
allowable service under the Medicare program.
Blue Shield paid the claim immediately, and you
had your money in a very short time. If. how-
ever, you checked “B”, or if there was some ques-
tion as to whether the procedure was authorized,
the claim went to the FMA Mediation Committee,
back to Blue Shield, then to the Office for De-
pendents’ Medical Care, and back to Blue Shield.
If it was recommended for payment by FMA and
ODMC concurred, then Blue Shield was author-
ized to make payment as soon as ODMC indicated
its approval.
The more complicated procedure necessary
after July 1. 1957 is set forth in Slide No. 16.
Again, if you have checked “A” in the certification
section of the claim form, the process is still as
simple as it was previously. If the claim is al-
lowable and you have filled in the form properly.
Blue Shield can pay the claim immediately. If.
however, you have checked under “B”, the claim
will go to your County Medical Society Mediation
Committee, back to Blue Shield, then to the FMA
Mediation Committee, back to Blue Shield, to
the Office for Dependents’ Medical Care, and back
to Blue Shield. If approved by ODMC. payment
can then be made by Blue Shield, but you can
readily see that this procedure will take consider-
able time, particularly since county and state
mediation committees probably will not meet of-
tener than once each month.
Once a claim form goes to ODMC with the
county and state Medicare committee recom-
mendations, it will not rest there indefinitely un-
til ODMC gets ready to act. If the claim has not
been rejected by ODMC within 20 days, Blue
Shield may go ahead and pay without waiting
for further instructions.
Another requirement which is greatly misun-
derstood and which has caused considerable con-
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
831
fusion is special reports. (Slide No. 17) This
slide is intended to show the general conditions
under which special reports should be made:
1. Complications of pregnancy for which ad-
ditional fees are charged.
2. Surgical operations not properly listed in
the Schedule of Allowances or any unusual
and trying circumstances.
3. Severe complications of medical illnesses,
which require more than usual hospital
visits.
4. Every case of hospitalization for nervous
or mental diseases. The report shall state
that the life, health or well-being of the
patient would have been endangered if not
treated.
5. Every case in which fees are above previous
schedule for any reason.
6. Cases in which two or more physicians
are required at the same time. (Supple-
mental skills)
7. Those procedures previously annotated as
“By Report.”
The general rule of thumb is that when any
complications arise, or whenever additional charges
are made, if the fees exceed the Schedule of Allow-
ances, a special report will have to accompany
the claim form.
It occurred to me that a few statistics might
be helpful. Slide No. 18 shows cases referred to
the state committee up to October 31, 1957:
(Slide No. 18)
Complicated Surgery and Related
Procedures 147
Maternity and Complications 101
Consultants’ Services, Surgical
Assistants, Consultations, etc. 49
Charges in Excess of the Schedule 35
Psychiatric (Acute Emotional) 35
Elective and Chronic Care 31
Complicated Medical Problems 26
Outpatient Diagnostic Procedures,
with and without Therapy 21
Supplementary Skills 14
Committee Function, Pediatrics,
Nonscheduled Procedures, Tran-
sient Surgery, Medicare and In-
surance, Allergy Tests and Dental
Problems 37
Total 496
You will note that heading the list is compli-
cated surgery and related procedures, followed
by maternity and its complications. Keep in
mind that these figures pertain only to those cases
referred to the committee and not to total claims
processed.
In Slide No. 19 an attempt is made to compare
utilization of Medicare in Florida with that of the
entire nation. It shows that Florida’s percentage
has increased and that the number of dollars
coming into the state is not insignificant.
Medicare Claims
December 7, 1956 - June 30, 1957
Florida
Nation
Florida %
of Total
Number
6,031
127,902
4.7
Amount
$425,397.38
$8,805,128.00
4.8
July 1, 1957 - August 31, 1957
Number
4,099
45,748
9.0
Amount
$319,053.45
$3,288,805.00
9.7
September 1, 1957 -
November 1, 1957
Number
4,279
Not available
—
Amount
$332,894.69
Not available
—
Let us think again for a moment of the resolu-
tion passed by the House of Delegates- last May.
You will recall that we made a definite promise
to the government that if physicians were allowed
to charge their regular fee, or the fees usual to
their community, not only would the expense to
the government not be more, but actually it would
be “at a lower cost to the taxpayer.”
Number of Cases below Schedule from July 1,
1957 to November 1, 1957 (Slide No. 20)
Florida Figures Only:
324 Cases — Amount below
Schedule of Allowances — $3 ,397.75
Paid in same period:
8,378 Cases — Total for these cases —
$651,948.14
Per cent of cases paid below Schedule to total
cases paid — 3.86 per cent
Per cent of money below Schedule to total
amount paid — slightly more than 0.5 per cent
Slide No. 20 shows that to date, from the
aspect of saving the taxpayer money, we do not
have much of a talking point. The total amount of
money paid to physicians below that which would
have been paid had we adhered to the Schedule
of Allowances is just slightly over 0.5 per cent.
It could be added that it probably would have
been higher had not the ODMC declined to ap-
prove charges in excess of the Schedule of Al-
lowances which were not justified by special re-
port.
We thought that you might be interested in a
breakdown by medical districts of the amounts
832
HOUSE OF DELEGATES
Volume XLIV
Number 8
which are below the Schedule. The selection of
the counties in each district was made on the
basis of those having the greatest utilization for
their area. Compared to the total amount of
money paid for Medicare in these counties, the
figures are indeed insignificant.
Amounts Below Schedule By Medical Districts
(Slide No. 21)
District Principal Counties Total for District
“A” Escambia — $487.50
Bay— 243.00 $ 898.25
“B” Duval— 694.50
Orange — 581.00 1,574.00
“C” Hillsborough — 235.00
Polk— 128.00 565.00
“D” Dade— 156.50
Martin — 93.50 360.50
Below Schedule — Total All Districts $3,397.75
We are here today to determine what course
we are going to follow in Florida from here on.
As we attempt to arrive at sound and logical con-
clusions, it may be helpful to contemplate what
will happen if our present plan is not successful
and we do not renew our contract. (Slide No. 22)
If we refuse to renew our contract, the Office for
Dependents’ Medical Care may
1. Ask the Third Army to care for dependents
in Florida. This might mean care in army
facilities by army doctors, or
2. Invoke a fee schedule and place adminis-
tration either in the hands of the Third
Army or a private insurance company. If
this should happen
a. Medical service would be provided by
physicians who would accept whatever
fees the government wishes to pay.
b. Neither the individual physician nor the
Association would have a voice in set-
ting those fees.
c. Inclusion of other groups by Congress,
with fees set at any level the govern-
ment wishes, would be facilitated,
d. Socialized medicine would be extended.
Unquestionably, the eyes of the medical pro-
fession of the nation are on Florida. (Slide No.
23) That is evidenced by the number of inquiries
that have come to the executive office from other
state medical associations and the fact that one
neighboring association has elected to send a rep-
resentative to this meeting.
If Florida physicians are honest and fair in
the handling of each and every Medicare claim,
it will
1. Prove that an inflexible Schedule of Al-
lowances is not necessary.
2. Preserve the rights of individual physicians
and the physician-patient relationship.
3. By precept, enable other states to negotiate
similar contracts with ODMC.
4. Retard the current trend toward socializa-
tion of medicine.
And now the decisions (Slide No. 24) which
this House of Delegates must make include:
1. Shall the Association continue to be a
party to a contract with the Office for
Dependents’ Medical Care?
2. If so, shall it be on a fixed fee (Schedule
of Allowances) or on a no fixed fee basis?
3. If a fixed fee is preferred, what changes
from the previous Schedule of Allowances
should be required?
4. If a no fixed fee is to be in effect, shall
the Association accept the government’s
policy of adhering to a maximum fee sche-
dule?
5. Selection of representatives for renegotia-
tion of contract in January 1958.
Gentlemen, that is Medicare from the view-
point of those who have been working closely with
it since its inception. Where we go from here is
in your hands and depends upon the decisions
which you now must make.
Dr. Milton: “It is a pleasure for me to in-
troduce your next speaker. I am sorry that I
have not had the pleasure of knowing this gentle-
man much longer than I have. I can assure you
that all the dealings I have had with him, and
the others who have come in contact with him,
convince me that he is a real gentleman, and
that, being a doctor, he is on the side of medicine
much more than you would judge by his uni-
form. He really wants medicine to call the shots.
I am sorry that I do not have all of his back-
ground, but you can see from his ribbons and his
rank that he has been through everything and has
shown his ability. I present to you General Paul
I. Robinson.”
The Dependents’ Medical Care Program
Major General Paul I. Robinson, (M.C.)
B.S., M.D., F.A.C.P.
Executive Director, Dependents’ Medical Care Program
Office of The Surgeon General, U.S. Army, Washington, D.C.
Dr. Roberts, Dr. Milton, Physicians of the
Florida House of Delegates: I want to assure you
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
833
that I appreciate very much the invitation to meet
with you today.
I have a series of Vugraphs which I believe
will make my presentation shorter and more readi-
ly understandable. (Chart No. 1)
We should all keep in mind the purpose of the
law. This is quoted directly from P. L. 569. The
purpose of this act is to create and maintain
high morale throughout the uniformed services
by providing an improved and uniform program
of medical care for members of the uniformed
services and their dependents.
(Chart No. 2)
This slide is one that the committee who pre-
pared the Joint Directive used. This is an ex-
haustive study to determine what the income of
service people actually is. You will notice that
they included not only the base pay but all the
allowances now given to service people. You will
notice also that nine out of 10 service personnel
have incomes less than $5,000. Actually, the
figures I have used in many presentations over
the country is that 82 per cent have incomes of
$4,300 or less. You can readily see that those
who have incomes of over $5,000 are really a very
small per cent.
The next slide may be difficult to see for those
in the back of the room. I tried to outline the
plan of the Program hereon. The Medicare Plan
we must consider as an absolutely new plan. It
does not conform to any insurance scheme; it
does not conform to any Blue Shield plan. This
plan is for wives and children of active duty ser-
vice men, and dependents of active duty service
women (we have a few nurses who have dependent
husbands) of the Army, Navy, Marines, Air
Force, Coast Guard, commissioned members of
the Public Health Service and Coast and Geodetic
Survey. It covers all authorized inpatient care
and all outpatient care incident to complete ma-
ternity care and bodily injury, and excludes care
for chronic illnesses, nervous and mental diseases
and elective surgery.
Authorized medical care may be received in
civilian hospitals if the dependent wishes and if
the dependent pays a stipulated amount. Service
can be rendered by civilian physicians if they
desire to accept the patient under the program,
under standards of civilian medical authorities,
at amounts not in excess of rates which are de-
termined by negotiation between the state medical
associations and the Office for Dependents’ Medi-
cal Care. Bills are paid by Blue Shield, by state
medical societies themselves in some states, by
commercial insurance companies in some states
and at a nonprofit administrative cost. Bills are
paid from funds appropriated by the Congress and
are provided to create and maintain high morale,
you must remember. You will recognize this slide
has a third column, and so you will know I am
not keeping anything from you; it is the hospital
part of the Program in which you are not too in-
terested.
(Chart No. 3)
Dr. Milton went over the care authorized
much better than I. but I thought I would show
these slides anyhow because there is a little dif-
ference in the care rendered in service facilities
and in civilian facilities. There is a little more lee-
way in service facilities. I think that is important
for you as civilian doctors to remember, particular-
ly in those cases which you question. The im-
portant thing I think is that throughout our en-
tire nation, Alaska, Hawaii, and Puerto Rico, there
is an absolute free choice by the dependents,
whether or not they will go to a service facility or
a civilian facility. Right here, I might say that
there is a provision in the law for this free choice
to be restricted by the secretaries of any of the
services, provided the Secretary of Defense will
approve. There has been no application for re-
striction made from any area at this time. Ap-
plications may be made, in the future, particularly
in certain fields in order to protect the residency
and internship training programs of some of our
large hospitals, but at the present time there have
been none, and we hope there never will be.
This slide shows care not authorized. I sat
with Dr. Milton’s committee until twelve-thirty
last evening, and I assure you that his committee
is working very hard on just these items about
which most of the questions arise. Whether or not
medical care rendered for a chronic disease really
is allowable under the Program creates many
questions. There is no line that we can draw yet.
We have been unable to write a directive delineat-
ing what procedures and treatments can and can-
not be accomplished. We will do so as soon as
possible. For nervous and mental diseases we did
so in our ODMC letter No. 8, which outlines
acute emotional disorder care.
In the area of elective medical and surgical
care, we have a tremendous amount of difficulty,
as Dr. Milton can tell you. Whether or not a
rhinoplasty is approvable; whether or not an ele-
phant ear operation is approvable; or scar cor-
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HOUSE OF DELEGATES
Volume XLIV
Number 8
rection on a previously accomplished hairlip, those
are most difficult decisions, and there just is no
generally applicable answer at present. We have
to judge each case on information furnished by
physicians. I am sure it is a nuisance to you to
have questions come back to you for detailed ex-
planations so that we can try to adjudicate the
claims reasonably and correctly. Here again, in
this area, it might be well for you, as civilian phy-
sicians, to suggest to the patients that they might
present themselves to a Service facility for this
questionable care or to seek decision before treat-
ment is accomplished.
(Chart No. 4)
The patient has to pay a considerable amount.
I talked to a young fellow the other day; his
wife had had hospitalization for a minor gyne-
cologic procedure, and his two children had had
tonsillectomies. He had paid $75. I talked to
some of my insurance friends, and they said that
for $75 he could have obtained considerable in-
surance; so, it is not a give-away program, and
we should remember this fact. Dependents must
pay the first $25 or $1.75 per day, which ever is
greater. If they have a private room, they must
pay the difference between the private room and
semiprivate accommodations, unless the physician
specifically says that the patient must have a pri-
vate room in order to render proper care. The
patient has to pay all private nurse charges unless
the physician prescribes, and even then she must
pay the first $100 plus 25 per cent of the addi-
tional. The patient must pay all outpatient care,
all care that is ordinarily rendered on an out-
patient basis, except for bodily injury or maternity
delivery (not in hospital) when she must pay the
first $15 of the physician’s charge. All x-ray,
laboratory, preoperative tests over $75 and post-
hospital over 50 per cent must be paid by the
patient. For deep x-ray, posthospital, there is no
charge for a condition treated or diagnosed while
in the hospital, but there must be a hospital con-
nection.
The next chart is the new identification card.
Beginning the first of January, no identification
is acceptable except this card. The services have
had nearly six months to distribute this card, and
if anyone presents himself to you after the first
of January with any identification other than this,
he should be questioned most carefully, except, of
course, in an emergency to save life and limb,
and then you can fall back on the standard prin-
ciples of medical practice.
(Chart No. 5)
I thought you all might like to see the present
setup of fiscal administrators. In all the states in
dark blue, Blue Shield is handling the plan. In
all the states in red, the medical associations them-
selves are handling their own plan. In Oregon
and Washington, the professional association has
designated Blue Shield to handle everything; they
make all the decisions that the Medicare Media-
tion Committee here makes. The decisions are all
made in the Health Plan offices, but I am sure with
medical advice in many instances. Alabama and
Louisiana suggested private insurance companies
to pay the bills, and we made contracts with them.
Rhode Island and Ohio, as you all know,
would enter into no contractual arrangement.
Ohio representatives sat with us and worked out
a schedule of allowances which is in effect. We
contracted with Mutual of Omaha to pay the
physicians in Rhode Island and Ohio. We have an
acceptable program in both states. Between 15
and 25 per cent of all physicians in those states
are participating in the Program. The questions,
however, have to come to our office; we, in turn,
have to deal with the individual physician. The
medical associations do not enter into the opera-
tion of the Program. As far as our relationships
with the individual physician are concerned, they
are excellent. In Hawaii, Blue Shield pays the
physicians; in Alaska, the Blue Cross of Wash-
ington; in Puerto Rico, the medical association it-
self. Remember, all of the state medical associa-
tions had the option of deciding whether or not to
do their own fiscal work, and we approved theii
selection of fiscal administrators if they had prop-
er offices and our auditors thought that they could
do the job.
(Chart No. 6)
In the beginning of the Program, everyone
wanted to be very sure that we did not have a
national Schedule of Allowances. I just slipped in
two or three slides here on the schedule to let
you see the differences. Hospital visits range
from $3.90 to $10; fees for nephrectomy from
$175 to $420; appendectomies from $125 to $210;
maternity care (complete, including antepartum
and postpartum care) from $120 to $180. Here
are 18 more items that are plotted a little different
way — the range there is shown — bronchoscopy for
removal of foreign body, $70 to $125, the average
is $107, and 15 states have $100; tonsillectomy,
the range is $42.50 to $75, the average is $64,
and 15 states have $65; herniorrhaphy from $100
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
835
to $180, the average is $138, and 17 states have
$150; classic cesarean section from $110 to $300.
the average is $203, and 11 states have $200.
There is a wide variation even in diagnostic
x-rays; complete spine, $25 to $60, average is
$42, and 27 states have $45. We plotted some
items by states: for tonsillectomy, all of the states
in blue have $65 ; all of the states in red have $75 ;
Michigan happens to be low with $42.50; and all
the states in white are somewhere between $42.50
and $75, but not $65.
These are complete maternity care, all blues
have $150; the two reds have $180; Oklahoma
and Puerto Rico, $120; the white states are all
in between $120 and $180, but not $150.
This is hospital visits, all blue have $5 ; Ore-
gon has $3.90; Alaska has $7.50; all the white
states have some figure in between.
(Chart No. 7)
Our business is 80 per cent female, as you can
see, the 20 per cent male being under 13 years
of age; this is to be expected in the Program.
Of course, the big bulk of our dependents are
between 20 and 29 years of age. This is a statis-
tical study of 5,000 cases taken at random.
(Chart No. 8)
Here is our business from the standpoint of
diagnosis. The medical and pediatric care is prac-
tically all accounted for in the hospital visits, as
you know, about 23 per cent; maternity in the
neighborhood of 37 per cent, including the com-
plications and circumcisions; tonsillectomies ac-
count for about 17 per cent; female genital sys-
tem, 8 per cent; abdominal operations, less than
5 per cent; skin, less than 3 per cent; and muscu-
loskeletal, less than 1 per cent. It seems that we
have had a very small number of accidents. The
other procedures amount to 5 per cent and these
include the direct billing for laboratory and x-ray
service.
(Chart No. 9)
Every month we take the bills that come in
that month and roll them back into the month
that the service was rendered, and I think this
chart very clearly depicts the volume of the Pro-
gram. In October, for example, we received 150
bills for service rendered in December 1956. We
think it is going to be 18 months before we know
positively what the Program is going to cost, but
I think there is no question at all that the Pro-
gram is going to run close to 6 million dollars a
month. You can see that we are up to 5.5 million
in April, May and June. These bars are split
between hospital and physicians. When this chart
was prepared, $41,000,000 actually had been paid
out by our office to reimburse fiscal administra-
tors; $21,000,000 to physicians; and $20,000,000
to hospitals. We are running about 4,000 cases
each day in civilian hospitals under this Program;
the average patient stay is about 5.3 for the over-
all program.
(Chart No. 10)
We wanted to look into diagnoses and costs
and selected eight states; Florida is one of these
states. We actually matched physician and hos-
pital claims for this study, which is a terrific
statistical job; the people told me it took 13
separate sortings to compile this study and, as a
consequence, they do not want to do very many
of them. At any rate, we felt the need of this
study, and so we went into it. This study included
8,326 cases and $1,743,349, and so it is possibly
a big enough study to be reasonably represent-
ative. I think it is interesting to see that, in
maternity deliveries, the number of cases corre-
sponds rather closely to the number of dollars.
The number of cases of tonsillectomies is some-
what less a proportion than the dollars involved,
as you can see. The amount which the Govern-
ment paid was $209.39 per case, or a total of
$49.59 per patient day. We must remember that
the antepartum care is in this study. The eight
states used in this study were California, Color-
ado, Florida. Kentucky, Texas, New York, Wash-
ington, and Wisconsin.
(Chart No. 1 1 )
We took all the cases that appeared in this
study more than 45 times and charted them by
cost. Now, remember, this is hospital plus physic-
ians cost. Uterovaginal prolapse was No. 1 at
$508; appendicitis, $335; hernia, $295; hemor-
rhoid, $290; other GYN conditions, $233; mater-
nity deliveries, $224; complications of pregnancy,
$171; respiratory infections, $164; miscarriages
and abortions, $155; gastroenteritis, $132; ton-
sillectomies, $113; all others not listed as many
as 45 times averaged $273 per case.
(Chart No. 12)
In this study we took the over-all program
as of the end of September, and we estimated
how much antepartum care had been included
in the per diem cost of the eight state study to try
to arrive at a more realistic cost per day. We
estimate that the cost per hospital day, eliminat-
ing the outpatient care, is approximately $38.33.
Now we realize that this study can be challenged,
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Volume XLIV
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but. on the other hand, it is the best estimate we
can make at the present time.
(Chart No. 13)
This is a selective study on acute emotional
disorders which was made in May. We were very
anxious to find out what was happening in these
cases. You can see that the majority stayed in
the hospital less than three days, and only a very
small number stayed over 21 days. This study
was made before OUMC Letter No. 8 really got
into effect. The average stay was 7.4 days and
the average cost. $32 a day for this particular
group.
(Chart No. 14)
I do not know whether there are any anesthe-
siologists in the audience or not, but I thought
you might be interested in seeing this chart.
There are so many ways in our schedules of cal-
culating anesthesiology fees that I prepared this
slide showing 10 of them and took it to the Amer-
ican Association of Anesthesiologists meeting in
Los Angeles a few weeks ago. You will notice that
state “A” calculates its fee by $20 for the first
half hour, $7.50 for the next two quarter hours,
and $5.00 for each quarter hour thereafter; state
“B” has $20 for the first half hour, $5, $5, and
$5 for the quarters; it runs on down to state “G”
which has a specific amount for each item; and
another state has, if the surgery fee is under $75,
a flat $15, and if over $75, 20 per cent of the fee.
Another one has 20 per cent of the surgical fee.
plus $5. The American Association of Anesthesiol-
ogists passed a resolution at this meeting to the
effect that they would prefer that anesthesiologists
have a stated fee for each procedure without re-
gard to time. In our new Schedule of Allowances,
which we expect to negotiate with you. we will
allow you to continue any of these methods, but
if you want to go to that fee for item basis as the
American Association of Anesthesiologists would
like to be done, we will negotiate along those lines.
(Chart No. 15)
We sent out questionnaires on this Program
to see what the recipients think about it. Of
course, we were interested in knowing how the
information was getting around. This is the result
of about 200 returns.
Where did you first find out about the Pro-
gram? Sixty-three per cent said from the hus-
band; 13 per cent, from Service publications; 11
per cent, from newspapers, and 11 per cent from
other sources.
Did your physician have the necessary Pro-
gram information? Eighty-four per cent said yes;
16 per cent, no.
Necessary forms? Eighty-eight per cent had
the forms; 12 per cent, no.
Did the hospital to which you were admitted
have the necessary Program information? Ninety-
four per cent said yes; 6 per cent. no.
Necessary forms? 96 per cent said yes.
Did you have a choice between military and
civilian hospitals? Forty-eight per cent said yes;
62 per cent. no.
Were you generally satisfied with the care
you received? One hundred per cent said yes.
(Chart No. 16)
We asked for comments, and 31 per cent were
extremely favorable toward the Program; 7 per
cent were unfavorable, said that the convalescent
period was too short, they should not have to pay
the hospital $25. the forms were too complicated,
and they received less respect than other civilian
patients. Others would like to have more cover-
age under the Program; dental care is always
very prominently mentioned; outpatient pediatric
care, et cetera.
(Chart No. 17)
This is a later study in which we are emphas-
izing more why the patient went to a civilian
facility. Fifty per cent said they resided too far
away from a military facility; 28 per cent said
that the type of care rendered at the military
facility was not the type of care they had to have;
13 per cent said the military facility was inade-
quate or overcrowded; 12 per cent said they just
preferred the care of civilian facilities; 8 per cent
said they liked a particular doctor; and 3 per-
cent said they were emergency cases and could
not get to a military facility.
(Chart No. 18)
In the comments on this second questionnaire.
27 per cent were extremely pleased; there was still
about the same group who want extension of the
Program to dental care, outpatient care, et cetera,
but for the first time, 2 per cent said. “We have
tried your civilian program; we are going back to
military.”
(Chart No. 19)
These are the claims from Florida which reach-
ed our office between 1 1 September and 20 Sep-
tember. I just had them plotted here to see if
they were all bunched in one area; they are not.
It appears that every hamlet in Florida is repre-
sented in that 1 1 days. I think that is significant
also for your own consideration. I notice in Lake
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
837
City there are two cases; in Gainesville there are
six cases; in Starke there are two cases; in Quin-
cy, three cases. Of course, the bulk of the cases
are in Greater Miami, Jacksonville, Pensacola, and
Palm Beach, but I think that is to be expected.
There are not very many in Key West, only 7.
I thought you might be interested in seeing that
you do have a tremendous distribution of cases
in your state.
Dr. Milton has given you a number of statis-
tics which are very much more up-to-date than
any statistics which I have so far as Florida is
concerned. I have some other facts, however,
which I think perhaps you will like to know.
According to the 1956 A. M.A. registry, you
had 4,530 physicians registered in Florida, and
as of 31 October 1957, 1,617, or 35.7 per cent,
have participated in the Medicare Program. Of
the 2,509 special reports we have received from all
the states, 111, or 4 per cent, have been from
Florida. Florida is the third highest in the num-
ber of physicians’ claims paid; California is first;
Texas, second; Florida, third; and Virginia,
fourth. This is for your information.
For maternity cases, your average stay in the
hospital has been 4.7 days; surgical cases, 4.3
days; and medical cases, 7 days. Percentagewise,
44 per cent have been for maternity care; 38 per
cent, surgical; and 18 per cent, medical. You are
running less medical than the country as a whole.
Your average physician’s claim has been
$74.37; the average claim for physicians all over
the “nation, Florida included, is $71.00.
Of the 1,655 physicians who have participated
in Florida, 1,161 have collected less than $500;
233, between $500 and $999; 213, between $1,000
and $10,000; 17 between $10,000 and $20,000; 6
between $20,000 and $30,000; 4 between $30,000
and $40,000; and one, $54,000. (Erroneous.
See Note)
Florida is scheduled to be our first state in the
nation to negotiate the new schedule, and I think
your dates are January 6 and 7. We have worked
diligently during the past year to take the experi-
ence we have had all over the nation, and the
suggestions that have been made by wonderful
committees like Dr. Milton’s, and incorporate
them into a schedule which we can negotiate.
We hope, at least 90 per cent of the questions
Xote: General Robinson apologizes for making the above
statement which was later found to be erroneous because of
faulty machine tabulation. The statement should read:
"Of the 1,617 physicians who have participated in Florida,
1,1.12 have collected less than $500; 245 between $500 and
$1,000; 214 between $1,000 and $5,000; 21 between $5,000
and $10,000; 8 between $10,000 and $15,000; and 2 more than
$15,000.”
which have arisen during the past year will be
thereby resolved. I was able to get two copies
of this new publication before I left Thursday.
You will have your copies within the next few
days. There are a few things which I would like
to mention.
The internists, in particular, have raised a
great many objections to the fact that the
schedule does not include a fee for complete phy-
sical examination. This new schedule will have
such an item; T would like to read it to you.
“ Complete history and physical examination
for a case of a medical nature during hos-
pitalization of adults. This may be used in
lieu of the initial hospital visit. Code 0012,
for medical patients presenting difficult
diagnostic or therapeutic problems. Pa-
tients will often be seriously ill, necessita-
ting a prompt, comprehensive study re-
quiring a complete and detailed, written
medical record. A copy of this record may
be requested by reviewing authorities.”
In other words, if Dr. Milton’s committee has
any question, he can ask you as the billing physic-
ian to please furnish him a copy of that record.
Only one such procedure is authorized per admis-
sion.
This has been worked out very carefully with
internists, but we felt we could not include a
statement they would like to have to the effect
that this item should apply only to the practice
of internal medicine.
There is also a similar item for examinations
for children.
We included a section on psychiatry so that
there would be some kind of a fee scale to pay the
psychiatrists who take care of acute emotional
disorders. It includes initial examination, shock
therapy, insulin therapy, somatic therapy of vari-
ous kinds, and psychotherapy. We have not in-
cluded psychologist’s examination. We went to
the psychiatrists and discussed this very carefully,
and it is their opinion that any case which requires
a psychologic examination is beyond an acute
emotional disorder state and is not included in
the Program.
We have rearranged the Surgery Schedule.
There will be a fee negotiated for what we have
now, except we have stipulated the number of
days of postoperative care, which are included in
the maximum fee. We have also stipulated the
number of posthospitalization visits which are the
government’s responsibility and they, of course,
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HOUSE OF DELEGATES
Volume XLI V
Number 8
are also in the surgeon’s fee. In some areas in
the country, we have a number of surgeons who
just come in and perform the operation and the
general practitioner assumes the postoperative
care. So, we have a fee for surgery only.
There are other changes. As far as the matern-
ity schedule is concerned, we have two methods.
Some of the states like the trimester method of
calculating; others have indicated, and Florida is
one, that they would like a visit basis. We have
provided both methods so that the states can
have one or the other. We, of course, cannot
negotiate both.
I would like to say, after sitting with Ur.
Milton and his committee last night, that I think
Florida physicians are very' fortunate in having
such careful study and care given to their prob-
lems. The majority of the problems arise in the
elective surgery category. We have gone through
this schedule and have marked every item where
questions are arising with an “E”, and we have
advised, in this schedule, physicians, who have
cases needing any of these procedures, to study
them very carefully and if there is any doubt in
their mind, to present them for decision before
they perform the surgery. Actually, none of these
are ever of an emergency nature. I believe.
I am sure that I could talk on and on; it is
a great pleasure. I believe you have a good pro-
gram in Florida; I hope you continue it. You
will have a maximum schedule. Whether you
publish it or not does not matter. I would person-
ally prefer that you do not publish it; I wrould
like you to continue the way you have during the
past, because I think it is much easier for the
county committees and the central committee to
adjudicate whether a claim is reasonable if they
do not have a schedule in everyone’s hands. The
schedule has been negotiated and will be negoti-
ated again as a maximum schedule. I think you
all realize if everybody charges maximum, some-
time somebody is going to question it.
Dr. Roberts: “General Robinson, I want you
to know that I, personally, and the House of
Delegates appreciate your most complete contri-
bution from the government standpoint and pre-
sented in such a friendly manner.”
Dr. Roberts introduced Dr. Kennard.
Dr. Kennard; “Dr. Roberts, Ladies and
Gentlemen: I did not come with any prepared
statement. I would just add confusion if I went
back into the problems of this program. I happen-
ed to be on the AMA task force which worked
with this program from the days following the
passage of the law. I heard the hearings in the
House and Senate concerning this law. I am ac-
quainted with the background of the efforts to
get a dependents’ medical care program before
this law came up. I think this law is probably as
equitable a law to do the job as they could have
gotten. The implementation of the law has been
a little more of a problem, almost, than writing
the law, which is usually true, particularly in this
difficult field. I know, as Dr. Roberts has stated,
that he would like to keep to the issues of the
problem and not get off on extraneous details. I
think the problem is what to do under this law
now that it is here. The only alternative would
be to go back to Congress and get it modified. I
am open-minded to the fact that there are certain
interpretations of the law. I think it is fair to say
that the American Medical Association’s repre-
sentatives repeatedly and to this day did not think
it was necessary to have a fee schedule in order
to implement the law. How this could be worked
out without a fee schedule and protect the interest
of the government was not explored beyond the
possibility of having a full fee schedule, a Sched-
ule of Allowances, as they prefer to call it. This
seemed to the negotiators for the Department of
Defense task force to be the only way in which the
government could determine its costs and ap-
propriate its funds in order to meet this need. I
do think it was the intent of Congress to give a
service. During discussions of the early bills at
the working level between the committees of the
House, in particular, which framed the bill, Mr.
Kilday’s counsel went into the problems of in-
surance. of participation by the service man, of
government programs, and of programs in indus-
try. Out of all this came a bill in which the serv-
ice man participates. As Dr. Robinson has indi-
cated, sometimes he participates more than if he
had an insurance policy; sometimes he partici-
pates less. It was considered to be more admin-
istratively feasible, of less expense to the govern-
ment, a greater service to the man in building
his morale and keeping the program in the proper
frame, to have this type of partly participating
program. I think the way the country has re-
sponded, the medical profession in particular, to
meet this program has been remarkable.
“We had a meeting in Philadelphia following
the Clinical Session. Dr. Milton, Dr. Roberts
and others of your society are probably better
able to discuss the results than I might be, but
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
839
it was a very harmonious meeting. There are still
some states that are not certain how they are
going to contract and work out this program. As
Dr. Milton knows, I am sure, there are a number
of states looking to you to see what you are do-
ing. I will say that many people in other states
are uninformed as to the facts of the case as it
exists here in Florida, or as it exists in certain
other states where the programs are not entirely
of similar pattern. Very frequently, we hear
stories and reports in Washington that come to
us from people who have wrong information. I
think the most important thing is to have the
kind of briefings you have had this morning
which bring to you again, for many of you have
probably had them before, the true state of af-
fairs, the facts as they are actually available now.
I think I should conclude with this and offer my
assistance at any time that any question may
arise, and I congratulate you heartily on having
the type of leadership you do in this program.”
Dr. Roberts: “Members of the House of
Delegates, we are almost finished with what your
Association has prepared for you. We have one
other man I want you to hear from because he
comes from our sister state and I believe you will
see that we are fair; we are trying to give you
both sides of the issue. I would like to introduce
to you now Mr. John D. Arndt, Medicare Ad-
ministrator of the Medical Association of Geor-
gia.”
Mr. Arndt: “Doctors, I am currently the
Medicare Administrator for the state of Georgia.
As you probably found out from the presentation
of General Robinson, we are our own fiscal agent;
that is, there is no three party contract arrange-
ment. The contract is strictly between the Medical
Association and the Department of the Army.
We receive all the claims forms; we process them,
compile all the data, have our own Review Board,
or Mediation Committee, and mail the checks or
make disbursements to the doctors. There is no
Blue Shield tie with the plan in Georgia. Our
plan is mechanically working very well in Geor-
gia, and we are satisfied we have a good arrange-
ment from that viewpoint.
“With the forthcoming renegotiation, we are
not satisfied with the fixed fee schedule — the
maximum fee schedule. There are several reasons
for this dissatisfaction: I think the primary rea-
son is that the maximum fixed fee schedule is
leading up to political or socialized medicine. For
this reason, although the patients at this time are
free to choose a physician and the physician has
complete freedom of choice as to whether he
wishes to attend a particular patient or not, as the
base of people on a full coverage, national, fee
schedule type plan expands to include a larger
element of the American population, this free-
dom of choice will be removed from the doctors’
hands. There will be so many patients under this
type of plan that the doctor will no longer have a
choice of accepting or rejecting a patient under it.
That is what I consider the long run aspect of the
plan and its end result. Currently, there are bills
in Congress or committees to expand the Medi-
care full service coverage plan. One bill, I have
been told, will include an additional 13 million
people in that type of plan. The progress I think
will continue in this direction. As you can see, 13
million people, with the existing people on the
plan, will be about 15 per cent of our population.
As this increases, you will lose your freedom of
accepting or rejecting a full maximum fee sched-
ule type plan.
“Georgia has not formulated its action on it
at this time; that is why I am down here attend-
ing your meeting. 1 want to get some additional
ideas and see what Florida is doing. We consider
Florida the leading state in the Southeastern area,
and I am down here for your guidance on the
problem.
“I was very much interested in the statistics
that General Robinson presented on the payments
to the individual physicians. 1 should like to state
that the trend is the same in Georgia. I would
say that 125 doctors out of our 2,900 doctors re-
ceive 80 per cent of the $135,000 we disburse a
month. These doctors are the ones who are not
going to want this plan changed. I think, how-
ever, the important thing to consider is the long
range aspects of it. Let us not sacrifice the dollar
in the hand for later independence.
“Recently I conducted a survey of the 48
states to find out what other states’ current
thinking on the problem is. T received answers
from 41 of them. The study produced some in-
teresting statistics. Seven states indicated that
they are not satisfied with the maximum fee
schedule. They did not have at the time a counter-
proposal other than merely stating they wanted
to eliminate the fee schedule; they wanted to
maintain our doctors' independence, or wanted an
indemnity type schedule. That is about the pic-
ture in Georgia at this time.”
Dr. Roberts: “I thank you, Mr. Arndt, for
840
HOUSE OF DELEGATES
Volume XI. I V
Number 8
those remarks. I am sure the House of Dele-
gates appreciates your contribution.
Dr. Roberts asked Dr. Kennard and General
Robinson to take seats on the rostrum for the
question and answer session.
Dr. Roberts: “We put on our agenda a few
items here, six in all, as a guide for the action
of this House of Delegates. Without going into
anything further, the House of Delegates repre-
sents the Florida Medical Association and we owe
our members a great deal. We owe every member
of the Florida Medical Association wise decisions
and we have to have them in the records. We
want them down in black and white. I hat is why
we listed these items as a guide. We may not have
to use them, but I think it would be well to go
along with them.
“The first thing that I desire to have this
House of Delegates decide is: Shall this Associ-
ation continue to be a party to a contract with
the Office for Dependents’ Medical Care? If we
can get that settled, I think our constituents
back home, whom we are representing, will be
satisfied with our decision. Let us get that done
now, and if I can hear a motion on that, I
would gladly entertain it.”
The Chair recognized Dr. Richard F. Sinnott,
delegate from St. Lucie-Okeechobee-Martin Coun-
ty Medical Society.
Dr. Sinnott: “I represent three counties, but
only 27 doctors. I have come up instructed to
mention first that our criticism of the Medicare
program does not ignore our admiration for Dr.
Milton, nor do we think that General Robinson
means to socialize medicine. We believe they have
endeavored to draw the best out of a bad situa-
tion. We think the situation is bad. Our criticism
is of the whole philosophy of the Medicare pro-
gram. I have been instructed to ask, how can we
defend the granting of a full service contract to
a full colonel and then deny it to a $125 a week
telephone lineman? Second, why can there not be
purchased by the government a major medical ex-
pense policy for ranks earning above the Blue
Shield field? Further, I have been instructed to
present this motion:
Resolution*
Medicare
WHEREAS: The Florida Medical Association is
for (1.) Continuing to provide medical care for the
dependents of men serving their country; (2.) Con-
tinuation of the free enterprise system in medicine
with the right of a physician to set a just value on his
own services, and (3.) The payment of a just salary
to service men — one which would permit them to pro-
* Not Approved
vide essentials for their families — including medical
care.
WHEREAS: The Florida Medical Association is
against: (1.) A fixed fee schedule as unjust, destruc-
tive of enterprise, by definition rigid and in practice
unchangeable; (2.) A system which gives its recipients
an illusion of “something for nothing;’’ (3.) A sys-
tem which creates division within the profession al-
ready evident in committee and within the House;
(4.) A system spelling out and enumeratng (like
David taking the census) that which cannot be num-
bered “by the eighth inch”, and (5.) A system pre-
viously designed by bureaucratic intent as essentially
invasive and intended to rapidly comprehend the en-
tire population.
HE IT THEREFORE RESOLVED: (1.) That the
Florida Medical Association fulfill in good faith its
present contract; (2.) That the Florida Medical Asso-
ciation enter into no new fixed fee contract with the
Department of Defense; (3.) That the Florida Medical
Association notify the proper authorities of its intent
regarding non-renewal; (4.) That the Florida Medi-
cal Association assure the appropriate parties that its
members will continue to provide good medical care
to dependents and will submit, for the time being,
individual bills to the Blue Shield as fiscal agent, and
(5.) That the Florida Medical Association notify the
Senators and Representatives from Florida that men
serving their country in the Armed Forces deserve
a just wage permitting them to provide their families
the essentials including medical care.
Respectfully submitted,
Adrian M. Sample, Secretary
St. Lucie-Okeechobee-Martin County
Medical Society
“I am further instructed to read back to Dr.
Roberts what he sent us to read, a quote from
George Washington: ‘If to please the people we
offer what we ourselves disapprove, how can we
afterwards defend our work? Let’s raise our
standards to which the wise and honest can re-
pair, the rest is in the hands of God.’ ”
Seconded by Dr. Cecil M. Peek, of Palm
Beach.
Dr. Turner Z. Cason of Duval: “I would like
to rise to a point of order. I understand this to
be a motion on which, if we vote, we can get up
and go home, because he proposes to answer all
the questions and settle every difficulty. It is
my understanding you asked for a motion on a
specific item — No. 1. Now if we are voting on
the whole matter, we can say goodbye and go on
home. It seems to me rather out of reason, to say
the least, to put in one motion the whole phil-
osophy unless we are ready to vote on the whole
subject at one time; if so, I am out of order. But
I think that the motion is out of order at this
time.
Dr. Robert E. Zellner of Orange: “Mr. Presi-
dent, before there is any discussion, it seems to
me you will have to rule on this point of order.
This is so comprehensive that it is not a motion;
it is a series of motions. It seems to me that, be-
fore we can vote, you are going to have to rule as
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
841
to whether this motion is germane to the question,
and, second, decide on whether we will vote on
any parts of this motion. Before further question-
ing, I again ask for a point of order.”
Dr. Jere W. Annis, of Polk: "I move that this
be tabled.”
Seconded by Dr. Cason.
Motion carried.
Dr. Roberts: “Now, No. 1 on your agenda.
Shall I read this again? The Chair would like to
entertain a motion: Shall this Association con-
tinue to be a party to a contract with the Of-
fice for Dependents’ Medical Care?”
Dr. Langley: “I move that the Association
shall continue to be a party to a contract with
the Office for Dependents’ Medical Care.”
Seconded by Dr. Douglas and Dr. Bowen.
Dr. Sinnott: “I would like to ask someone to
defend the idea of a contract when General Rob-
inson mentioned that a noncontractual arrange-
ment has been working so well in Ohio.”
General Robinson: “I have asked to make a
comment. I have told you that the program is
working well in Ohio and Rhode Island and that
our relations with individual physicians are good,
but the medical associations in these two states
have nothing to say about the standards of medi-
cal practice except as applied generally. They do
not take an active part in the management of the
program and they have nothing to say about
whether or not the fee is reasonable. I do not
think it is good for the state medical associations
to take no active part in this program.”
Dr. Kennard: “I would like just for informa-
tion— this is just a fact — to say that while Ohio
does not have a contract, there is a contract in
existence with Mutual of Omaha to pay the bills,
to act as fiscal agent in Ohio. The work that is ac-
complished by Dr. Milton’s committee and by the
committees of other states and their county com-
mittees, is being done by General Robinson’s of-
fice. It’s a fairly large job for his office. If other
states relinquish their own contract and turn it
over to the government and they form a contract
with someone else, it will just build up this
bureaucracy in General Robinson’s office to do
the work of deciding whether the physician’s fee
is equitable and just, whether he makes a fair
claim. The feature of this whole thing is whether
you want to keep control at the state level, or
whether you want to pass this control to Wash-
ington. Under the bill, as it exists today, General
Robinson is charged with furnishing this care
through civilian sources and he has to make a
contract with somebody.”
Motion carried with Dr. Sinnott dissenting.
Dr. Roberts: “We will continue some kind of
agreement with the Office for Dependents’ Medi-
cal Care.”
The Chair recognized Dr. W. Dean Steward
of Orange County Medical Society.
Dr. Steward: “I move that the House of
Delegates reaffirm its action of last May and
continue to take care of dependents on a fee for
service as previously agreed by the House of
Delegates; also, that the contract be renegotiated
yearly and that the contract may be terminated
on 30 days’ notice by either party.”
Seconded by Dr. Madison R. Pope of Hills-
borough.
Dr. Karl Hanson of Duval: “I would like to
know whether that means that there will be no
renegotiation of the maximum fee schedule which
has been used during the past six months?”
Dr. Herschel G- .Cole of Hillsborough: “As
Chairman of the Hillsborough County delegation,
I have been instructed to follow a similar pro-
cedure and recommend that negotiations be car-
ried on and the contract be renewed without the
maximum fee schedule, and in addition that the
psychiatric group be included under this program
as they have not been in the past. We are in favor
of renegotiation without a fixed fee schedule.”
Dr. Burns A. Dobbins Jr. of Broward: “In-
asmuch as Broward County had a little some-
thing to do with this no fixed fee last time, I think
I should say something at this time. A little
knowledge about a problem can create much con-
fusion. Many of you yesterday at the Blue Shield
meeting realized that improving your knowledge
of actual conditions helps understand the problem.
I wish that I could express myself as eloquently
as Bob Zellner did in saying that he was wrong
18 months ago about Blue Shield. I wish I could
say how wrong I was five months ago. I did not
understand all of the details of this contract, and
our county society did not last spring when we
brought it up to the House of Delegates. We were
against set fees and we thought it could be done
much cheaper otherwise, because we knew, as
you know, that some of the fees are much higher
than the average fee in the community. So we
brought the matter up.
“Actually, as I understand the problems now,
the Office for Dependents’ Medical Care intended
842
HOUSE OF DELEGATES
Volume XU V*
N o kf BEK x
all the time that the schedule would be maximum
fees that would be allowable, that the state could
adjudicate and pay without question; it was not
intended to be the fee that was charged because
it is their intent that this be carried on on a local
basis and settled on a local basis in so far as
possible, but that the maximum fee schedule is so
that we can pay locally. Now that does not mean
that there will not be greater fees paid if a special
report is submitted and the extra charge justi-
fied. The government will pay more than the
schedule and has paid more in the past, but as
any of you know, the government cannot enter
into a contract agreeing to pay just anything; it
must know what the maximum will be that it
will pay without question. That is the reason for
the maximum fee schedule.
‘ I wish that Medicare could have a full day
just like Blue Shield did yesterday, so that all
of us could understand some of these problems a
little bit more. The prime thing is that we want to
control this as much as we can. We can do nothing
about the law. We cannot say what is covered: the
law specifically states what will be taken care
of; Congress has taken care of that. It is up to
us to try to represent the members of the Florida
Medical Association to the best of our ability
and see that their interest is taken care of. If we
do not have a fee schedule, whether we want it
or not. a schedule will be imposed at some level.
If we have a schedule that we negotiate. w7e can
do the membership a much greater service than
we can by going into this thing blind and saying
we will charge what we please."’
Dr. Samuel M. Day of Duval: <-I would like
to ask a question. When this matter came up last
spring, Dr. Milton and I were the only ones that
threw out a word of caution: I withdrew mine
later when it seemed that we could have a chance
to prove a principle and allow the doctors to
charge what they please. I found that I was think-
ing along different lines from what others were
thinking. Certainly the information we sent out
had a hint of what we thought or a direct state-
ment of it. Our feeling was that if the doctors
went along charging lower fees for the low income
groups, which represent about 85 per cent, ac-
cording to the way we are supposed to do with
Blue Shield, and our private practices, then there
would be some money left to charge the generals
and the colonels more. Now, it turned out that it
did not work because we did not do that, and
then we find that some groups thought that the
big counties were supposed to charge more and
the little counties less; so that is another reason
it did not work. There are two points there indi-
cating why it did not work. We did not go along
completely with it with the sincerity which we
thought we might. 1 am not sure that it could
be worked in that manner now. I would like Gen-
eral Robinson's answer to that — if we charged
the lower income groups less, could we not charge
the higher income groups more? Indiana has a
plan whereby its over-all figure is supposed to
average out. Say. an appendectomy should aver-
age at $150. If it is more than that the Medical
Society of Indiana is supposed to pay the differ-
ence, and it is administering the plan. So, if we
could have something where we could average out,
it might work even better.”
Dr. Zellner: “I would like to express a thought
with reference to Dr. Steward’s motion. In the
first place, I do not think Dr. Steward disagrees
with anything that has been said with reference
to the fee schedule. We need not kid ourselves
about this; irrespective of whether we vote for it,
there will be a fee schedule. If we do not negotiate
it. General Robinson will draw one up. In other
words, as a taxpayer I would not be willing for
the government to buy shirts on a basis on which
it had not negotiated a per unit cost. It does not
make sense. The sense of Dr. Steward’s motion,
as I understand it. is to continue the status quo.
We have a fee schedule, whether you realize it
or not. and we are having to use it. The im-
portance of Dr. Steward’s motion, I think,
is this: If we negotiate a fixed fee schedule and
publish it. everybody in the state is going to
charge maximum fees. If we have a fee schedule
and do not publish it. wdiich is w7hat we have
now, and then send back the fees that do not
conform to the schedule, then it leaves the matter
in the hands of the local county medical society
and the state, wThich I think is most important.
It keeps the control where it belongs, not in Wash-
ington. not in Jacksonville, but in the local
county society. As I understand Dr. Steward's
motion, therefore, he wants to continue the same
situation which we have, in which we will have to
negotiate a fee schedule, changing various items
in it. but it will not be published. That seems to
me the most sensible approach, to continue to
handle this matter on the lowest possible level.”
Dr. James L. Anderson, of Dade: “I have
been requested to speak about the neuropsychi-
atric schedule. It is not true that wre are complete-
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
843
lv eliminated from participating in the Medicare
program. I think it is that the statute regarding
the compensation of neuropsychiatrists is some-
what unclear and ambiguous. It states that we
can take care of acute emergencies. I think that
it was the intent of the authorities involved to
avoid prolonged hospitalization and prolonged
psychotherapy, in so far as neuropsychiatric ill-
nesses are concerned. The program, however, is
not realistic in that it does not recognize the fact
that about 80 per cent of our acute neuropsychi-
atric cases really turn out satisfactorily at the
present time; that is, the patients are able to
return to their homes and resume normal life.
The few cases that I have had referred to me by
Medicare have mostly been suicidal attempts
necessitating shock therapy. Now, under strict
interpretation of the law the period of hospitali-
zation in such cases would be so limited that the
psychiatrist would be in the position of taking
care of the first few' days of treatment and not
being allowed to follow through on that type of
case, whereas, if the patients could stay a few-
more days in the hospital, they probably would be
over their depression entirely and able to go home
a well man or woman. Actually, in practice what
happens is that the brass just stated that the
emergency was for that length of time and more
or less told the hospital to pay the hospital bill
for about four weeks; so we treated the patient
until she got all right. Strangely enough, mental
attitudes concerning neuropsychiatry have not
improved to the point of burdening us with Medi-
care as far as the Army brass is concerned. For
some reason or other, when we get visits from
top echelon officers, and we do occasionally, the
care definitely does not come under the Medicare
program as far as the officers are concerned.
They seem to want no record whatever made that
it has to do with Medicare.”
Dr. William M. Straight of Dade: “I would
like to ask if the Department of Defense is ada-
mant against the concept of paying a little higher
fee for the 1 per cent who have an income above
$9,000? I know from being in the Navy for
three years, that when the brass gets sick, they
get a better room in the sick officers’ quarters
and frequently have a private orderly or nurse
waiting on them. They segregate them in the
service. Why will they not pay us a little more
in private practice?”
General Robinson: "Dr. Roberts has asked
me to answer. I might say that at the time of the
development of this program, the question w-as
asked of the Congressional Committee as to
whether or not there should be any leeway on
charges to those in the higher ranks. I have been
told by those w-ho had to do with the development
of the program that the Congressional Committee
definitely made the statement that it wanted to
run this program straight across the board for the
majority of the people and that it wanted to in-
clude all ranks under the same provisions. Actual-
ly. it amounts to so little that it is hardly worth
thinking about.
“Dr. Roberts, if I may, I would like to dis-
cuss the neuropsychiatric situation a little, too.
Now-, you know already that the law says that
care for neuropsychiatric diseases is not included.
It. however, also says that we will take care of
all kinds of acute emergencies, and we do know
that a great many of the acute emergencies occur
in the neuropsychiatric field. So, we have lumped
those all together and called them acute emotional
disorders, and we have stated that acute emotional
disorders are treatable for 21 days. This 21 days
was not arrived at by any arbitrary means. A
conference was held including all of the members
of the group still left in Washington who had to
do with the preparation of the Directive, the psy-
chiatric consultants of the Army, the Navy, the
Air Force and the Public Health Service and Dr.
Overholser, who is the Director of St. Elizabeth’s
Hospital. We spent all afternoon devising a
means of taking care of acute emotional dis-
orders, and what came out of that meeting was
ODMC Letter no. 8, with which I am sure many
of you are familiar.
“We provided for extensions beyond this 21
days for three reasons. First, if the patient were
having to be committed and her sponsor had to re-
turn from a battleship or Korea or some place
which required more time than 21 days, an ex-
tension could be made. Second, if the patient were
going to get well and be able to go back and as-
sume her duties if she were kept a week or two
weeks longer (a reasonable length of time), this
extension could be approved. And the third reason
was if there were difficulty in getting her into a
state institution. We recognize that sometimes it
takes longer than 21 days to get a patient trans-
ferred to the state institution. Now, we put the
responsibility on the hospital administrator to get
this additional authority.
"I know, you think you should not have to
get the additional authority, but honestly, we
844
HOUSE OF DELEGATES
Volume XLIV
Number 8
have to keep the program so it will pass the Comp-
troller General, and this is important. Conse-
quently, we want the payments to be sound and
to have approval so that they will not be ques-
tioned. The number of physicians who have fur-
nished information for extensions is too few; they
are just not doing it to the extent necessary. And,
I would like to prevail upon all of you who have
anything to do with the treatment of those afflicted
with acute emotional disorders please to furnish
necessary information when extensions beyond 21
days are indicated. We are changing the method
of requesting extensions. We are leaving the re-
sponsibility with the hospitals, but we are letting
the hospitals come direct to our office. Before
we can approve one single day past 21 days, we
have to go to all four Surgeon Generals and de-
termine whether the patient can be taken in one
of their facilities. That is just required. Psy-
chiatric care is unauthorized care, and I think
all psychiatrists, at least those to whom I have
talked, think that even the 21 days, in a great
percentage of cases, extends long over the period
of an acute emotional disorder. I had one bill
from a psychiatrist in Illinois, for example, who
said he treated the patient for 40 days but that
the government owed only for three days because
her acute emotional disorder terminated in three
days, and that the patient owed for the rest of
the care.
“As soon as the new contracts are in effect,
we will allow the hospital administrator to come
direct to our office for extension authority in or-
der to save time. We will try to have the answer
back to the hospital before the 21 days is over.
We, of course need the cooperation of the phy-
sicians caring for these patients.”
Dr. H. Phillip Hampton of Hillsborough:
“May I ask what you did in that case in which
the doctor only charged you for three days and
the patient for the rest of the time?”
General Robinson: “We paid for the three
days; that is all he charged us for.”
Dr. Hampton: “Was he justified in charging
the patient?”
General Robinson: “Oh yes; it was unauthor-
ized care. A physician is supposed to charge the
patient for any care he renders which is unauthor-
ized.
“Now, on the Indiana plan, which has been
discussed, I have been to Indiana and I have
seen how the plan is working. Actually, the Medi-
cal Society of Indiana had not approved many
bills, when I was there, over the Schedule of Al-
lowances. It had had several under the Schedule
of Allowances. But, it has encumbered itself
with a complicated bookkeeping system. For every
item in the Schedule, it has to maintain a card,
and it has to show the charge that it approves.
It does not send in special reports. If, for any
reason, it has a charge over the schedule, it may
pay, but another charge which is less must have
been paid in order to maintain a balance for each
item. You can understand the necessary book-
keeping. I am sure that the Florida volume is so
large that such a system could not be followed
here with any reasonable staff.
“Now, then, as to whether or not you publish
the schedule, as I said in my remarks, we have
left this decision entirely to the states. The Sched-
ule from the very beginning has been a maximum
schedule. There are a sufficient number of doc-
tors in Florida, and in all of the states, apparently,
who are willing to take these cases, and I think
this is very clear when 36 per cent of your phy-
sicians in Florida have already accepted cases.
“When the dependent goes to the doctor, she
should ask him if he will take her case under the
Dependents’ Medical Care Program. If the doc-
tor does not desire to accept the allowance, we
think he should refer her to someone who will
take her case and give her good service. On the
other hand, you may have more than one Sched-
ule of Allowances if you desire. We made this
known before the first negotiation. If you want to
have six maximum Schedules of Allowances to
cover various areas of Florida, we would not op-
pose. No state, however, has submitted such a
plan. It is probably impossible to cover what
specialists will get, what general practitioners will
get, what resort area physicians will get, what
physicians in rural areas will get, all in one Sched-
ule of Allowances. Therefore, it was thought that
the best thing to do is to have a reasonably liberal
maximum Schedule of Allowances and let you con-
trol that which is normal for individual physicians.
Those physicians who are submitting bills which
you know are not normal fees in their practice,
we hope you can somehow control. This cannot
be done by our office because we do not have
the knowledge.”
Dr. Kennard: “I concur with what General
Robinson said about the intent of the committees
that considered the problem of the lower income
and the higher income military personnel. Mr.
Kilday, the chairman of the committee, for whom
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
845
this bill is often named, recognized that this would
create a question for the profession. It was, how-
ever, the consensus of the members of the com-
mittee when it was considered that they could
not make an exception. There has been for 150
years or longer, since the first military establish-
ment had a form, some form of care for dependents
of military personnel. The earlier bills presented
to Congress, which we opposed very vigorously
from 1945 on, were bills to provide care completely
in military facilities, to expand military hospitals
and the military medical corps to take care of all
military personnel in those facilities. One of our
biggest objections was the fact that they were
drafting doctors, and might have to for some time,
or at least encourage them to come in the service
to take care of a large number of dependents. So,
we asked them to put this extra work load, this
40 per cent for which this bill was designed, into
civilian facilities on a basis similar to that pro-
vided in military facilities, and that is where your
leveling out influence counts.
“Personally, having been a military man for
26 or 27 years, I think the brass, or the majority
of them, will go to military facilities where they
get special care. There are going to be exceptions
to this. I know that many of you have had col-
onels’ and probably generals’ dependents come to
you for care, but these are the exceptions.
“I do not think you have very much of a prob-
lem here except on the basis of principle. I can
say just one word about principle. This bill, this
program, actually has, and I will not categorically
say it is not going to have, some influence upon
other forms of medical care. It was, however, de-
signed to accomplish one specific purpose and in
this respect it is different from the indigent care
program, which is a big problem, the federal civil
employees program which is coming up in Con-
gress, which is on another basis and is a different
problem, and the Forand bill, which was referred
to by one of the earlier speakers. I surely hope we
get out and fight the Forand bill with everything
we have because here we really have the first step
in socialized medicine. In this proposal, we have
a compulsory health insurance plan for the 1,3
million over age 62 or 65, and it can be extended.
These are different programs and they should
not be confused with this one. That is the prob-
lem, not to bring this program into the picture
and focus attention upon it as a solution to these
other problems, because it is not the same thing.”
Dr. Robert L. Tolle of Orange: “Bascially,
I am opposed to closed sessions and being kept
ignorant. I see no good reason why the schedule
should not be published so that we will know
where we stand. That does not prevent those who
would charge less, if they are basically honest
anyhow, from charging what they would normally
charge. I am heartily in favor of knowing where
we stand in regard to what is considered an
equitable fee as far as the Defense Department
is concerned.”
Dr. Henry L. Harrell of Marion: “Since the
figure was quoted that about 97 per cent of us
kept using this fee schedule after July 1, I won-
der if all of our members would not like to have
this maximum fee schedule kept published and
also would it not take much load off our state
association and its constituent members?”
Dr. Anthony C. Galluccio of Broward: “We
know there is free choice of physicians. Now
with reference to the large amounts paid to the
small number of physicians, is there any explana-
tion for that other than physical proximity of phy-
sicians to large numbers of Medicare dependents?”
General Robinson: “If I understand the ques-
tion. are you referring to the ranges that have
been paid?”
Dr. Galluccio: “Yes.”
General Robinson: “I do not know where they
are located. Sir, nor who they are. The information
was obtained from cards punched by Blue Shield
and furnished to us. We do not have the names of
the physicians to compare with the card numbers.”
Dr. Straight: “At the risk of being repetitious,
T would like to talk a little more about getting
a different fee schedule for those people in the
services who have incomes ranging above $4,300.
I do not think there are many people in this
room who are deluded to the point that they do
not believe this is the beginning of a gradual
socialization of medicine in this country. If, as
time goes on and more and more employees of the
government get pulled into schemes such as this,
which I think we will have to accept gradually be-
cause we will have no choice, there will still
be some of the poor who do not work for the
government whom we will take care of with very
h'ttle or no remuneration. At present, we make up
the loss we take on these charity patients or near
charity patients by better fees from those who
can afford to pay. As the present pattern ex-
pands into more and more of a social system, we
will not have that source to fall back on to recoup
846
HOUSE OF DELEGATES
Volume XLIV
Number 8
our losses. 1 still think that some effort ought to
be made to get the provision in our agreement
that for those people who have a better than aver-
age income should pay a little higher for our ser-
vices, if only as a pattern or policy for the future
because it seems this is only part of a program to
change us gradually to government physicians.”
Dr. Hampton: “I think it is time to ask
for the question, and in order to answer some of
these remarks that have been made, I believe the
best economic system of medical payments for the
physicians must be the one that provides the best
medical care for the patient most economically.
The crux of the matter as to whether this plan
is going to lead to socialized medicine or not is
whether the civilian care that these patients have
the freedom to choose will provide better medical
care more economically. I would, therefore, like
to ask three questions of General Robinson to
determine whether perhaps the law is so rigged
that it will not favor civilian medical care. 1.
Why is the patient not required to pay the first
$25 of hospital care costs in military hospitals?
Is this $25 payment fixed by law or by regulation?
2. Are there any estimates of the cost of depen-
dents’ care in military hospitals? 3. What is the
percentage of dependents hospitalized in civilian
hospitals at this time as compared to those hos-
pitalized in military facilities? I realize that this
may be off the motion at this time, and if you
think it would be better for these questions to be
asked later, I will certainly understand.”
I)r. Roberts: £‘I will have to rule that they are
to be answered later.”
Someone asked: ‘ Does that include nonpubli-
cation of the list?”
Dr. Roberts: “That is not in the motion. I
want to ask Dr. Steward if he intended to include
in his motion item No. 4 on the agenda: 'If no
fixed fee is to be in effect,’ in other words as we
are going now, status quo, ‘shall the Association
accept the government’s policy of adhering to a
maximum fee schedule?’ The status quo would
be what we are doing now. That would be in or-
der in your motion?”
Dr. Steward: “At each renegotiation, if the
government is going to say that this is a maximum,
each of these cases would have to be considered
individually for each area in my opinion. I think
it should be done at the county level.”
Motion was read again.
Motion carried.
The Chair recognized Dr. Steward.
Dr. Steward: “I move to empower the Medi-
care Committee to renegotiate a fee schedule as a
guide for state and county committees to use in
going over the fees submitted.”
Seconded by Dr. Zellner.
Dr. Gretchen V. Squires of Escambia: “I
would like to ask Dr. Steward if he would con-
sider an amendment to that in which the state
schedule be subdivided on the basis of districts
for easier use by the local Medicare committees,
since there are such wide variations in fees in
various sections of the state.”
Dr. Roberts: “Do you accept that. Dr. Ste-
ward?”
Dr. Steward: “No, sir, because what will be
set up will be a maximum schedule. Each local
committee in each district is supposed to adjust
the fees according to what is generally charged
in that area. I can not see where separate sched-
ules would be necessary.”
Dr. Melvin M. Simmons of Sarasota: “I would
like to ask Dr. Steward if he will accept substitute
wording to make that a ‘maximum schedule of
allowances’ rather than a fee schedule — to change
the wording to a 'schedule of maximum allowances'
as a guide?”
Dr. Steward: “I accept that.”
Dr. Day: “I would like to clarify a little bit
— if an individual doctor writes the office for a
copy of this schedule, are we to give it to him?”
Dr. Roberts: "How can you refuse?”
Dr. William R. Ploss of Monroe: “I believe
the proper answer to an individual requesting
such a fee schedule would be to refer him to
his own county society, if those copies are avail-
able on a local level.'’
Dr. Day: “That is what we would like to
have clarified.”
Motion carried.
The Chair recognized Dr. Dobbins.
Dr. Dobbins: “My county has asked me to
introduce this resolution.”
Resolution
Local Medicare Committees
WHEREAS: It is the intent of the Florida Medi-
cal Association that medicare fees be determined and
administered on a local basis.
BE IT RESOLVED THAT: The Florida Medical
Association urge each of its component county societies
to establish a strong local committee which will ac-
quaint itself with medicare and administer medicare
affairs on a county basis insofar as possible.
BE IT FURTHER RESOLVED THAT: In the ab-
sence of a local committee the Florida Medical As-
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
847
sociation empower its Medicare Mediation Committee
to determine fees based on local standards.
Respectfully submitted,
Garland M. Johnson, Secretary,
Broward County Medical Association
“I move the adoption of this resolution.”
Seconded by Dr. Jack L. Wright of Dade.
Dr. Sinnott: “As a member of a small county
society, I would like to object to any coercive
instructions from the state society to a county
society.”
Dr. S. Carnes Harvard of Pasco-Hernando-
Citrus: “I do not see from this resolution where
these local county levels are going to set up fees
for that particular small county or large county;
I do not see where that would be equitable.”
Motion carried.
Dr. Roberts: “Next, we must select represen-
tatives for the negotiation of a contract in Janu-
ary. I want you to know that is soon. How shall
we go about it?”
Someone asked: “Who is the present com-
mittee?”
Dr. Roberts: “John Milton.”
Dr. Milton: “As I told you, I did not want to
be chairman of the negotiating team this time.
According to regulations already sent out by
ODMC, there will be two negotiators paid by
ODMC. Any others will have to be paid by the
state association.”
Dr. Zellner: “I can appreciate Dr. Milton’s
desire to get off this committee, but this is still
a new baby, and I do not see how we can afford
to let him go. It seems to me, therefore, that it
is a foregone conclusion that we are going to have
to ask him to do it again. Now there is one item
that needs more thought, and that is the medical
section of the schedule. If nominations are in or-
der therefore, I would like to nominate Dr. Donald
Marion as the second member of the negotiating
team, if for no other reason than to have him learn
how this is going so that if Dr. Milton insists on
quitting, we will have another good man to carry
on.”
Dr. Hampton: “I second both nominations.”
Dr. Roberts: “Do I get your nomination
straight, Dr. Zellner? Do you presume that Dr.
John Milton has been nominated?”
Dr. Zellner: “I presume he has no choice.”
Dr. Roberts: “Are there any other nomina-
tions for chairman of this negotiating team?”
Someone asked: “Who is nominated?”
Dr. Roberts: “Dr. John Milton.”
Dr. Hampton: “I move that nominations be
closed.”
Seconded by Dr. Dobbins.
Someone in the audience said: “That was not
chairman, was it? Dr. Zellner just nominated
two men for the nominating team.”
Dr. Roberts: “Will you give the Chair the
prerogative to appoint him?”
Dr. C. Robert DeArmas of Volusia: “Is it
possible to have more than two on that team?”
Dr. Roberts: “Two only will be paid by the
government. You can have as many others as
you want.”
Dr. DeArmas: “I would like to nominate Dr.
Judson Graves.”
Dr. Roberts: “Did you understand Dr. Mil-
ton’s remarks? If you have more than two nego-
tiators, that the Florida Medical Association will
have to bear the expense?”
Dr. Hampton: “I rise to a point of order.
There was a nomination on the floor that has
been seconded that after the first two nominations,
nominations be closed. I would suggest that we
vote on that and then if there are additional nom-
inations they can be acted on.”
The Chair called for a voice vote which was
inconclusive. Dr. Roberts then called for a
standing vote.
Motion carried.
Dr. Hampton: “I would like to suggest that
if anyone wishes to nominate other members to
the negotiating team at their own expense or at
the Florida Medical Association’s expense, that
be done.”
Dr. Roberts: “I would be glad to entertain
such a motion, but if you make a motion, you
should stipulate whether the FMA pays or whether
the man himself pays. The Board of Governors
has to know these things.”
“Are there any other nominations?”
Dr. DeArmas: “I would like to nominate Dr.
Judson Graves of Jacksonville to go at his own
expense.”
Dr. Herbert W. White of St. Johns: “I would
like to nominate Dr. Burns Dobbins of Broward
County.”
Dr. Steward: “If it is possible to amend this
motion, I would like the Florida Medical As-
sociation to send at least one of these men. I
do not think it is fair to nominate a man and
ask him to pay his own expenses.”
Dr. Roberts: “Will you accept that amend-
ment?”
Dr. DeArmas: “Yes.”
Dr. Jere Annis: “Before we keep nominating.
848
HOUSE OF DELEGATES
Volume Xf.IV
Number 8
I think we should decide how many we want on
this negotiating team. Let us set a limit.
Dr. Cecil Peek: “I nominate Dr. Leo Wach-
tel.”
Dr. Zellner: ‘‘It seems to me some decision
should be made as to how many are going. If
we can amend this motion once more. I would
like to amend it that we send one more to be
elected from the ones nominated, expenses to be
paid by the Florida Medical Association.”
Dr. Walter E. Murphee of Alachua: ‘‘I move
that Dr. Zellner’s motion be a substitute motion
so that we can vote on it first.”
Seconded by Dr. Hanson.
Motion carried.
Dr. Roberts: “Dr. Zellner, will you clarify
the motion that just has been passed so that
everybody will understand.'
Dr. Zellner: “The motion was that we send
one additional negotiator whose expenses will be
paid by the Florida Medical Association, to be
selected from those nominated.”
On motion, duly seconded and carried, nomina-
tions were closed.
Dr. Squires asked for the specialties of the
nominees.
Dr. Roberts: “Dr. Wachtel specializes in dis-
eases of men, women and children; Dr. Dobbins
specializes in diseases of those under 15 or 12;
and Dr. Judson Graves is a radiologist.”
The Chair asked for a standing vote for the
nominees:
Dr. Leo Wachtel — 19
Dr. Burns Dobbins — 46
Dr. Judson Graves — 17
Dr. Roberts: "Dr. Dobbins will be your
paid delegate.”
The Chair recognized Dr. Russell B. Carson,
President of Blue Shield.
Dr. Carson: “I am a visitor, but I do not see
on the agenda the selection of a fiscal agent and
I am wondering if you are desirous of continuing
Blue Shield or shall we be relieved of our duties?”
Dr. Roberts: “I am very thankful to you for
suggesting it. Dr. Carson. Will some member
of the House of Delegates talk about that?”
Dr. Harvard: “I move that Blue Shield be
kept as our fiscal agent.”
Seconded by Dr. Eugene G. Peek Jr. of
Marion.
Motion carried.
Dr. Douglas: “May I present a foreign mo-
tion, so to speak? The delegates from Escambia
County wish to present the following motion in
regard to antepartum care: that the House of
Delegates of the FMA officially approve the
principle of payment for each antepartum visit
rather than by* trimesters, that the drugs allowed
under the Medicare program be obtained by the
patient from the pharmacy of her choice and that
the pharmacist be paid directly by the Medi-
care program under a plan similar to that used
by the Veterans Administration for payment for
drugs.”
Seconded by Dr. Herbert L. Bryans of Es-
cambia.
Dr. Murphree: “I move that resolution be
referred to the negotiating committee.”
Motion seconded.
Dr. Douglas: “I will be very glad to accept
the motion that it be referred to the* negotiating
committee to save time.”
Motion carried.
Dr. Hampton: “I rise to ask whether that
resolution is referred without approval or re-
jection?”
Dr. Roberts: “It is referred to them, I pre-
sume, for their consideration and to do the best
they can do with it.”
Dr. Douglas: “Is that dropped now? I
wanted to explain why I brought it up.”
Dr. Roberts: “Go right ahead.”
Dr. Douglas: “The General has pointed out
that there will be a choice in the handling of
antepartum care. We think that is one of the
big criticisms of the entire system in our part
of the state. If antepartum care is paid for by
visits, we believe the fee will be much more
just.”
Dr. Roberts: “I think it was understood
when General Robinson talked about antepartum
care that you have to take one or the other.
I am sure the negotiating team would like to have
an expression from the House as to whether you
prefer to take it on a trimester basis or on a fee
for service basis. It will help the committee mem-
bers make up their mind and will give the doctor
what he wants. We can take one or the other,
but we cannot take them both. I think it is a
good question.
“Now, you want an expression from the House
of Delegates; is that what your motion intended
in the beginning?”
Dr. Douglas: “Air. President, I simply wanted
it down in writing, the fact that it is a question.
I do think that the three man group can very
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
849
ably handle the problem, and I see no particular
reason for discussion.
Dr. Milton: “In May, your committee in ref-
erence to the schedule made this particular recom-
mendation to the Reference Committee that we
have a fee for service and on the strength of that,
the Office for Dependents' Medical Care has been
contacted.”
Dr. Rowland E. Wood of Pinellas: “I would
like to move that the House of Delegates adjourn
and any matters that have not been brought up
be referred to the three man committee.”
Motion seconded.
Dr. Roberts: “I want to beg your motion
just a little bit, Dr. Wood, to give Dr. Hampton
a chance to ask a question here that we think is
germane to our whole setup with reference to
Medicare.”
Dr. Hampton: “I have asked three questions
of the General as further information to the excel-
lent presentation of the studies that have been
made of this plan so far. to try to point out that
we have been quite concerned about fee schedules
and certain principles, but perhaps some of us
have overlooked what 1 think is the basic issue.
This is an opportunity for a certain segment of
the population in this country to choose govern-
ment care or civilian care. I think it is an excel-
lent opportunity. I think it has been fairly pre-
sented, and I wanted to ask three questions to
see if these patients actually have free choice, and
if they may be influenced by other factors than
actually the best and most economical care that
they can get. I have, therefore, asked these three
questions of General Robinson.
“1. Why is the patient not required to pay the
first $25 of his hospital costs in a military hospital,
and is this $25 payment to a civilian hospital the
law, or is that the regulation?
“2. Are there any estimates of the cost of
dependent care in military hospitals?
“3. What percentage of dependents of the
military are now choosing civilian hospital care
and what percentage are choosing military hospital
care?”
General Robinson: “You have asked ques-
tions that are unanswerable.
“Why the $25 was put on the civilian program
and not on the military program, I cannot posi-
tively say. This was determined before I had any-
thing to do with the program. I would imagine
the decision to charge $25 was probably made to
act as a control to keep down unnecessary hos-
pitalization in civilian hospitals.
“In service hospitals, we do not have quite
the need for such controls that you have in civil-
ian medicine because we control it through com-
mand. I am sure this is the reason.
“The estimates of costs in military hospitals
came up in Congressional appropriation hearings
last year. The committee was of the opinion that
costs in military hospitals were considerably less
than in civilian hospitals. I have already showed
you our best estimate of what this program is
costing. The Appropriations Committee wrote in-
to their report that consideration should be given
by the Defense Department to making limitations
in areas around military hospitals for economy
reasons. That was advised against by our office,
the A.M.A., and the American Hospital Associa-
tion. Nothing has been done to establish such
restrictions at this time. We have recommended
that consideration be given to employing a statisti-
cal agency to determine what comparable costs
are. There really are no existing comparable
figures. I think probably the civilian program will
cost more, mainly because in our hospitals we
have command control, and theoretically a more
economical program should result. Also, it is
rather generally recognized that civilian physicians
are better remunerated than military. These two
generalizations would lead to the conclusion that
care in uniformed services facilities would be
somewhat less expensive.
“As to the number of military and civilian
patients, I have already told you we are running
more than 4,000 patients a day in the civilian
program. I might be able to make a ‘guesstimate’
as to how many we are running in the military
program, but I would say that it might be about
7.000 or 8,000 a day.
“Between the two programs, in spite of the
fact that the military services have come down in
strength, in the year that we have been in opera-
tion, 35 per cent more dependents are being cared
for than last year.
“May I just say, since this will be my last
appearance, I have enjoyed very much coming
to Florida and working with you. I assure you
that we do not know all the answers to all ques-
tions concerning the program at present. We
are going to continue to do our very best to re-
solve the questions as they arise. We hope the
manual which we have prepared will do much to
create better understanding. Whether or not you
850
HOUSE OF DELEGATES
Volume XLIV
Number 8
enter the fees which we negotiate in the manual,
we are going to ask you officially to publish it at
government expense, so that every physician has
a copy.”
Dr. Hampton: “Thank you. General Robin-
son, for those statistics. I take it that it is run-
ning about two to one, the utilization of this pro-
gram, in favor of military hospitals. I here are
approximately two patients to be cared for in
military hospitals to one in civilian.”
General Robinson: “That is very rough; you
understand that.”
Dr. Hampton: “I would like to ask further
then whether that $25 the patient is required to
pay is the law or the regulation?”
General Robinson: “It is the law.”
Dr. Hampton: “It is the law. It seems to me
that that is definitely weighing the balance in
favor of military hospitals in the patient making
his choice as to whether he will be hospitalized in
civilian or military hospitals. I think that $25 is
an unfair weight in this plan in favor of military
hospitals. We have heard it stated that 2 per cent
of the patients are stating that they would not
choose civilian hospitals again. Obviously, if over
the period of the next five or six years more and
more patients choose military hospitals, it would
be a very strong factor for the development of
more government medical care. This is a chal-
lenge to the civilian physicians and civilian hos-
pitals to provide better medical care for depend-
ents of military personnel, and we must show
that it can be done more economically, in addition
to being better. This $25 is a very strong factor
in the patient’s mind in choosing between civilian
and military hospitalization, but I somewhat
doubt, General, that the position of the civilian
physician and that of the military physician dif-
fer much as far as the patient’s desire to go into
a hospital is concerned. I think it would be just
as much a deterrent factor for the patient to go
into the hospital unnecessarily in a military hos-
pital as it would for him to go unnecessarily into a
civilian hospital.
General Robinson: “There may be other rea-
sons; I just don’t know.”
Dr. Hampton: “I wonder if it is possible for
us to make strong recommendations that the $25
be charged the patient who goes into a military
hospital.”
Dr. Kennard: “I can add one further clarify-
ing comment. This $1.75 a day happens to be the
present rate. The law provides the following: ‘For
each admission, the plan shall also provide for
payment by the patient of hospital expenses in-
curred under paragraph 1 hereof, in the amount
of either (1) $25 or (2) the charge established
pursuant to Sec. 103-C of this act multiplied by
the number of days of hospitalization.’ Section
103-C states: ‘The Secretary of Defense after
consultation with the Secretary of Health, Educa-
tion, and Welfare shall establish fair charges for
in-patient medical care given dependents in the
facilities of the uniformed services, which charges
shall be the same for all dependents.’ The Secre-
tary of Defense has it in his capability, in the
law, to set the fee at anything above or below
$1.75 a day. This is something that can be dealt
with with him.”
Dr. Hampton: “In other words, he could say
that the first day would be $25 in a military hos-
pital if he wished, or the first five days would be
$5?”
Dr. Kennard: “That is right. He could estab-
lish a different rate. It does not take any law: he
has the authority here to equalize it if that should
be appropriate.”
Dr. Hanson: “There is a motion before the
House.”
Dr. Roberts: “Before we call for the vote
on that. Dr. Tolle, did you want to say some-
thing?”
Dr. Tolle: “Yes, there is one other thing. We
are dealing now with General Robinson, who is
extremely cooperative, but I was wondering, what
provision there is, since there is so much authority
wielded by his office, for replacing the Executive
Director in case he is dictatorially inclined and we
are unable to get along with him.”
General Robinson: “I think you can expect
that there will always be excellent personnel in
the office.”
Dr. Roberts: “We will have that 30 days’
grace anyhow.”
Dr. Roberts: “This is the House of Delegates,
and I do not want anybody to go home unhappy.”
Dr. Edwin W. Brown of Palm Beach: “I just
wanted to say that I think we should all be re-
minded that our government is for the people
and by the people and that we doctors are the peo-
ple. In a sense, we are negotiating with ourselves.
We are paying from one pocket into the other. We
would like our cost of government to be reduced,
that the budget be balanced, that our taxes be
reduced. We are dealing with largely a lower in-
come group of people in the Medicare program
J. Florida M.A.
February, 1958
HOUSE OF DELEGATES
851
and we would like the Medicare program to be as
low as possible.”
Dr. Roberts: “We had seated today 101 dele-
gates out of 155; 78 were required for a quorum.
Now, I want to take this opportunity to thank this
House of Delegates, first, for coming, for being
here. You are the people who are definitely in-
terested in organized medicine. About those fish-
ing friends, who could not bother to come up here
on the weekend, I shall have something to say
later on, probably in my annual address. I want
to thank you from the bottom of my heart for be-
ing brainy and learned men, and men of states-
manlike qualities. You did not confuse me too
much. Fortunately, the gods were with me since
my parliamentarian did not come. I thank you
for your kindness.
“I want to thank General Robinson and Dr.
Kennard for coming and I want to thank Mr.
Arndt; we appreciate your interest. If nobody
objects, Dr. Woods motion is in order; it will not
require any discussion.”
Motion carried.
Meeting was adjourned at 1:10 p.m.
852
Volume XLIV
Number 8
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON, M.D., Editor
STAFF —
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
Editorial Consultant
Managing Editor
Ernest R. Gibson
Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman. .. .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
Program for Eighty-Fourth Annual Meeting
The program for the Eighty-Fourth Annual
Meeting of the Florida Medical Association at the
Americana Hotel, Bal Harbour, Miami Beach,
May 10-14, 1958 has been arranged to follow the
plan of last year’s successful meeting. The scien-
tific sessions and the organizational work of the
Association have been arranged to avoid conflicts.
The majority of the scientific papers have been
scheduled on one day to permit members who
find it impossible to attend the full session to come
on Tuesday. The work sessions of the House of
Delegates have been spread so that adequate time
is available between the sessions for hearings of
reference committees; the time is not interrupted
by other meetings.
The activities of the speciality groups are
planned for Saturday and Sunday. The first ses-
sion of the House of Delegates will convene in
midafternoon Sunday. The General Session on
Monday will include, in addition to talks on or-
ganizational aspects of medicine, two general
scientific talks. Outstanding out-of-state speakers
have been obtained to review the up-to-the-minute
status of such subjects as the relation of tissue
specificity to surgical transplantation of organs
and the changing concepts of tuberculosis. It has
been impossible to schedule for the Association’s
program all of the distinguished visitors who are
speaking at the meetings of the special societies.
The popular panels will be continued this year
on Tuesday and will cover both medical and sur-
gical aspects of chest diseases and recent advances
in modern methods of diagnosis and therapy. The
remaining scientific sessions will be devoted to the
specialties and to surgery. The second session of
the House of Delegates on Wednesday will con-
clude the meeting.
The Scientific Exhibit will feature health eval-
uations for physicians attending the meeting. The
Committee on Tuberculosis and Public Health of
the Association, in conjunction with the Woman’s
Auxiliary, State Board of Health, and the Medi-
cal Schools of Florida, will conduct physical ex-
aminations, run screening laboratory procedures
and have experts to interpret them for busy phy-
sicians while they wait. Though physicians rec-
ommend these periodic evaluations for their pa-
tients, few take the time from practice to have
J. Florida M.A.
February, 1958
EDITORIALS AND COMMENTARIES
853
themselves examined. A special exhibit on acci-
dents has been arranged to emphasize the increas-
ing importance of this useless waste of life. The
hotel has built a new exhibit hall so that more
space is available under better circumstances for
display of scientific material than has been possible
in recent years. A few spaces are still available
for new exhibits.
The program of motion pictures and kinescopes
planned for Monday evening still has a few open-
ings.
The program allows adequate opportunity for a
balance of scientific postgraduate education and
much needed rest and relaxation. The hotel is
cooperating to the fullest in planning the use of
its beautiful facilities for an excellent meeting.
Association Policies on Medicare
Determined at Called Meeting
Of House of Delegates
Medicare was the subject of a special meeting
of the House of Delegates of the Florida Medical
Association, held at the George Washington Hotel
in Jacksonville on Dec. 8, 1957. Of the 155 dele-
gates eligible to participate in the called meeting,
101 were seated, and other members of the Associ-
ation were present.
Dr. John D. Milton, who has served as chair-
man of the Association’s Medicare Mediation
Committee from the beginning and is thoroughly
conversant with the Medicare Program, was the
first speaker. He presented a comprehensive re-
view of Medicare in Florida. Among the several
guests who were in attendance were three who
addressed the House. Major General Paul I.
Robinson, Executive Director of the Office for
Dependents’ Medical Care, Washington, D. C.,
presented the current over-all picture of Medi-
care and in the question and answer period was
most cooperative in elucidating many aspects of
the Medicare Program. The Assistant Director of
the Washington Office of the American Medical
Association, Dr. William J. Kennard, Washington,
D. C., discussed several facets of the subject. Mr.
John D. Arndt, Medicare Administrator of the
Medical Association of Georgia, Atlanta, Ga., ex-
plained the handling of the Medicare Program in
Georgia. Blue Shield of Florida was represented
by Dr. Russell B. Carson, President, Mr. H. A.
Schroder, Executive Director, and Mr. N. G. John-
son, Medicare Coordinator.
The House voted to continue to be a party
to a contract with the Office for Dependents’
Medical Care. It reaffirmed its action of May
1957, which was to continue to provide authorized
professional care for eligible dependents on a fee
for service basis, accepting the policy of the
government that the Schedule of Allowances shall
be a maximum for all fees not substantiated by
special report.
The FMA Medicare Committee was empower-
ed to renegotiate a maximum Schedule of Allow-
ances as a guide for the Association and county
medical society Medicare committees. The ne-
gotiating team authorized by the House to repre-
sent Florida at the first of the renegotiation con-
ferences, scheduled to be held in Washington on
Jan. 6-7, 1958, was Dr. John D. Milton, chair-
man, of Miami, who was drafted to continue in
that capacity, Dr. Donald F. Marion, also of
Miami, and Dr. Burns A. Dobbins Jr., of Fort
Lauderdale.
It was emphasized in the discussion leading
to the House actions that the fees charged eligible
dependents under the Medicare Program should
be those usual to the community, that all author-
ized care is on a full service basis, and that per-
sistent charging to the maximum could encourage
the Office for Dependents’ Medical Care to re-
quest a re-evaluation of the maximum Schedule
of Allowances.
The House accepted with appreciation Blue
Shield’s offer to continue as the Fiscal Adminis-
trator of the Program in Florida.
The complete proceedings of this called meet-
ing of the House are published in this issue of The
Journal.
Seminar on Cardiovascular Diseases
Jacksonville, February 20-22, 1958
The Fifth Annual Seminar on Cardiovascular
Diseases will be presented by the Northeast
Florida Heart Association on February 20, 21
and 22 at the Prudential Auditorium in the Pru-
dential Building in Jacksonville. Co-sponsors of
the meeting are the Division of Postgraduate Edu-
cation of the College of Medicine of the Univer-
sity of Florida, the Florida State Board of Health
and the Florida Medical Association. The Seminar
is endorsed by the Florida Heart Association and
is accepted by the American Academy of General
Practice for 15 hours’ credit in Category I.
The outstanding faculty includes such distin-
guished teachers as Dr. Samuel Bellet, Professor
of Clinical Cardiology, University of Pennsylvania
854
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 8
Graduate School of Medicine, Philadelphia; Dr.
George E. Burch, Professor and Chairman of the
Department of Medicine, Tulane University
School of Medicine, New Orleans; Dr. Denton A.
Cooley, Associate Professor of Surgery, Baylor
University College of Medicine, Houston; and
Dr. Ben I. Heller, Professor of Medicine, Univer-
sity of Arkansas School of Medicine, Little Rock.
Local faculty members are Dr. James E. Cousar
III, Dr. Lawrence E. Geeslin. Dr. Karl B. Han-
son and Dr. Joseph J. Lowenthal.
Registration will begin at 8:30 a.m. on Thurs-
day, February 20. The registration fee is $10,
with no charge for residents, interns and physi-
cians in the armed services. A special parking area
will be provided for those in attendance. On
Thursday and Friday, luncheon groups will meet
in the St. Johns Room in the Prudential Building.
The Roosevelt Hotel will be the downtown head-
quarters, and reservations may be secured by con-
tacting the hotel or the Northeast Florida Heart
Association, 425 W. Duval St., Jacksonville.
At the opening session on Thursday morning,
Dr. Turner Z. Cason, President, will welcome the
registrants and guests. Dr. Daniel R. L’sdin,
Chairman of the Program Committee, will preside,
and the other members of this committee, Dr. J.
Brooks Brown, Dr. David R. Moomaw and Dr.
Richard A. Nelson, will preside at succeeding
sessions. On Friday morning. Dr. Simon D. Doff
will preside.
The program follows:
FIFTH ANNUAL SEMINAR
ON CARDIOVASCULAR DISEASES
PRUDENTIAL BUILDING, JACKSONVILLE, FEBRUARY 20-22, 1958
THURSDAY, FEBRUARY 20 Presiding:
8:30 Registration
9:20 Address of Welcome
9:30 “Electrolyte Disturbances in Congestive Heart Failure, Part I”
10:05 “Electrolyte Disturbances in Congestive Heart Failure, Part II.”
10:40 Recess
11:00 “Cardiac Arrhythmias”
11:35 Panel Discussion: “Arrhythmias and Electrolytes”
12:30 Lunch
Presiding: Dr. David R. Moomaw
2:00 “Pericarditis with Effusion”
2:35 “Cardiac Complications in Renal Failure”
3:10 Recess
3:25 “Cardiac Arrest”
4:00 Clinical Conference: “Cardiovascular Problems”
Moderator: Dr. A. Sherrod Morrow
Dr. Daniel R. Usdin
Dr Cason
Dr. Heller
Dr. Heller
Dr. Bellet
Drs. Heller,
Bellet, Hanson
Dr. Bellet
Dr. Heller
Dr. Bellet
Drs. Bellet,
Heller, Geeslin
FRIDAY, FEBRUARY 21 Presiding: Dr. Simon D. Doff
9:00 “Correctable Forms of Hypertension” Dr. Burch
9:35 “Management of Patients with Hypertension” Dr. Burch
10:10 Recess
10:30 Panel Discussion: “Hypertension” Drs. Burch, Cooley, Heller, Bellet, Lowenthal
Moderator: Dr. George T. Harrell
11:30 “Surgical Aspects of Arterial Occlusive Disease” Dr. Cooley
12:30 Luncheon Conference
“Medicine and Russia,” Dr. Burch
Presiding: Dr. J. Brooks Brown
1:30 “Surgery of Aortic and Arterial Aneurysms” Dr. Cooley
2:20 “Interesting Aspects of the Aging Process” Dr. Burch
J. Florida M.A.
February, 1958
EDITORIALS AND COMMENTARIES
855
2:55 “Open Heart Surgery— Results in 300 Pati
3 : 40 Recess
4:00 Panel Discussion: “Heart Surgery”
Moderator: Dr. Arthur R. Nelson
SATURDAY, FEBRUARY 22
9:00 “Chronic Renal Disease”
9:35 “Coronary Artery Disease”
10:10 Recess
10:30 “Unusual Problems in Cardiovascular Sur
11:05 Question and Answer Period
3 Using Pump Oxygenator” Dr. Cooley
Drs. Cooley,
Burch, Bellet,
Cousar
Presiding: Dr. Richard A. Nelson
Dr. Heller
Dr. Bellet
y” Dr. Cooley
Drs. Heller,
Bellet, Cooley
Symposium on Cardiovascular Problems
Of the Aging
Miami Beach, April 12, 1958
A symposium by outstanding experts on the
Management of Cardiovascular Problems of the
Aging is being sponsored by the Dade County
Medical Association in conjunction with the J. B.
Roerig Company on Saturday afternoon. April
12, 1958 at the Eden Roc Hotel in Miami Beach.
All members of the Florida Medical Association
are invited to attend.
Dr. O. Whitmore Burtner, Chairman of the
Symposium Committee, has announced that the
titles of the three papers planned for this after-
noon symposium are: Peripheral Vascular Disease,
Cerebral Vascular Insufficiency and Emotional
Aspects of Coronary Disease. The names of the
four speakers who will participate will be an-
nounced at an early date.
A cocktail party at 12 p.m., in the Imperial
Room of the Eden Roc Hotel, will be followed by
a luncheon with a guest speaker in the adjoining
Pompeii Room. The luncheon speaker is expected
to touch upon some of the lighter aspects of lipid
metabolism. The three papers will then be present-
ed. A question and answer period will end the
meeting at about 5 p.m.
The wives of the members of the Florida
Medical Association will be invited to the cock-
tail party and the luncheon. Entertainment will
be provided for them in the Mona Lisa Room of
the hotel while the symposium is in session.
Second Annual Fracture Course
Chicago, April 16-19, 1958
The second annual Post Graduate Course in
Fractures and Other Trauma will be given by
the Chicago Committee on Trauma of the Ameri-
can College of Surgeons, for four days from Wed-
nesday, April 16 through Saturday, April 19, at
the John B. Murphy Memorial Auditorium, 40
East Erie St., Chicago.
All phases of trauma will be discussed by out-
standing teachers from five medical schools, and
chiefs of services of leading hospitals in the Chi-
cago area as well as notable guest speakers from
other parts of the country. Among the visiting
guest speakers are Dr. Walter Blount of Mil-
waukee, Dr. H. Relton McCarroll of St. Louis,
Dr. Don O’Donoghue of Oklahoma City, and Dr.
Joseph Boyes of Los Angeles.
Topics will include trauma of the hand, head,
chest, abdomen, heart, knee, shoulder, treatment
of burns, athletic injuries, and other subjects se-
lected in answer to a questionnaire sent last year’s
registrants. Illustrated lectures, patient demon-
strations, and question and answer periods will
also be held. All inquiries may be addressed to Dr.
John J. Fahey, 1791 W. Howard St., Chicago 26.
Report of Delegates
To American Medical Association
1957 Clinical Meeting
Fluoridation of public water supplies, free
choice of physician, the Heller Report on organi-
zation of the American Medical Association, the
Forand Bill providing hospital and surgical bene-
fits for Social Security beneficiaries, guides for
occupational health programs covering hospital
employees, distribution of Asian Influenza vac-
cine and guides for the medical rating of physi-
cal impairment were among the variety of sub-
jects acted upon by the House of Delegates at
the American Medical Association’s Eleventh
Clinical Meeting held Dec. 3-6, 1957 in Philadel-
phia.
Dr. Cecil W. Clark of Cameron, La., was
856
EDITORIALS AND COMMENTARIES
Volume X LI V
Number 8
named 1957 General Practitioner of the Year after
his selection by a special committee of the Board
of Trustees for outstanding community service.
Dr. Clark. 33 year old country doctor who was a
medical hero during Hurricane Audrey last June,
was present at the meeting to receive the gold
medal which goes with the annual award.
Speaking at the opening session on Tuesday,
Dr. David B. Allman of Atlantic City, A.M.A.
President, called for “more freedom, not less, in
America and in the medical profession.” Dr. All-
man urged the delegates to embark on local action
campaigns to enlist full community support in
opposition to the Forand Bill, a pending Con-
gressional proposal which would provide hospital
and surgical benefits for persons who are receiv-
ing or are eligible for Social Security retirement
and survivorship payments. The Forand Bill, he
said, is “cut from the same cloth” as national
compulsory health insurance and “emanates from
the same minds.”
Total registration at the end of the third day
of the meeting, with half a day still to go, had
reached 5,375. including 2,562 physician members.
Fluoridation of Water
In settling the most controversial issue at the
Philadelphia meeting, the House of Delegates ap-
proved a joint report of the Council on Drugs
and the Council on Foods and Nutrition which
endorsed the fluoridation of public water sup-
plies as a safe and practical method of reducing
the incidence of dental caries during childhood.
The 27 page report on the study which was di-
rected by the House at the Seattle Clinical Meet-
ing one year ago contained these conclusions:
“1. Fluoridation of public water supplies so
as to provide the approximate equivalent of 1
ppm of fluorine in drinking water has been estab-
lished as a method for reducing dental caries in
children up to 10 years of age. In localities with
warm climates, or where for other reasons the in-
gestion of water or other sources of considerable
fluorine content is high, a lower concentration of
fluoride is advisable. On the basis of the available
evidence, it appears that this method decreases the
incidence of caries during childhood. The evidence
from Colorado Springs indicates as well a reduc-
tion in the rate of dental caries up to at least
44 years of age.
“2. No evidence has been found since the 1951
statement by the Councils to prove that contin-
uous ingestion of water containing the equivalent
of approximately 1 ppm of fluorine for long pe-
riods by large segments of the population is harm-
ful to the general health. Mottling of the tooth
enamel (dental fluorosis) associated with this
level of fluoridation is minimal. The importance
of this mottling is outweighed by the caries-in-
hibiting effect of the fluoride.
“3. Fluoridation of public water supplies
should be regarded as a prophylactic measure for
reducing tooth decay at the community level and
is applicable where the water supply contains less
than the equivalent of 1 ppm of fluorine.”
Free Choice of Physician
Acting on the issue of free choice in relation
to contract practice, the House passed a resolu-
tion which reaffirmed approval of previous inter-
pretations of the Principles of Medical Ethics by
the Association’s Judicial Council and directed
that they be called to the attention of all constit-
uent associations and component societies. One
Council opinion, issued in 1927 and reaffirmed
in Philadelphia, stated that the contract practice
of medicine would be determined to be unethical
if "a reasonable degree of free choice of physician
is denied those cared for in a community where
other competent physicians are readily avail-
able.” The resolution also cited a Council opin-
ion. published in the October 19, 1957, issue of
The Journal of the A.M.A., which stated that the
basic ethical concepts in both the 1955 and 1957
editions of the Principles of Medical Ethics are
identical in spite of changes in format and word-
ing. This opinion added that “no opinion or report
of the Council interpreting these basic principles
which were in effect at the time of the revision has
been rescinded by the adoption of the 1957 prin-
ciples.”
The 1927 Council report also pointed out that
“there are many conditions under which contract
practice is not only legitimate and ethical, but in
fact the only way in which competent medical
service can be provided.” Judgment of whether or
not a contract is ethical, the report said, must be
based on the form and terms of the contract as
well as the circumstances under which it is made.
In another action related to the issue of free
choice, the House adopted a resolution condemn-
ing the current attitude and method of operation
of the United Mine Workers of America Welfare
and Retirement Fund “as tending to lower the
quality and availability of medical and hospital
care to its beneficiaries.” The resolution also
called for a broad educational program to inform
the general public, including the beneficiaries of
J. Florida M.A.
February, 1958
EDITORIALS AND COMMENTARIES
857
the Fund, concerning the benefits to be derived
from preservation of the American right to free-
dom of choice of physicians and hospitals as well
as observance of the “Guides to Relationships
Between State and County Medical Societies and
the UMWA Welfare and Retirement Fund” which
were adopted by the House last June.
The Heller Report
Acting on the report of the Committee to
Study the Heller Report on Organization of the
American Medical Association, the House reached
the following decisions on 10 specific recommen-
dations:
1. The office of Vice-President will be con-
tinued as an elective office.
2. The offices of Secretary and Treasurer
will be combined into one office to be known as
Secretary-Treasurer, and that officer will be select-
ed by the Board of Trustees from one of its num-
ber.
3. The duties of the Secretary-Treasurer will
be separated from those of the Executive Vice-
President.
4. The office of General Manager will be
discontinued, and the new office of Executive
Vice-President will be established. The latter, ap-
pointed by the Board of Trustees, will be the
chief staff executive of the Association.
5. The Council on Medical Education and
Hospitals and the Council on Medical Service will
continue as standing committees of the House of
Delegates, but their administrative direction wilt
be vested in the Executive Vice-President.
6. The voting members of the Board of
Trustees will be limited to 1 1 — the nine elected
Trustees, the President and the President-Elect.
The Vice-President and the Speaker and Vice-
Speaker of the House of Delegates will attend
all Board meetings, including executive sessions,
with the right of discussion but without the right
to vote.
7. The House disapproved of the proposal
to elect the Trustees from each of nine physician-
population regions.
8. The office of Assistant Secretary will be
discontinued, and a new office of Assistant Ex-
ecutive Vice-President will be established.
9. The Committee on Federal Medical Serv-
ices will be retained as a committee of the Council
on Medical Service and will not become a part of
the Council on National Defense.
10. The Speaker of the House will appoint
a joint and continuing committee of six members,
three from the Board of Trustees and three from
the House, to redefine the central concept of
A. M.A. objectives and basic programs, consider
the placing of greater emphasis on scientific activi-
ties, take the lead in creating more cohesion among
national medical societies and study socioeconom-
ic problems.
The accepted recommendations were referred
to the Council on Constitution and By-laws with
a request to draft appropriate amendments for
consideration by the House at the 1958 annual
meeting in San Francisco.
The Forand Bill
The House condemned the Forand Bill as
undesirable legislation, approved the firm position
taken in opposition to it and expressed satisfac-
tion that the Board of Trustees has appointed a
special task force which is taking action to de-
feat the bill. In a related action, giving strong
approval to Dr. Allman’s address at the opening
session, the House adopted a statement which
said:
“It is particularly timely that our President
has so forcefully sounded the clarion call to the
entire profession for emergency action. With com-
plete unity, definition and singleness of purpose,
closing of ranks with all age groups and elements
of our organization we must at this time stand
and be counted. Thus we can exert the physician’s
influence in every possible direction against in-
vasion of our basic American liberties in the form
of proposed legislation alleged to compulsorily in-
sure one segment of the population against health
hazards at the expense of all.”
Health Programs for Hospital Employees
A set of “Guiding Principles for an Occupa-
tional Health Program in a Hospital Employee
Group” was approved by the House. The guides
were developed by a joint committee of the Ameri-
can Medical Association and the American Hospi-
tal Association and already had been formally
approved by the A.H.A. They include these state-
ments:
“Employees in hospitals are entitled to the
same benefits in health maintenance and protec-
tion as are industrial employees. Therefore,
programs of health services in hospitals should use
the techniques of preventive medicine which have
been found by experience in industry to approach
constructively the health requirements of em-
ployees.
New rapid-acting ACHROMYCIN V Capsules offer more
patients consistently high blood levels— at no sacrifice
to the broad anti-infective spectrum of ACHROMYC^
Tetracycline, its low incidence of side effects, or its dosage
and indications.
The pure, unaltered crystalline tetracycline HCI molecul*
of ACHROMYCIN, now buffered with citric acid, provide!
Tetracycline HCI Buffered with Citric Acid
prompt and high blood levels, faster broad-spectrum action
; ...rapidly decisive control of infections. New ACHROMYCIN
V Capsules do not contain sodium.
REMEMBER THE V WHEN SPECIFYING ACHROMYCIN V
CAPSULES: (blue-yellow) 250 mg. tetracycline HCI (buffered with citric acid, 250 mg.); 100 mg. tetracycline HCI
[buffered with citric acid, 100 mg.). ACHROMYCIN V DOSAGE: Recommended basic oral dosage is 6-7 mg.
per lb. body weight per day. In acute, severe infections often encountered in infants and children, the dose should be 12
j|j mg. per lb. body weight per day. Dosage in the average adult should be 1 Gm. divided into four 250 mg. doses.
-EDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
U.S. Pot. Off.
I A
IS Reg
860
EDITORIALS AND COMMENTARIES
Volume XLI V
Number 8
“It is essentia] that employee health programs
in hospitals, as in industry, be established as sep-
arate functions with independent facilities and per-
sonnel. The fact that hospitals are engaged in
the care of the sick as their primary function
does not alter the necessary organizational plan
for an effective occupational health program.'’
Asian Influenza Vaccine
The House considered three resolutions dealing
with the Asian influenza immunization program
and then adopted a substitute resolution calling
attention to “certain inadequacies and confusions
in the distribution of vaccines” and directing the
Board of Trustees to seek conferences through
existing committees "with a view to establishing
a code of practices regulating the future distri-
bution of important therapeutic products, so that
the best interest of all the people may be served.”
The resolution pointed out that the American
Medical Association already has a joint committee
with the American Pharmaceutical Association
and the National Association of Retail Druggists,
in addition to a liaison committee with the Drug
Manufacturers Association.
Medical Rating of Physical Impairment
The House accepted a 115 page “Guide to the
Evaluation of Permanent Impairment of the
Extremities and Back” which was developed by
the Committee on Medical Rating of Physical
Impairment as the first in a projected series of
guides. The delegates commended the committee
for doing “a superb job on this difficult subject-’
and expressed pleasure that the guides will be
published in The Journal of the A.M.A. The
guides are expected to be of particular help to
physicians in determining impairment under the
new disability benefits program of the Social
Security Act.
Miscellaneous Actions
Among a wide variety of other actions, the
House also:
Directed that a new committee be established
in the Council on Industrial Health to study
neurological disorders in industry;
Noted with approval the establishment of the
American Medical Research Foundation.
Decided that informational materials which
are sent to A.M.A. delegates should also be sent
to all alternate delegates;
Affirmed that it is within the limits of ethical
propriety for physicians to join together as part-
nerships. associations or other lawful groups pro-
vided that the ownership and management of the
affairs thereof remain in the hands of licensed
physicians;
Instructed that the appropriate committee or
council should engage in conferences with third
parties to develop general principles and policies
which may be applied to the relationship between
third parties and members of the medical pro-
fession ;
Urged state medical society committees on
aging and insurance to make continuing studies
cf pre-retirement financing of health insurance
for retired persons;
Endorsed a suggestion that the Committee
on Federal Medical Services sponsor a national
conference on veterans’ medical care during 1958;
Asked the Board of Trustees to study the
feasibility of having the Association finance a
thorough investigation of the Social Security sys-
tem by a qualified private agency;
Suggested that physicians and their friends
make a vigorous effort to obtain Congressional
enactment of the Jenkins-Keogh Bills;
Approved the “Suggested Guides to Relation-
ships Between Medical Societies and Voluntary
Health Agencies”;
Strongly recommended that a completely
adequate and competent medical department be
established in the Civil Aeronautics Administra-
tion directly responsible to the CAA Administra-
tor.
Opening Session
At the Tuesday opening session Rear Admiral
B. W. Hogan, Surgeon General of the U. S. Navy,
presented the Navy Meritorious Public Service
Citation to Dr. Dwight H. Murray of Napa,
Calif., immediate past president of the Association.
Contributions to the American Medical Education
Foundation, for financial aid to the nation’s medi-
cal schools, were presented by four state medical
societies: California, $143,043.25; Utah, $10,390;
New Jersey, $10,000. and Arizona, $8,040. The
Interstate Post Graduate Medical Association of
North America gave $1,000. and the Illinois State
Medical Society announced that it was adding
$10,000 to the $170,450 presented at the New
York meeting last June.
Respectfully submitted.
Louis M. Orr, M.D.
Reuben B. Chrisman Jr., M.D
Francis T. Holland, M.D.
J. Florida M.A.
February, 1958
861
BLUE
SHIELD
Informational Meeting Held for Blue Shield Active Members
On Dec. 7, 1957, an informational meeting
of the Active Members of Blue Shield was held
at the Blue Cross -Blue Shield Building in Jack-
sonville. Some 105 of the Active Members of
Florida Blue Shield, which includes the seated
House of Delegates of the Florida Medical As-
sociation, met in an all day session to hear pres-
entations about Blue Shield and to participate in
discussions concerning the past, present and future
of the Florida Plan.
By resolution of the House of Delegates, it
was the purpose of the meeting to inform the
profession better on prepayment matters and to
improve the channels of communication between
the profession and the Plan. No authority to act
was granted; therefore, no voting or final action
was taken at the meeting.
The program, arranged by the Florida Medi-
cal Association Advisory Committee to Blue Shield
and the Blue Shield Board of Directors, featured
two speakers of national prominence in the field of
medical economics, Dr. Fredrick H. Good of Colo-
rado, and Mr. Jay C. Ketchum of Michigan, as
well as speakers of prominence and authority from
the state organization. Also included was a panel
discussion in which the Committee of Seventeen
presented various topics and the entire assembly
joined in a general question and answer period.
Dr. William C. Roberts, President of the
Florida Medical Association, in a brief talk stated
that he was intensely interested in Florida Blue
Shield and that he favored a complete study of it
by Florida Physicians. He said that in his recent
travels he had found organized medicine over the
country watching Florida’s decisions. He also in-
dicated that he believed the Florida Plan now was
a reasonable facsimile of what Blue Shield should
be and urged that all doctors acquire better
knowledge of prepayment and be prepared to
make decisions regarding it at the next annual
meeting of the Association.
Dr. Russell B. Carson, President of Florida
Blue Shield, reviewed the history of Florida Blue
Shield, its relationship to Blue Cross, and its re-
sponsibility to the profession, the public and the
State Insurance Commissioner. Speaking of its
relationship to Blue Cross, Dr. Carson pointed
out that all the facilities, including the building,
used by Blue Shield were the property of the
Blue Cross Plan and that Blue Shield was a renter
from that corporation. He also commented on the
financial aspects of the Plan that have given the
Board of Directors concern for the past few years.
He indicated that the Plan was now paying 86.5
per cent of its income to the doctors for services
rendered its subscribers.
Addresses by Dr, Henry J. Babers Jr., Chair-
man of the Florida Medical Association Advisory
Committee to Blue Shield, and Judge Ben C.
Willis, Judge in the Second Judicial Circuit Court
and a member of the Board of Directors of Florida
Blue Shield, are published in this issue of The
Journal of the Florida Medical Association. The
other addresses made at the meeting are scheduled
for publication in subsequent issues of The Jour-
nal.
Many favorable comments at the time of the
meeting and correspondence from individuals and
societies since that time indicate that the meeting
was successful in creating an area of better under-
standing between the physicians of Florida and
their Blue Shield Plan. The Florida Medical As-
sociation Advisory Committee to Blue Shield and
the Blue Shield Board of Directors invite your
comments.
Opening and Explanatory Remarks
Henry J. Babers Jr., M.D.
GAINESVILLE
Chairman of the Florida Medical Association
Advisory Committee to Blue Shield
Gentlemen: It is time for us to start our
meeting because there are many important things
to be discussed here today. We should all feel
at home in this building because it has been made
possible by our control and support, especially
the medical leaders who began Blue Shield of
Florida in 1946.
It is fitting that we start this important meet-
ing with a prayer, and 1 have asked Dr. Henry
L. Harrell of Ocala to lead us in prayer.
(Prayer by Dr. Harrell)
In 1956 (it seems years ago now) at the an-
nual meeting of the Florida Medical Association,
862
BLUE SHIELD
Volume XUV
N u \i beb 8
at the request of the Dade County Medical Associ-
ation and also by request of the Hoard of Direc-
tors of Blue Shield of Florida, a resolution was
presented and passed requesting a committee of
the Florida Medical Association to act as Adviso-
ry to Blue Shield and as a reference committee for
Blue Shield matters. This resolution was presented
by Dr. Louis M. Orr (who was chairman of the
reference committee) and seconded by Dr. H.
Phillip Hampton. This group of doctors was ap-
pointed by President Langley in August 1956, and
had its organizational meeting on Sept. 30, 1956.
Little did we know what we were getting into.
Our thoughts were much the same as those of
many of you in reference to Blue Shield. We
simply knew nothing about the immensity of
the economic problems facing the medical pro-
fession except in a general sort of way; we found
that Blue Shield was only a small but important
facet of the over-all problem. We can show you
our committee minutes and show you that we all
had our own ideas of what to do and what was
wrong; but we were wise as a group (I admit
that freely). We said that we would not make
any statements until we knew what we were talk-
ing about. As individuals, we have not hesitated
to state our feelings; but as a committee, we have
been very careful. Please refer to our report, the
Committee of Seventeen’s Report, to the House
of Delegates at the last annual meeting of the As-
sociation, published in The Journal of the Florida
Medical Association and you will find that this is
true.
We want you to know that from the outset
we refused to make ourselves apologists for Blue
Shield. We were and we have remained a Florida
Medical Association committee to study Blue
Shield problems and to advise Blue Shield through
the Association. Blue Shield through its Board
of Directors and administration, and this is im-
portant. has shown itself completely cooperative;
we have been given every bit of information on
its operation; nothing has been withheld.
At first, we decided mainly to study the situa-
tion about which we quickly recognized much
ignorance on our part. Later, we voted to get and
give information to and from the membership of
the Association. Little did we know as a commit-
tee how doctors individually, in county societies
and in specialty groups, would respond to our ef-
forts.
Our group has studied. We have had four long
meetings on Sept. 30, 1956, Dec. 2, 1956, April 7,
1957, and July 28, 1957. Most of our members
have attended all of these meetings, and that in
itself is remarkable because of the time, expense,
and distances involved. I now honestly believe
that a majority of our group have a great deal
more knowledge of our economics than do the
majority of doctors in Florida. We have been
consistent. We agreed after study that we believed
that Blue Shield was, by its nature, a good thing
and should be continued. (Dr. Donald F. Marion
was not a member of this committee until June
1957; so I will not include him in this statement,
although I hope and believe he agrees with me.)
If you will look into our actions, you will see that
we have been fair and judicial in our approach.
We want to be consistent and fair, and there is
not a Casper Milquetoast in the lot of us.
So surely, it must be evident that there is some
reason for our obvious worries. Every now and
then a doctor will ask, “What in the world are
you talking about? What controversy?” There
is controversy, and if a man does not recognize
it, that does not mean there is not. Is there any
reason but common sense why so many of us can
see this problem in a different light than many
of you? Is there possibly any ulterior motive that
would make any of us say or do anything that
was not honest or fair? We have had our motives
questioned. Our knowledge after a year of study
has given us insight into problems that many of
you do not realize exist. Do you have any knowl-
edge of the responsibilities of Blue Shield’s Board
of Directors to the Insurance Commissioner of
the State of Florida? Do you have any knowl-
edge of the make up of the Board of Directors
of Blue Shield? Do you know that its members,
both physicians and laymen, are people of the
highest caliber and integrity? Do you realize the
importance of having such laymen on the side
of medicine when the public tests come, and soon?
If I have learned anything from this work, it is
the power and help we get from the laymen.
Do you realize that with our vacillation, in-
competence and bickering on economic problems
we run the risk throughout the country of
such friends of medicine becoming disgusted with
us? We could not blame them if they did, but
fortunately they are men and women of stature
who see beneath our inconsistencies and like us
for our good qualities. Do you think that the
members of the Board of Directors of Blue Shield
benefit monetarily from Blue Shield? The facts
are clear; they do not. At times I wonder why
J. Florida M.A.
February, 1958
BLUE SHIELD
863
they continue. Suffice it to say that within them
(and all of us, I hope) there is still the American
current of fair play and the feeling of public
service; otherwise, I am sure our leaders both
medical and lay would throw up their hands and
go home or else hang themselves from the handiest
limb.
Now a word of explanation of how this educa-
tional meeting came about. At the last annual
convention of the Association in 1957 a resolu-
tion was passed on the sponsorship of the Com-
mittee of Seventeen requesting Blue Shield to have
an informational meeting. This was agreed to by
the voting members of Blue Shield and by the
Board of Directors, hence this gathering today.
And believe me, we have every reason to say a
prayer for guidance.
This meeting is important, and it is gratify-
ing to see so many here this early. I think that it
is a bit unusual in a medical group, and Florida is
a long state. With the cooperation of Blue Shield,
we have prepared a full program. We have
brought here two national figures, Dr. Fredrick
H. Good of Colorado and Mr. Jay C. Ketchum
of Michigan, whom we will introduce in due time.
As our work program has developed, one
thing has become obvious to us: Things are not
simple. When you make one move, you do not
always realize that it may cause two or three other
things to happen that you did not consider when
you made the original move; so things are not
simple. There are a thousand angles to the eco-
nomics in medicine. A striking and dismaying
factor at times has been for us to find tremendous
diversity and lack of unity of our general mem-
bership in Florida.
Here, then, is the beginning of our meeting
and here is our projected course of action. If one
wishes to make a good decision on any matter,
he must know what he is doing. Do not buy a
pig in a poke or some phony uranium stock,
but do not turn down a good proposition either.
We have learned to our utter amazement, at times,
that doctors can go from sheer apathy to rank
hysteria in one jump on these economic problems;
they will at times insult their friends and bless
their enemies without knowing what they are do-
ing. We have realized that if we applied the same
methods to medical care problems as we do to the
economics of medicine, no patient would be safe.
Thank heaven, by training and aptitude, doctors
do use reason and analysis in medical cases, but
often they do not in economics. Here is the pro-
jected course of action: At this meeting we hope
to give you many of the facts and ideas concern-
ing Blue Shield that we have learned in the past
year. At least, if we have to put on the gloves
and fight, let us know what we are fighting about;
let us truly understand the issues. This we hope
to do today, to outline the facts. There is
nothing to decide today. Let your heads and
consciences guide you to your future course.
After today, our Committee will continue to
study and to make available to you all informa-
tion possible including the thoughts of our “Grass
Roots” in the membership. Then by the time of
the next annual meeting of the Florida Medical
Association, in the spring of 1958, let us make
a decision. Too, let us hope that all elements of
the Florida Medical Association will combine to
make whatever this decision is, in reference to
Blue Shield, unanimous, or at least in great ma-
jority. Our Committee has requested of the Board
of Governors, and they have agreed, that adequate
time and space be alloted in reference committee
for a full formal debate and then decision of the
House of Delegates on three matters: (1),
whether to continue Blue Shield with good and
positive support, or not to continue Blue Shield
after that; (2) to straighten out the inequities
of Blue Shield, especially in reference to the non-
surgical portions, if we wish to continue Blue
Shield; and (3) to empower somehow, someway.
Blue Shield so that it can act and not be com-
pletely hamstrung as it is now, if we vote to con-
tinue Blue Shield.
So today’s program is simply setting the stage
for the spring meeting, and you are hereby put
on notice. Please let everybody at home know. In
reference committee at that time, an agenda
should be set up so that all interested parties can
be heard; this should be worked out ahead of
time so that each person heard has thought out
his remarks carefully and the hearing does not
degenerate into a foolish time-wasting hassel, out
of keeping with our medical heritage. Could
anything be fairer?
Please refer to the agenda for this meeting.
The first half until after lunch is for Blue Shield
to present its position as an insurance vector, re-
sponsible to the laws of the State of Florida and
to the public as well as to the medical profession.
The afternoon will be devoted to the presentation
by the Committee of Seventeen, including a panel
discussion.
864
BLUE SHIELD
Volume XUV
Nu M BER 8
Blue Shield From
The Layman’s Viewpoint
Judge Ben C. Willis
TALLAHASSEE
Circuit Judge, Second Judicial Circuit and
Member of the Board of Directors of Florida Blue Shield
Dr. Carson, Dr. Babers and Active Members
of Blue Shield, I am deeply grateful to Dr. Car-
son for his more than generous remarks and I
am sure that he has committed a gross extrava-
gance in the estimate that he has given of my ser-
vices or my contribution to the Blue Shield Board
of Directors.
I have been requested to talk a few minutes
about a layman’s observation, or “Blue Shield
from the Layman’s Viewpoint.” When I speak
of layman, I mean one who is not a Medical Doc-
tor.
My first contact with Blue Shield, or my first
real knowledge that there was such an organiza-
tion, came through a physician. I had been like
everyone else, I suppose, plagued almost daily by
insurance agents of one kind or another, who
wanted me to increase my life insurance, or take
out insurance on my home to provide against this
calamity and that holocaust, and one thing and
another, until there had been built up a great deal
of resistance. I remember, however, one social
evening when, quite casually, a physician in my
home town described to me something of Blue
Cross and Blue Shield, and for the first time, I
learned that Blue Shield was an organization that
was created by and administered by physicians.
Immediately, I became interested, and when an
opportunity came some months later, when indi-
vidual applications were being received in my
county, I eagerly submitted an application and
became a subscriber. I mention my experience
for the reason that I think it was not greatly dif-
ferent from that of many others. The reason
that Blue Shield and Blue Cross, its twin and
the organization which goes hand in hand with
Blue Shield, have achieved such remarkable suc-
cess, not only in Florida, but the Plans in other
states, has been the fact that the medical profes-
sion was associated with it.
Observing as a layman, the members of the
medical profession and the medical profession as
a whole, I find, and I think the overwhelming ma-
jority of the public finds that it is a group of men
and women who are highly trained, who are highlv
skilled and who are accomplished scientists and
artists. In addition to their proficiency and their
skills, they also are a dedicated group of people.
They are dedicated professionally and dedicated
to the highest of human attributes, the relief of
suffering, and the curing of ills of the human race.
This combination of attributes necessarily as-
sociated with their profession, the skill, the train-
ing and the dedication that go with it, has placed
the physician — and I do not think that many of
you realize it — in high regard among his fellow
men.
I know that the physician perhaps thinks more
of the ungrateful patient who has complained of
what he thought was a modest bill after he had
rescued that patient from the brink of death. Or,
perhaps he thinks of the uncharitable remarks
that some uninformed person would make about
the nature of certain treatment that had been
given, but I venture to say, gentlemen, that for
every complaint you have had. for every un-
pleasant remark that has been made to you or
about you, there are dozens who may not have
expressed themselves, but who regard you with
deepest affection. Because they have observed
that in practically every instance, and I think
that is a universal truth, physicians are compas-
sionate. and physicians are those who give en-
couragement and relief in times of great stress,
you do have and you have earned a deep love and
affection from the people among whom you dwell.
That, gentlemen, is the reason Blue Cross and
Blue Shield, particularly Blue Shield, have the ap-
peal they do to the public; it is because the phy-
sicians are associated with it. and because the
public associates with the physician the very
highest of integrity, the very highest in service
and the very best of everything. That was the
reason I became interested in Blue Shield and
became a subscriber.
Since that time, I have had some opportunities
to know a little bit more about Blue Shield. I
had the privilege of being the legislative consult-
ant. sometimes vulgarly referred to as a lobbyist,
in the state legislature for a number of interests
including Blue Shield, and I had to learn, and
did learn, much of the inner workings of the or-
ganization. At first, my impression was that it
was just another insurance company, that per-
haps a group of doctors had put up the money,
and that they owned and controlled and adminis-
tered the company. I find that I was in error.
It was originated by the physicians, and it was
through the devoted efforts, and sometimes the
very discouraging efforts, of some energetic and
J. Florida M.A.
February. 1958
BLUE SHIELD
865
ambitious people that Blue Shield of Florida
came into existence. There was at one time enough
money put up to get it started, but there is not
a dime now that is owned by anyone.
Blue Shield is an insurance company to be
sure. It is a corporation; but unlike the ordinary
corporation, it has no stockholders, it has no
dividends, but it does have a tremendous service.
The ones who foot the bill, the subscribers, have
no voice whatever in its operation. I hey have no
voice in the choice of directors; they have no
vote in any of its deliberations. The subscribers
are contributing and are placing into the channels
of Blue Shield something like a half million dol-
lars each month; and as Dr. Carson has stated,
86.5 per cent of this amount is returned to the
subscriber, that is, nominally it is returned to the
subscriber, but actually it goes into the pockets
of the physicians of Florida because the benefits
are paid directly to the physicians. So it is a
multimillion dollar proposition so far as the phy-
sicians of this state are concerned.
Very properly, the enabling act requires that
a majority of the Board of Directors shall be phy-
sicians. Actually, 12 out of 19 members of the
Board of Directors are physicians. Now, what
would be comparable to the stockholders, that is,
those who have a voice in the election of directors
and the direction of the policy, is also cast very
heavily in the medical profession. It is provided
that the Active Members of Blue Shield, of
which this is an assembly, shall be the members
of the House of Delegates of the Florida Medical
Association, plus the Blue Shield Board of Direc-
tors, and there is some word about such other
persons as may be elected to membership. There
is also the requirement that such other persons
shall never exceed 20 per cent of the entire mem-
bership. So you can see that from the very re-
quirements of the organization, it is the medical
profession which dominates it, as it should do.
So it is your Blue Shield. It is the Blue Shield
of the Florida physicians.
I have also had the privilege of observing the
operation of the Florida Medical Association,
which I think is one of the finest organizations in
the state. It is certainly a very representative or-
ganization. I believe that you have a large per-
centage of the practicing physicians as members
of your Florida Medical Association. It is the
delegates from the individual societies, presumably
I suppose, chosen by the physicians themselves
in their local societies, who constitute the active
members of this organization.
Being a multimillion dollar organization and
being an insurance company, subject to regula-
tion by the State Insurance Commissioner, having
an obligation to its subscribers, steadily growing
as it has in the past and bids to do in the future,
Blue Shield is confronted with created problems.
There are created problems of policy. There are
created problems of trying to anticipate develop-
ments and to meet conditions which are rapidly
changing. Perhaps the initial reason for the bring-
ing into existence of Blue Cross and Blue Shield
was the fact that the commercial insurance com-
panies themselves were reluctant to enter the pre-
paid medical and hospital care program. It is un-
derstandable because commercial companies have
to show a profit. It requires a tremendous out-
lay both in money and in organization to put a
program like this over, and the chances are, with-
out experience behind them, the companies were
reluctant to go into this field because they did not
know just what the result might be.
After it was pioneered by the Blue Shield and
Blue Cross corporations, however, and it was
found that it would work and did work, the com-
mercial companies came into the field. Their
activity presents a problem, too, to Blue Shield,
in that it does have competition. It is competition
that is actively seeking, though not dishonorably
— I am not going to accuse any insurance com-
pany of being dishonorable — to eliminate Blue
Shield. They would like to see Blue Shield fail.
They would like to see it out of the picture be-
cause it is a good thing and something in w'hich
they would like to be more active and have a big-
ger share. Blue Shield has never sought to be
exclusive in this field. It has welcomed compe-
tition, it has welcomed the opportunity that the
public would have to receive whatever benefits
the commercial companies are able to provide. We,
however, are here and we must recognize that we
do have competition. If we are to survive, and to
carry on the program which has been set out,
that competition must be recognized and that
competition must be met.
I paid you a compliment, that is, I paid the
medical profession a compliment a moment ago.
It was not a compliment that is undeserved by any
means or in any way exaggerated, because you do
have the affection, the regard, and the confidence
of your fellow men. I do want to point out, how-
ever, that there is nothing that reminds me so
866
BLUE SHIELD
Volume XLI V
Number 8
much of a group of lawyers, as a group of doctors.
When we get together and have our meetings, we
behave just about like a group of doctors, and I
imagine the engineers and the other professions
behave pretty much the same way. I do want to
mention this in all good humor and in all sincerity,
and without any intention of being critical because
it is perfectly natural that when persons do be-
come highly skilled and become artists, there are
a few who become prima donnas. I am happy
to say, that from my observation, those have been
in the great minority and that the great majority
have sought to approach whatever questions or
problems that may have confronted them, or may
have occurred to them, on a very rational and
reasonable basis with a keen desire to pursue them
as one would any other scientific fact, to search
for and obtain the truth.
Blue Shield is not beyond criticism. It is not
beyond improvement. There are many instances
in which criticism is warranted and welcomed
and from which improvements have .been made.
Nevertheless, for all of those criticisms that come
about in a reasonable and rational manner, when
they are presented in other ways, it creates a great
handicap to those who are attempting to form the
policy or to administer the actual workings, be-
cause it takes time and sometimes it takes a great
deal of time to fathom what is behind many of
these things and to get to the bottom of it. I
believe that the Committee of Seventeen has done
a wonderful job in bringing to the physicians of
this state the problems of Blue Shield and also in
bringing to the Board of Directors and to the
management of Blue Shield the problems of the
physicians, so that the two might be matched
and the problems might be resolved. I think a
great deal of misunderstanding has been dis-
sipated. More in that line of course is needed and
will always be needed; it is a continuing project.
I should like to impress upon this group that
Blue Shield is yours. It is yours to continue to
grow and continue to serve, or it is yours to de-
stroy. It will do one or the other. It will not
stand still. Blue Shield must meet changing con-
ditions, it must meet competition, it must seek
to give the service that the public itself is demand-
ing, and which it will get one way or another,
either from the government or from the commer-
cial insurance companies, if they are willing to
enter it. The public is going to get what it de-
mands, one way or the other. There are many
fine things about a Blue Shield Plan. I think it
preserves the very finest that we have in our
system of economics. It certainly recognizes the
value and the necessity of free enterprise. It rec-
ognizes the sanctity of the physician and patient
relation. It recognizes the freedom of- choice of
the patient or the physician. It recognizes all that
we cherish and hold dear and it seeks and has ac-
complished much towards solving the great prob-
lem which -has faced our people in these times of
having an income which barely provides what we
consider to be the actual necessities.
Very few of us, and I say “us,” set aside very
much for the so-called rainy day. We are not able
to do so even though our income may be con-
sidered rather substantial. We feel that we want
to educate our children and want to send them to
creditable colleges and universities. We feel that
we want to maintain certain standards in our
home. We want to have a comfortable home and
we want it equipped. We do not want a fireplace;
we want a furnace. We do not want an old gramo-
phone; we want a TV set. We want the things
that we feel our age and times entitle us to have.
When those things are provided, we find that there
is not much to set aside for the rainy day. So a
person can have a rather substantial income, and
yet in a very short time become medically indi-
gent. If suddenly some disease or accident befalls
him and he is unable to continue his earnings and
is required to make the expenditures which hos-
pitalization and medical expenses bring forth now,
he finds that in a short time he is behind the eight
ball, so to speak. So, Blue Shield is not merely
for the common laborer; it is not merely for the
low'-salaried worker; it really reaches into the
realm of those who do have substantial incomes;
and it does provide against those contingencies
which arrive and relieves both the tensions and
the economic demands that those unfortunate oc-
currences bring about.
I would ask that each of you take this message
back to your fellows in your own communities;
that if there is a problem, if there is a question,
to try to understand the reason for the existence
of the problem and come forth with a concrete
suggestion for correcting whatever may be the
thing to be criticized.
I think the management and Board of Direc-
tors both recognize that without the support that
has been given by the physicians of Florida, Blue
Shield would long ago have failed. There have,
however, been instances in which they have been
rather veximr. Criticisms have been resolved when
J. Florida M.A.
February, 1958
OTHERS ARE SAYING
867
full knowledge was brought forth. I ask you to
cooperate with your Committee of Seventeen, and
to seek to know more about your organization
and what it seeks to do and the problems that
it faces.
I will tell this little story, in closing, of an old
gentleman who had for many years nursed very
tenderly and very devotedly an invalid wife who
had suffered from rheumatism for about 30 years.
When the dear old soul passed away, the old man
was very much grieved and hurt. About six weeks
later it was noticed that he began to pay attention
“Doctors should be dedicated,” is heard fre-
quently enough when laymen discuss physicians.
That type of conversation is usually triggered by
an occasion when no physician can be found at
the precise moment that the patient expects him
to be on tap. The inference is that their ideal is
a chap who is always on hand, day or night, 7
days a week, 52 weeks a year; and that the physi-
cian who is not Johnnie-on-the-spot is not dedi-
cated. This “devoted” fellow never sleeps, never
takes a vacation, never sends a bill, never deviates
from his jolly, unruffled composure, and always
goes along with every suggestion that the family
makes. To complete the deal he has to die pre-
maturely of a heart attack or double pneumonia
incurred in the course of some extraordinary ex-
hibition of medical heroism, such as getting out
of his sick bed at 2 a.m. and plodding his way
2 miles through 2 feet of snow to get to some kid
whose mother just found out he had swallowed
a nickel two days ago.
Well then, what is a dedicated physician? It
doesn’t have to be a person who dashes into a
burning building to save an unconscious child.
Those other than physicians would do this if the
calculated risks were favorable. He might be the
physician who innocently enters a dive to sew
up a cut, only to find carving knives brandished
menacingly. He might be the physician who acci-
dentally stabs himself with an i.v. needle dripping
with luetic blood. He might be the physician who
tries to make time on the icy glare of a highway
strewn with wrecks, himself skidding through on-
coming traffic and into the guard rail a half dozen
times and ending up tipped over on his side. He
might be the physician who sucks out a mouthful
of inhaled vomitus with a rectal tube and goes
to a rather young woman; and finally, to the sur-
prise of the community, the announcement was
made that he and this young girl had married.
One of his old friends went to him and said,
“Well, Uncle John, it’s mighty fine, glad you did
it, hope you’ll be happy, but you were so devoted
to your first wife that it comes as sort of a sur-
prise to us that you have done this thing.” He
replied, “Well, son, I smelled liniment for 20
years and now I’d like to smell a little perfume.”
So. the Board of Directors and the management
would like to smell a little perfume. Thank you.
back for more until breathing is restored. He
might be the physician who goes into the den of
a homicidal maniac to make an examination. He
might be the isolated G.P. who operates on a red
hot appendix because no surgeon would be avail-
able for many hours. He might be the physician
who orders an appendectomy on an acutely ill
patient who insists his appendix was removed
when the hernia was repaired.
We know all of these “might have” situations
have happened, and without considering them at
the time to be any more than routine. It is likely
that few physicians ever look upon themselves as
being dedicated or not dedicated.
We feel that it is not the dramatic incidents
taking a total of a few hours of a physician’s life-
time that count. A physician is more likely than
not to be dedicated if he is a consistent worker.
("Anything over 40 hours a week should do, and
allow him at least 2 weeks vacation a year.) He
is dedicated if he inconveniences himself day or
night for anyone who feels worse than he does.
He is dedicated if he takes enough time off, and
at proper intervals, to keep his body fit and his
mind keen. He is dedicated if he forgets to send
any other than the first bill in certain hardship
cases, but is businessman enough to provide for
his family and his family’s future, with due re-
gard to the investment made in money and ardu-
ous years of application. He is dedicated if he
has the right proportion of empathy and sympathy
to make a neat job of children’s injuries and still
have them like him. He is dedicated if he pulls
his weight at staff meetings, medical society meet-
ings, medical conventions and in committee work.
He is dedicated if he goes to church, takes an in-
terest in civic affairs, gets acquainted with his
OTHERS ARE SAYING
Doctors Are Dedicated
868
Volume XL1V
Number 8
family occasionally, and has a few friends in to
dinner.
We believe that physicians, almost without
exception, are dedicated. They should in their
daily contacts play down the intriguing and
amusing incidents of practice. They should accent
the devotion of daily duty and the varied social
and quasi-medical activities that make the whole
man. Through the medical press and other media
of publicity there should be a continuing educa-
tion of the patient to get him down to earth.
To some a dedicated physician is one who is
so hypnotized by the emotional impact of his
profession, the glamour, the appeal of the distress-
ed, the noble and spiritual concepts of the healing
art that the practical side never touches him.
They see him up there surrounded by a glow of
light, suspended ecstatically between his halo and
his pedestal, ignoring the laws of gravity. It has
been said that a crack-pot is a person with 90
per cent zeal and 10 per cent motive. We’ll take
dedicated in lower case letters.
Massachusetts Physician
December, 1957
LETTER TO THE EDITOR
Dear Sir:
Recent reports in the ophthalmologic literature
of toxic chorioretinopathy following the use of
phenothiazine compounds as tranquilizing drugs
lead me to believe it may be worth while to bring
them to the attention of the medical population
as a whole who prescribe most of these drugs.
Grant1 in a review of ophthalmic pharma-
cology and toxicology quoted four reports of reti-
nal pigmentary degeneration following the use of
piperidylphenothiazine.2-5
Goar0 reported severe toxic chorioretinopathy
in 28 of 34 patients given chlorophenothiazine,
some of whom apparently suffered permanent vis-
ual damage.
Sincerely
William J. Gibson, M.D.
1. Grant, W. M.: Ophthalmic Pharmacology and Toxicology,
A M. A. Arch Ophth. 58:265-281 (Aug.) 1957.
2. Kinross-Wright V.: Clinical Trial of New Phenothiazine
Compound; N P-207, Psychiat. Res. Rep. 4:89-94 (April)
1956.
3. Rintelen, F.; Hotz, G., and Wagner, P. : N.P. 207, Med.
cl Hyg., Geneva, 14:426, 1956.
4. Verrey, F. : Degenerescence pigmentaire de la retine d’origine
medicamenteuse, Ophthalmologica 131:296-303 (Apr.-May)
1956.
5. Wagner, P. : Investigation of Effect of Phenothiazine Deriv-
atives on Fundus of Animals, Klin. Monatsbl. Augenh
129:772-781, 1956.
6. Goar, E. L., and Fletcher, M. C. : Toxic Chorioretinopathy
Following Use of N.P. 207, Am. f. Ophth. 44:603-608 (Nov.)
1957.
STATE NEWS ITEMS
Dr. Hawley H. Seiler of Tampa has been
elected secretary-treasurer of the Southern Thor-
acic Surgical Association.
Dr. L. Roland Young of Daytona Beach
after attending the Clinical Session of the Ameri-
can Medical Association in Philadelphia remain-
ed there a few days to visit clinics at the Univer-
sity of Pennyslvania Graduate School of Medicine.
The Fifty-Fourth Annual Congress on Medi-
cal Education and Licensure is being held Feb.
8-11, 1958. in the Palmer House, Chicago. It is
sponsored by the Council on Medical Education
and Hospitals of the American Medical Associ-
ation; Advisory Board for Medical Specialties,
and the Federation of State Medical Boards of
the United States.
A grant of $64,000 has been awarded the Uni-
versity of Florida College of Medicine by the Na-
tional Institutes of Health as a fellowship for Dr.
Vergil H. Ferm, Associate Professor in Anatomy.
The grant is to extend over a five year period
during which time Dr. Ferm will continue his re-
search in the role of placental function as it re-
lates to the effects of various prenatal stimuli on
the production of congenital malformations.
Dr. Hugh A. Carithers of Jacksonville has ac-
cepted the appointment as a member of the selec-
tion committee for the Wyeth Laboratories pe-
diatric residency fellowship program. Recipients
of the 20 two year pediatric residency fellowships
to be offered annually by Wyeth, beginning July
1, 1958. are to be designated by the committee.
The 26th Annual Alumni Postgraduate Medical
Convention of the College of Medical Evangelists
begins Tuesday, February 25, at the Hotel Bilt-
more in Los Angeles. Ten nationally recognized
physicians from medical centers across the coun-
try. an equal number of California physicians and
three attorneys will participate in the three days
of scientific sessions.
The Marion County Medical Society, through
Dr. Richard C. Cumming of Ocala, has presented
the Dr. Stewart Thompson Memorial Award to
Mr. Raymond J. Sever of Hialeah, a student at
J. Florida M.A.
February, 1958
869
Nilevar
stimulates protein synthesis,
corrects negative nitrogen balance
Increased nitrogen loss, with resulting nega-
tive nitrogen balance, occurs in infection,
trauma, major surgery, extensive burns, cer-
tain endocrine disorders and starvation and
emaciation syndromes. The intrinsic control
of protein metabolism is lost and a protein
“catabolic state” occurs. A patient requiring
more than ten days of bedrest usually has had
sufficient metabolic insult1 to precipitate such
a “catabolic” phase.
Nilevar (brand of norethandrolone) has
been used in patients with varied conditions
including hyperthyroidism, poliomyelitis,
aplastic anemia, glomerulonephritis, anorexia
nervosa and postoperative protein depletion.
The patients gained weight and felt better.
It was concluded2 that “the drug certainly
caused a reversal of rather recalcitrant or
progressive catabolic patterns of disease.”
Nilevar is unique among anabolic steroids
in that androgenic side action is minimal or
absent.
The suggested adult dosage is three to five
tablets (30 to 50 mg.) daily. For children 1.5
mg. per kilogram of weight is recommended.
G. D. Searle & Co., Chicago 80, Illinois.
Research in the Service of Medicine.
1. Axelrod, A. E.; Beaton, J. R.; Cannon, P. R., and others:
Symposium on Protein Metabolism, New York, The National
Vitamin Foundation, Incorporated, (March) 1954, p. 100.
2. Proceedings of a Conference on the Clinical Use of Ana-
bolic Agents, Chicago, Illinois, G. D. Searle & Co., April 9,
1956, pp. 32-35.
s
870
Volume XUV
Number 8
the University of Miami School of Medicine at
Miami. The award was given for outstanding
scholarship and is one of two awards given as a
memorial to Dr. Thompson. The other award
has been presented to Mr. Santford Russell Wil-
son, a student at the University of Florida College
of Medicine, Gainesville.
The New York University-Bellevue Medical
Center’s Post-Graduate Medical School is offering
postgraduate courses in Medicine, Dermatology
and Syphilology, Orthopedic Surgery, Opthal-
mology, Radiology, Pediatrics and Otorhinolaryn-
gology to be given or started during the month
of February. Information about the courses may
be obtained from the Associate Dean, NYU Post-
Graduate Medical School, 550 First Ave., New
York 16.
Dr. Walter W. Sackett Jr. of Miami has been
presented the second annual Outstanding Alumni
Award given by the University of Miami Student
Body Government. Dr. Sackett has been active
in the American Academy of General Practice.
Grants totaling $12,000 have been awarded
the University of Miami School of Medicine by
the National Institutes of Health to be used to
develop research programs in heart surgery and
the relationship of different gases to the chemical
energy of the heart. Physicians connected with
the new research projects include Drs. Banning
G. Lary, John J. Farrell, George Paff, Robert J.
Boucek and Robert S. Litwak.
The Midwinter Meeting of the Florida Ob-
stetric and Gynecologic Society was held late in
November at the Ft. Harrison Hotel in Clear-
water. Physicians presenting papers included Drs.
Jackson L. Allgood Jr., Jacksonville; William T.
Mixson Jr., Coral Gables; Henry L. Wright Jr.,
Tampa, and Arthur N. Berry, Columbus, Ga. A
panel discussion was conducted by Dr. Ralph
Gause, New York, and members of the panel were
Dr. Robert Barter, Washington D. C., Dr. Berry,
and Dr. Dorothy D. Brame, Orlando. Drs. Charles
A. Johnson Jr. and Davis H. Vaughan, both of
Clearwater, were in charge of local arrangements.
Dr. Duncan T. McEwan of Orlando, a past
president of the Florida Medical Association, has
been visiting clinics and hospitals in the Hawaiian
Islands and in Japan.
A
nnouncma . . .
SPRING POSTGRADUATE COURSES
ON
DISEASES OF THE CHEST
sponsored by the
Council on Postgraduate Medical Education
AMERICAN COLLEGE OF CHEST PHYSICIANS
Concerning the most recent advances in the diagnosis and treatment of cardio-
vascular and pulmonary diseases (medical and surgical).
11th Annual Course
Warwick Hotel, Philadelphia
March 3-7, 1958
4th Southern Course
Grady Hospital, Atlanta, Ga.
March 10-14, 1958
TUITION: $75.00
(Including round table
luncheons at each course)
Executive Director
American College of Chest Physicians
112 East Chestnut Street Department F
Chicago 11, Illinois
I wish to enroll in the Philadelphia ( ) At-
lanta ( ) Postgraduate Course on Diseases
of the Chest. Enclosed is my check for $75.00.
Name
Address
City/State
Registration for these postgraduate courses is limited.
Applications will be accepted in the order received.
J. Florida M.A.
February, 1958
871
ACH ROCI DIN
TETRACYCLINE- ANTIHISTAMINE- AN ALGESIC COMPOUND LEDERLE
A versatile, well-balanced formula capable of modifying
the course of common upper respiratory infections . . .
particularly valuable during respiratory epidemics; when
bacterial complications are likely; when patient’s history >
is positive for recurrent otitis, pulmonary, nephritic, or
rheumatic involvement.
Adult dosage for Achrocidin Tablets and new caffeine-
free Achrocidin Syrup is two tablets or teaspoonfuls of
syrup three or four times daily. Dosage for children ac-
cording to weight and age.
Available on prescription only.
TABLETS (sugar coated ) Each Tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Bottles of 24 and 100.
SYRUP (lemon -lime flavored ) Each teaspoonful (5 cc.)
contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyrilamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
Bottle of 4 oz.
the
rapidly relieves
debilitating symptoms
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
*T rademark
872
Volume XLIV
Number 8
hector "
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G. B. Griffith, President
J. Florida M.A.
February, 1958
873
Dr. Cayetano Panettiere of Miami Beach has
been presented the Barry College Laudare Medal
in recognition of outstanding service to the college
and to the community.
Dr. William H. Everts of West Palm Beach
has been elected president of the Florida Psy-
chiatrists Association. Dr. Samuel G. Hibbs of
Tampa will serve with Dr. Everts as secretary-
treasurer.
Dr. Thomas H. Bates of Lake City has been
reappointed a medical advisor by the American
Cancer Society and has accepted appointment to
the Society’s Survey Committee and the Patient
Aid Committee.
Dr. Caroline B. Hunter of Coral Gables has
been elected president of the Women Physicians
of the Southern Medical Association.
The Greater Miami Eye, Ear, Nose and Throat
Society have elected the following officers for
1958: Dr. William B. Steinman, Miami, presi-
dent; Dr. James H. Mendel Jr., South Miami,
president-elect, and Dr. H. Carlton Howard,
Miami, secretary-treasurer. The Society meets
quarterly at the Urmey Hotel in Miami.
The Fifth International Congress of Internal
Medicine will be held in Philadelphia April 23-
26, 1958. This is the first meeting of the Society
to be held in the United States and was arranged
after an invitation was officially extended by the
American College of Physicians.
Members of the Florida Medical Association
attending the 1957 Clinical Meeting of the Ameri-
can Medical Association in Philadelphia included
Drs. Louis M. Orr, Orlando; Reuben B. Chris-
man Jr., Coral Gables; Francis T. Holland and
J. Elizabeth Jeffress, Tallahassee; Homer L.
Pearson Jr. and Carl H. Davis, Miami; Joseph J.
Lowenthal, Bernard J. McCloskey and John H.
Mitchell, Jacksonville; William C. Roberts, Pan-
ama City; L. Roland Young, Daytona Beach, and
Richard A. Mills, Fort Lauderdale.
The Council on Postgraduate Medical Educa-
tion of the American College of Chest Physicians
will sponsor the Fourth Southern Postgraduate
(Continued on page 879)
PERFORMANCE WITH
GREATER PERMANENCE
IN THE MANAGEMENT .
OF DERMATOSES...
(Regardless of Previous Refractoriness)
Confirmed by
an impressive and
growing body of published ^
clinical investigations
IA!CQlTIi:_
Hydrocortisone 0.5% and Special Coal Tar Extract 5%
(TARBONIS®) in a greaseless, stainless vanishing cream base.
neo-tarcortin:_
Hydrocortisone 0.5%, Neomycin 0.35% (as Sulfate) and Special
Coal Tar Extract 5% (TARBONIS) in an okitment base.
ATOPIC DERMATITIS * ECZEMAS ' SEBORRHEA • ANOGENITAL PRURITUS » DERMATITIS VENENATA • PSORIASIS
& CARNRICK j Jersey City 6, New Jera
*
1. Clyman, S. G. : Postgrad. Med. 1 1 :309, 1957.
2. Bieiberg. J.: J, M. Soc. New Jersey 53: 37, 1956.
3. Abrams. B. P. and Shaw. C. : Clin. Med. S :839. 1966
4. Welsh. A. L., and Ede. M. : Ohio State M. J. 50:837. 1954.
6. Bleiberg, J.: Am. Practitioner *:1404, 1957.
874
Volume XLIV
Number 8
of infant feeding
Standard formulas for NEWBORNS
Breast feeding is the procedure of choice fc;
the newborn. But it may need to be comph
mented with standard formulas given here.
The first feeding, 12 hours after birth, consisia
of a prelacteal solution of 5% Karo Syrup, or^
or two ounces, repeated at two-hour interval
Breast feeding is started on the second day f<
five-minute intervals and the prelacteal fee<
ing continued immediately thereafter an
between nursings.
Formula feeding is given on the second day
breast feeding is denied. The small infat
prefers the three-hour schedule and the larj
infant the four-hour schedule.
The initial formula is a low-caloric milk mi
ture, gradually increased in concentratic
over several day intervals according to tole
ance. Standard formulas for whole cow’s mi
or evaporated milk modified with dilutf
Karo Syrup as shown here, constitute tl
dietary regimen for well newborns.
First formulas for newborns,
concentrated, according to tolerance
Evaporated Milk Formulas: 3 oz. q 4h x 6 feedings
FORMULA I FORMULA II FORMULA I
12.5 cals./oz. 16 cals./oz. 20 cals./oz.
Evap. Milk . . 4 oz 5 oz. 6 oz.
Water 14 oz. 13 oz. 12 oz.
Karo Syrup . . 1/2 oz. 3/4 oz. 1 oz.
Whole Cow's Milk Formulas: 3 1/2 oz. q 4h x 6 feeding;
FORMULA I FORMULA II FORMULA I ,
11 cals./oz. 11.5 cals./oz. 13.5 cals./oz
Whole Milk . . 8 oz.
Water 12 oz.
Karo Syrup . . 1/2 oz.
9 oz.
11 oz.
3/4 oz.
10 oz.
10 oz.
1 oz.
'
ADVANTAGES OF KARO IN INFANT FEEDING
Composition: Karo is a 5
perior maltose-dextrin mixtu
because the dextrins are non-f< j
mentable and the maltose
rapidly transformed into dextn
which requires no digestion.
Concentration: voi ume f
volume Karo furnishes twice
many calories as similar mi:
modifiers in powdered form.
Purity: Karo is processed
sterilizing temperatures, seal,
for complete hygienic protecti .
and devoid of pathogenic •
ganisms.
Low Cost: Karo costs l/5th i
much as expensive milk modifi i
and is available at all food stor.
«.♦ \ Medical Division
CORN PROOUCTS REFINING COMPA
*♦*,*♦* 1 7 Battery Place, New York 4, N. Y
New... from Pfizer Research
compounds tested
compound unexcelled
Progress has been made in antibiotic therapy
through the use of absorption-enhancing agents,
resulting in higher, more effective antibiotic blood
levels.
For the past two years, in a continuing search
for more effective agents for enhancing oral anti-
biotic blood levels, our Research Laboratories
screened eighty-four adjuvants, including sorbitol,
citric acid, sodium hexametaphosphate, and other
organic acids and chelating agents as well as phos-
phate complex and other analogs. After months of
intensive comparative testing, glucosamine proved
to be the absorption-enhancing agent of choice.
Here’s why :
1 Crossover tests show that average blood levels
achieved with glucosamine were markedly higher
than those of other enhancing agents screened. In
some cases this effect was more than double.
2 Of great importance to the practicing physi-
cian is the consistency of the blood level enhance-
ment achieved with glucosamine. Extensive tests
show that the enhancing effect with glucosamine
occurs in a greater percentage of cases than with
any other agent screened.
3 Glucosamine is a nontoxic physiologic metabo-
lite occurring naturally and widely in human se-
cretions, tissues and organs. It is nonirritating to
the stomach, does not increase gastric secretion,
is sodium free and releases only four calories of
energy per gram. Also, there is evidence that glu-
cosamine may favorably influence the bacterial
flora of the intestinal tract.
For these reasons glucosamine provides you with
an important new adjuvant for better enhance-
ment of antibiotic blood levels. Tetracycline, po-
tentiated physiologically with glucosamine, is now
available to you as Cosa-Tetracyn.
Capsules 250 mg. and 125 mg.
COSA-TETRACYN
CtUCOSAMINE-POTENTIATED TETRACYCLINE
The most widely used
broad-spectrum antibiotic
now potentiated with
glucosamine, the
Pfizer laboratories enhancing agent of choice
Urfizer) Division, Chas. Pfizer & Co., Inc. ^ w
^ Brooklyn 6, N. Y.
"Trademark
876
Volume XL1V
Number 8
why
wine
in Cardiology?
TT'or generations without number wine
has been extolled as an "effective stim-
ulant” and, therefore, valuable aid to treat-
ment in various types of cardiovascular
disease. It was this peculiar property, no
doubt, which prompted the poet, Salerno,
some 800 years ago to write — "Sound wine
revives in age the heart of youth.”
Now, as a result of modern research, we are
obtaining concrete evidence of the favor-
able physiologic action of wine to lend sup-
port to the empiricism of ancient usage.
Both brandy and wine in moderate quanti-
ties have been found to substantially in-
crease the pulse rate and step up the stroke
volume of the heart.
x-
■J
relieving the pam of angina pectoris and
obliterative vascular disease.
Moreover, aside from the purely hypoten-
sive actions of wine, its unquestionable
euphoric effects help counter the depres-
sion, apprehension and anxiety so fre-
quently present in sufferers from heart and
coronary disorders.
The beneficial actions of wine appear to
transcend those of more concentrated alco-
holic beverages — valuable cardiotonic
properties having been attributed to the
aliphatic aldehydes and other nonalcoholic
compounds recently isolated from certain
wines and grape varieties.
It goes without saying that the use of alco-
hol, even in the form of wine, is contra-
indicated in hypertension accompanied by
certain types of renal disease.
For a discussion of the many modern Rx uses for wine, write
for the brochure, “Uses of Wine in Medical Practice" to Wine
Advisory Board, 717 Market Street, San Franciscio 3, California.
when are
tranquilizers
indicated in
pediatrics
ATARAX
in any
hyperemotive
state
for childhood behavior disorders
10 mg. tablets-3-6 years, one tab-
let t.i.d.; over 6 years, two tablets
t.i.d. Syrup — 3-6 years, one tsp.
t.i.d.; over 6 years, two tsp. t.i.d.
for adult tension and anxiety
25 mg. tablets -one tablet q.i.d.
Syrup-one tbsp. q.i.d.
for severe emotional disturbances
100 mg. tablets— one tablet t.i.d.
for adult psychiatric and emotional
emergencies
Parenteral Solution-25-50 mg.
(1-2 cc.) intramuscularly, 3-4
times daily, at 4-hour intervals.
Dosage for children under 12 not
established.
Supplied: Tablets, bottles of 100. Syrup,
pint bottles. Parenteral Solution, 10 cc.
multiple-dose vials.
Some doctors have questioned the use of tranquilizers in children. They feel, and
rightly so, that these drugs should not be used as palliatives to mask distressing
symptoms, while etiological factors go uncorrected. But there are three situations in
which even the most conservative physician would not hesitate to use tranquilizers:
1. When the usually well-adjusted child needs a buffer against temporary emo-
tional stress, such as hospitalization.
2. When a child needs relief from an anxiety-reaction that is in turn anxiety-
provoking, so as to pave the way for basic therapy.
3. When anxiety underlies or complicates somatic disease, as in asthma.
In such situations, tranquilizers are likely to be more effective and better tolerated
than previously accepted therapy, such as barbiturates.
But the question arises: which tranquilizer is suitable for children?
Most of the physicians now using tranquilizers in pediatric practice have found the
answer to be ATARAX, confirming the conclusions of repeated clinical studies.
ATARAX is effective in a wide range of pediatric indications.
ATARAX has produced a “striking response” in a wide range of hyperemotive states.*
In a study of 126 children, “the calming effect of hydroxyzine (ATARAX) was
remarkable" in 90%.* Among the conditions that are improved with ATAR/0< are
tics, nervous vomiting, stuttering, temper tantrums, disciplinary problems, crying
spasms, nightmares, incontinence, hyperkinesia, etc.*
ATARAX is well tolerated even by children.
“ATARAX appears to be the safest of the mild tranquilizers. Troublesome side
effects have not been reported. . . ."*
ATARAX offers two pediatric dosage forms.
ATARAX Syrup is especially designed for acceptability by medicine-shy youngsters.
A small 10 mg. tablet is also available. In either case, you will get a rapid, uncom-
plicated response. Why not, for the next four weeks, prescribe ATARAX for your
hyperemotive pediatric patients. See whether you, too, don’t find it eminently
suitable.
* Documentation on request n .. ..
Pe^CGoFMiNDynTIMX
(•HAND or HYDROXYZIMC)
Medical Director
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
;
"care of
the man
rather than merely
his stomach"1
Milpath
Mil town1® O anticholinergic
two-level control of
gastrointestinal dysfunction
at the central level The tranquilizer Miltown* reduces anxiety and tension.1- 3- 6- 7
Unlike the barbiturates, it does not impair mental or physical efficiency.6-7
> . " *» " - '
at the peripheral level The anticholinergic tridihexethyl iodide reduces
hypermotility and hypersecretion.
Unlike the belladonna alkaloids, it rarely produces dry mouth or blurred vision.2-
indications: peptic ulcer, spastic and irritable colon, esophageal
spasm, G. I. symptoms of anxiety states.
each Milpath tablet contains:
Miltown.® (meprobamate WALLACK) 400 mg.
(2-methyl-2-/t-propyl-l,3-propunediol dicarbamate)
Tridihexethyl iodide
(3-diet by lamino- 1 -cyclohexy 1-1 -phony l-l-j>ropanol-cth iodide)
.2.) mg.
dosage : 1 tablet t.i.d. at mealtime
and 2 tablets at bedtime.
available : bottles of 50 scored tablets.
references: I Altschul, A. and Billow, B : The clinical use of meprobamate. (Miltown4). New York J. Med. 57: 2561.
July 15, 1957. 2. Atwater. J S. : The use of anticholinergic agents in peptic ulcer therapy. J. M. A. Georgia J,n:\ 21. Oct. 1956.
3 Borrus, J. < .: Study of elTeet of Miltown (2-mcthy!-2-/t-propy 1-1. 3-propanediol (licarbamate) on psychiatric states.
J. A. M. A. /57:1596. April 30. 1955. 1. Gayer. 1>.: Prolonged anticholinergic therapy of duodenal ulcer. Am. J. Digest. I)is.
/:301. July 1956. 5. Marquis. 1> G.. Kelly. K. L., Miller. J. G.. Gerard, R. W. and Rapoport. A : Experimental studies of
behavioral effects of. meprobamate on normal subjects. Ann. New York Acad. Sc. 67:701. May 9. 1957. 6. Phillips. R. E.:
Use of meprobamate (Miltown*-) for the treatment of emotional disorders. Am. Praet. & Digest Treat. 7:1573. Oct. 1956.
7. Selling. I. S A clinical study of Miltown4. a new tranquillzing agent . J. Clin. & Ex per. Psychopath. 17: 7. March 1956.
3 Wolf, S. and Wolff. 11 G.: Human Gastric f unction. Oxford University Press. New York. 1947.
#
WALLACE LABORATORIES. New Brunswick, N. J.
relaxes
both
mind
muscle
without
impairing
mental
or physical
efficiency
nontoxic / no blood dyscrasias, liver toxicity,
Parkinson-like syndrome or nasal stuffiness /
well suited for prolonged therapy
Supplied: 400 mg. scored tablets, 200 mg. sugar-coated
tablets. Usual dosage: One or two 400 mg. tablets t.i.d.
For anxiety, tension and muscle
spasm in everyday practice .
Milt own
tranquilizer with muscle-relaxant action
2 - methy I -2 -n- propyl -1,3 -propanediol dicarbamate
THE ORIGINAL MEPROBAMATE
DISCOVERED & INTRODUCED BY
WALLACE LABORATORIES
NEW BRUNSWICK, NEW JERSEY
CM -6058
lN important advance in menopausal therapy
Because it replaces half control with full control.
Because it treats the whole menopausal syndrome.
Because one prescription manages both the
psychic and somatic symptoms.
SUPPLIED : Bottles of 60 tablets.
Each tablet contains :
Two -dim ension al
MILTOWN1^ ( meprobamate, Wallace) 400 mg.
2- methyl -2-n-propyl-l, 3-propanediol dicarbamate.
U. S. Patent No. 2,724,720.
“Milprem”
MILTOWN® , CONJUGATED ESTROGENS (EQUINE)
A Proven Tranquilizer * A Proven Estrogen
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who discovered and introduced Miltown, the original meprobamate.
treatment
of
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Licensed under U. S. Patent No. 2,429,398.
DOSAGE: One tablet t.i.d. in 21-day courses with one week rest periods.
Should be adjusted to individual requirements.
Samples and literature on request.
J. Florida M.A.
February, 1958
879
(Continued from page 873)
Course on Diseases of the Chest at the Grady
Memorial Hospital in Atlanta, Ga., March 10-14,
1958. The most recent advances in the diagnosis
and treatment of chest diseases, both medical
and surgical, will be presented. The tuition fee
is $75. A registration form for the course may
be found on page 870 of this issue of The Journal.
Dr. Victor H. Witten of New York discussed
“What’s New in Dermatology” at the January
meeting of the Jacksonville Dermatological Soci-
ety held in the Marshall Taylor Doctors’ Building
at Jacksonville. Dr. Lauren M. Sompayrac of
Jacksonville, president of the Society, presided.
Dr. Witten, a native of Jacksonville, is co-editor of
the “Yearbook of Dermatology” and an associate
of Dr. Marion Sulzberger.
A meeting of the Air-Medics Association has
been scheduled for April 20-21, 1958, at Hous-
ton, Texas. It is being held in connection with
the 91st Annual Session of the Texas Medical
Association. Information may be obtained from
Dr. C. F. Miller, secretary-treasurer, P. O. Box
1338, Waco, Texas.
BIRTHS AND DEATHS
Births
Dr. and Mrs. John I. Williams, of Fort Lauderdale,
announce the birth of a son, John Irving Jr., on Novem-
ber 7, 1957.
Marriages
Dr. Cabell Young Jr., of West Palm Beach, and Miss
Nancy Ellen Matthews, of Leaksville, N. C., were married
November 16, 1957, in Leaksville.
Deaths — Other Doctors
Ginsburg, Samuel, DeBary September 12, 1957
Hodge, Otto Phillip, St. Petersburg August 28, 1957
Elder, James Franklin, Ormond Beach October 2, 1957
Beam, Eugene Cecil, Sarasota October 11, 1957
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
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OPPORTUNITY
The Daniel Rehabilitation Institute of Florida
has a fully developed Physical Therapy Service and
Department that needs the services of an M.D.
interested in this type of work; also for prescription
of surgical supplies, orthopedic shoes, artificial limbs
and braces that the Institute sells and produces.
A fully equipped Physical Therapy Dept.; Doc-
tor’s office and examining room are available for
lease or rental or rental purchase plan. Therapist,
a member of American Physical Therapists Assn,
and Florida Chapter, would continue to work for
M.D. if desired.
Write, phone or call in person for further partic-
ulars.
Daniel Rehabilitation Institute of Florida
2120 W. Broward Blvd.,
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Your one-stop direct source for the
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TAMPA
1009 W. Platt St. • Phone 8-3757
A. C. MARTIN
3045 Sumter Ave. • AMherst 4-7616
880
Volume XLI V
Number 8
SIGN OF GOOD TASTE
The purity, the
wholesomeness,
the quality of
Coca-Cola as
refreshment has helped
make Coke the
best-loved sparkling
drink in all the world.
J. Florida M.A.
February, 1958
881
SENSITIZE
US
POLYSPORIN
Orand
POLYMYXIN B-BACITRACIN OINTMENT
to otcdcM bmi^'Qhedmti tlm/by
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For ophthalmic use: in '/e oz. tubes.
BURROUGHS WELLCOME & CO. (U.S.A.) INC.. Tuckahoe, n. y.
882
Volume XLIV
Number 8
COMPONENT SOCIETY NOTES
Alachua
Dr. G. Leonard Emmel has been installed as
president of the Alachua County Medical Society
for the year 1958. Dr. George H. Putnam has
been chosen president-elect. Other officers recent-
ly elected include Dr. Charles H. Gilliland, vice
president, and Dr. Eugene H. Cummings, secre-
tary-treasurer. All are from Gainesville.
Brevard
Dr. Jack T. Bechtel, of Eau Gallie, has been
elected president of the Brevard County Medical
Society. Serving with Dr. Bechtel will be Dr.
Louis C. Jensen Jr., of Rockledge, vice president,
and Dr. Cyrus E. Warden, of Melbourne, secre-
tary-treasurer. Dr. Jensen served as secretary-
treasurer during 1957.
Broward
Dr. Russell R. Hippensteel, of Hollywood, has
been installed as president of the Broward County
Medical Association. Dr. Hippensteel served the
Association as president-elect last year. Dr. Gar-
land M. Johnson, of Fort Lauderdale, has been
re-elected secretary.
Twenty-two years devoted exclusively to the design and
production of the world’s choicest electronic medical-su
equipment is now culminated in the presentation of
this new — finest of all, electrocardiograph.
Columbia
Dr. Robert M. Sasso is serving as president of
the Columbia County Medical Society following
his election at the recent annual meeting. Serving
with Dr. Sasso will be Dr. Harry S. Howell, as
vice president, and Dr. Louis G. Landrum, secre-
tary-treasurer. All the officers are from Lake City.
Collier
Dr. Reider Trygstad, of Naples, has been
elected president of the Collier County Medical
Society. Dr. John J. Meli, of Naples, has been
chosen vice president, and Dr. Loral F. Gwaltney,
of Naples, treasurer. Dr. Ethel G. Trygstad, also
of Naples, has been re-elected secretary.
Dade
Dr. Nelson Zivitz, of Miami, has been in-
stalled as president of the Dade County Medical
Association. Chosen president-elect at the recent
annual meeting was Dr. Robert P. Reiser, of
Coral Gables. Other newly elected officers of the
Association are Dr. Franklin J. Evans, of Coral
Gables, vice president; Dr. Francis N. Cooke, of
Miami, treasurer, and Dr. George W. Robertson
III, of Miami, secretary.
a
completely new
all NEW
electro-
cardiograph
by Birtcher
THE
BIRTCHER
CORPORATION
Los Angeles 32. California
THE BIRTCHER CORPORATION
Department FM-258
4371 Valley Boulevard, Los Angeles 32, California
Please send me descriptives detailing
the 19 new engineering features found exclusively
in your all-new Electrocardiograph
Dr.
Address
City Zone State
T. Florida M.A.
February, 1958
883
versatile dermatotherapy
for JUNIOR and SENIOR citizens
in pediatrics
Desitin Ointment is
unequalled in preventing
and clearing up diaper rash,
excoriation, irritation,
chafing.
in geriatrics
an incomparable protectant
and healing agent against
excoriation due to incon-
tinence; senile pruritus,
excessive skin dryness.
DESITIN CHEMICAL COMPANY
812 Branch Ave., Providence 4, R. I.
884
V OLUME XLI V
N I II BER 8
Duval
Dr. Ashbel C. Williams has been installed as
president of the Duval County Medical Society.
Dr. Samuel M. Day has been chosen president-
elect. Elected at the recent annual meeting to
serve with Drs. Williams and Day were Dr.
Frederick H. Bowen, vice president; Dr. William
J. Knauer Jr., secretary, and Dr. Sidney Stillman,
treasurer. All are from Jacksonville.
Escambia
Dr. Joseph W. Douglas has begun serving as
president of the Escambia County Medical So-
ciety following installation ceremonies at the So-
ciety’s annual meeting. Dr. Egbert V. Anderson,
president-elect, Dr. J. Melvin Young, vice presi-
dent, and Dr. Joseph Q. Perry, secretary, are the
other new officers of the Society who will be serv-
ing during 1958. All are from Pensacola.
Franklin-Gulf
Dr. William F. Wager, of Port St. Joe, has
been elected president of the Franklin-Gulf Coun-
ty Medical Society. Dr. Wager served as secretary
last year. Dr. Joseph P. Hendrix, also of Port
St. Joe, has been chosen vice president, and Dr.
Photis J. Nichols, of Apalachicola, secretary.
Hillsborough
Dr. Wesley W. Wilson, who served as presi-
dent-elect during 1957 has been installed presi-
dent of the Hillsborough County Medical Associa-
tion. Dr. Harold G. Nix has been chosen presi-
dent-elect. First vice president is Dr. Charles L.
Pope and second vice president is Dr. Frank H.
Lindeman Jr. Dr. Marvin B. Miller is the newly
elected treasurer. Dr. James A. Winslow Jr. was
re-elected secretary. All are from Tampa.
Jackson -Calhoun
Dr. Sarah M. Schulz, of Marianna, has been
elected president of the Jackson-Calhoun County
Medical Society. Dr. Glenn E. Padgett has been
chosen vice president and Dr. Francis M. Watson
has been re-elected secretary-treasurer. Drs. Pad-
gett and Watson are also from Marianna.
Lake
Dr. George PC Engelhard, of Leesburg, has
begun serving as president of the Lake County
Medical Society following his election at the So-
ciety’s annual meeting. Serving with Dr. Engel-
hard are Dr. Lawton F. Douglass, of L'matilla,
vice president, and Dr. Frederick C. Andrews,
of Mount Dora, secretary-treasurer.
nECAUSE OF TENSION, MILD DEPRESSION,
ANXIETY, FEARS-THIS IS AN INDICATION
SUAVITII
(benactyzine hydrochloi
r* si rl m n 'll "i
WHEN
LIFE
SEEMS
OUT
OF
FOCUS
J. Florida M.A.
February, 1958
885
Leon-Gadsden-Liberty- Wakulla- Jefferson
Dr. T. Bert Fletcher Jr. has been elected presi-
dent of the Leon-Gadsden-Liberty-Wakulla-Jef-
ferson County Medical Society. Dr. Odis G. Ken-
drick Jr. will serve with Dr. Fletcher as vice presi-
dent, and Dr. Nelson H. Kraeft as secretary-
treasurer. Dr. Kraeft was re-elected. All are from
Tallahassee.
Manatee
Dr. Eugene E. Biel has been elected president
of the Manatee County Medical Society. Dr.
Albert A. Simkus is the Society’s new vice presi-
dent. Serving with Drs. Biel and Simkus is Dr.
Irving E. Hall Jr., as secretary-treasurer. The
officers are from Bradenton.
Marion
Dr. Harry M. Edwards has been installed as
president of the Marion County Medical Society.
Installed with Dr. Edwards were Dr. Harry S.
Gibboney Jr. as vice president and Dr. Charles
H. Marks as secretary-treasurer. Drs. Edwards,
Gibboney and Marks are from Ocala.
Monroe
Dr. William R. Floss has been elected presi-
dent of the Monroe County Medical Society.
Dr. Joseph J. Scarlet, who served as secretary
during 1957, has been elected vice president. The
Society's new secretary-treasurer is Dr. Walter
R. McCook. All the officers are from Key West.
Orange
Dr. Robert E. Zellner has been installed as
president of the Orange County Medical Society.
Chosen president-elect at the Society’s annual
meeting was Dr. Robert L. Tolle who will assume
the duties of president at the end of 1958. Dr.
John J. Scanlon has been elected vice president;
Dr. Charles R. Sias, treasurer, Dr. Robert W.
Curry, secretary, and Dr. Benjamin Glaser, re-
porter. Drs. Zellner, Tolle, Curry, Sias and Glaser
are from Orlando; Dr. Scanlon is from Winter
Garden.
Palm Beach
Dr. W. Lawson Shackelford, of West Palm
Beach, has begun serving as president of the Palm
Beach County Medical Society following installa-
tion ceremonies at the Society’s recent annual
meeting. Dr. Younger A. Staton, also of West
Palm Beach, has been chosen president-elect to
take office at the end of 1958. Other officers in-
clude Dr. Fred E. Manulis, of Palm Beach, vice
RESTORE PERSPECTIVE WITH
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;ly, gradually, without euphoric buffering,
TIL helps patients recover normal drive and
3 free them from compulsive fixations.
MMENDED DOSAGE: 1.0 mg. t.i.d. for two or three
If necessary this dosage may be gradually
ased to 3 mg. t.i.d.
^ MERCK SHARP & DOHME
W DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
886
Volume XLI V
Number 8
president, Dr. Willard F. Ande, of West Palm
Beach, treasurer, and Dr. Robert Y. Wheelihan,
of Riviera Beach, secretary. Dr. Wheelihan was
re-elected.
Pasco-Hernando-Citrus
Dr. S. Carnes Harvard, of Brooksville, has
been elected president of the Pasco-Hernando-
Citrus County Medical Society. Serving with Dr.
Harvard will be Dr. Dwayne L. Deal, of Dade
City, and Dr. Alfred G. Brown Jr., of Inverness,
as vice presidents, and Dr. W. Wardlow Jones, of
Dade City, who was re-elected secretary-treasurer.
Pinellas
Dr. Whitman H. McConnell, of St. Petersburg,
has been installed president of the Pinellas County
Medical Society. Chosen to serve with Dr. Mc-
Connell at the Society’s annual meeting were Dr.
Rowland E. Wood, of St. Petersburg, president-
elect; Dr. Julio J. Guerra, of Clearwater, first
vice president; Dr. Edward L. Cole Jr., of St.
Petersburg, second vice president, and Dr. Whit-
man C. McConnell, of St. Petersburg, secretary-
treasurer. Dr. Whitman C. McConnell was re-
elected.
Polk
Dr. Marion W. Hester, of Lakeland, has been
installed as president of the Polk County Medical
Association. Chosen president-elect at the Soci-
ety’s recent annual meeting was Dr. Newell J.
Griffith, of Winter Haven. Dr. John E. Daugh-
trey, of Lakeland, was elected vice president, and
Dr. Charles Larsen Jr., also of Lakeland, was re-
elected secretary-treasurer.
Sarasota
Dr. Karl R. Rolls has been elected president of
the Sarasota County Medical Society. Dr. Mil-
lard B. White has been chosen as treasurer, and
Dr. James E. Kicklighter has been re-elected sec-
retary. All are from Sarasota.
Seminole
Dr. Daniel H. Mathers is the new president
of the Seminole County Medical Society. Elected
to serve with Dr. Mathers was Dr. Vann Parker
as vice president. Dr. Terry Bird was re-elected
secretary-treasurer. Drs. Mathers, Parker and
Bird are from Sanford.
Suwannee-Hamilton-Lafayette
Dr. Irby H. Black, of Live Oak, has been
elected president of the Suwannee-Hamilton-La-
fayette County Medical Society. Dr. William P.
(Continued on page 892)
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A
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Phenacetin 150 mg. (2V2 grains)
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Demerol hydrochloride 30 mg. (V2 grain)
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Narcotic blank required.
Potentiated Pain Relief
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890
Volume XEI V
Number 8
Where To Find Us...
Jacksonville
Mr. George R. Garrett
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Phone EL 5-8391
Residence Phone EX 8-7940
Mr. John R. Gregory
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Phone EL 5-8391
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Mr. J. Beatty Williams Jr.
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Phone EL 5-8391
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Jacksonville Beach
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1215 9th Street N.
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uraica
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Rutin 10 mg
Ascorbic Acid 30 mg
B- 1 2 1 meg
Molybdenum 0.5 mg
Cobalt 0.1 mg
Copper 0.2 mg
Vitamin A . 5.000 I.U
Vitamin D 400 I.U
V'itamin E 1 I.U
Cal. Pantothenate 3 mg
Thiamine Hcl. 2 mg
Riboflavin 2 mg
Pyridoxine Hcl. 0.3 mg
Niacinamide 20 mg
Manganese 1 mg
Magnesium 5 mg
Iodine .... 0.15 mg
Potassium — 2 mg
Zinc 1 mg
Choline Bitartrate... 40 mg
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Write for Latest Technical Bulletins.
‘REFERENCE: J.A.M.A. 163: 359, 1957 (February 2)
^ I DETROIT 34, MICHIGAN
. Florida M.A.
February, 1958
891
892
Volume XLIV
Number 8
(Continued from page 8 86)
Blackmon, of Jasper, who served as secretary-
treasurer during 1957, has been chosen vice presi-
dent, and Dr. Hugo F. Sotolongo, of Live Oak,
secretary-treasurer.
Volusia
Dr. Achille A. Monaco, of Daytona Beach,
has been elected president of the Volusia County
Medical Society. He previously served as secre-
tary-treasurer. Also elected during the recent an-
nual meeting were Dr. Robert O. Burry, of De-
Land, as vice president, and Dr. John J. Cheleden,
of Daytona Beach, secretary-treasurer.
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Bilotta, Laurence A., Winter Park
Bond, James W., Jacksonville
Bryan, Donald M., St. Petersburg
Campbell, Alan B. Jr., St. Petersburg
Crews, Frederick F., Fort Walton Beach
Derry, William H., Miami
Erdman, Leonard A., Fort Lauderdale
Fixel, Irving E., Hollywood
Folsom, John H. Jr., Orlando
Foss. Harold G., South Miami
Gates. Kermit H., Coral Gables
Griffin, Joseph A., South Miami
Gilbert, J. C. Jr., Fort Lauderdale
Gurinsky, Abraham, Miami
Harris, Harry, Miami
Huntley, Earl S. Jr., Miami
Kibler, Gordon E., Jacksonville
LaRue, Raymond A., Winter Haven
McCreary, Albert B., St. Petersburg
McDaniel, Grover C. Jr., Fort Lauderdale
Marrero, Emilio J., Jay
Ragona, Robert F., Hollywood
Rawlings, Joseph E. Jr., St. Petersburg
Rogers, Alexander S., Hollywood
Sanford, Marshall C., Fort Lauderdale
Sporn, Hyman, Hollywood
Swink, Robert L., Miami
vanBoven, John III, Palm Beach
Weisman, Joseph C., Orlando
Wells, Leonard R. Jr., Lake City
Williams, Thomas C. Jr., Crestview
Wold, Keith C., Fort Lauderdale
Zucker, Reuben, Orlando
Our Customer
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J. Florida M.A.
February, 1958
893
CLINICAL
COLLOQUY
My 'patients complain that
the pain tablets I prescribe
are too slow-acting . . .
they usually take about
30 to JfO minutes to work.
Why don't you try
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What is it ...
how fast does it act?
It's Percodan®— relieves pain
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with a single dose
lasting 6 hours or longer.
How about side effects?
No problem. For example,
the incidence of constipation
with Percodan* is rare.
Sounds worth trying —
what’s the average adidt dose?
One tablet every 6 hours.
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Where can I get
literature on Percodan?
Just ask your Endo detailman
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U. S. Pat. 2,628,185. PERCODAN contains salts of dihydrohydroxycodeinone and
homatropine, plus APC. May be habit-forming. Available through all pharmacies
894
Volume XLIV
Number 8
1. TRAPPED — This highly mo-
tile, viable sperm becomes non-repro-
ductive the instant it contacts
IMMOLIN Cream-Jel.
2. WEAKENED - Devitalized,
and no longer motile, the sperm
swerves from line of travel and is
pulled aside by spreading matrix.
3. KILLED — Motion, whiplash
stop as sperm succumbs to matrix.
“freezes,” weakens and kills
even the most viable sperm
The unique sperm-trapping matrix formed with explo-
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Cream-Jel accounts for the outstanding effectiveness
of this new contraceptive for use without diaphragm.
These unusual pictures, taken at high speed and mag-
nification, show the IMMOLIN matrix in action — how
a single sperm “freezes,” weakens and dies — within the
distance it normally travels in one-quarter of a second.
DEPENDABLE WITHOUT D I APH RAG M -With this
new contraceptive technique, a pregnancy rate of 2.01
per 100 woman-years of exposure is reported.* “This
extremely low pregnancy rate indicates that IMMOLIN
Cream-Jel used without an occlusive device is an effi-
cient and dependable contraceptive.”
•Goldstein. L. Z.: Obst. & Gynec. 70:133 (Aug.) 1957.
JULIUS SCHMID, INC.
423 West 55th Street, New York 19, N. Y.
IMMOLIN is a registered trade-mark of Julius Schmid, Inc.
4. BURIED The dead sperm is trapped
deep in the impenetrable IMMOLIN matrix.
895
f. Florida M.A.
February, 1958
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SULFAMETHOXYPYRIDAZINE LEDERLE
New authoritative studies show that Kynex
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• Effective Antibacterial Range — exceptional
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The recommended adult dose is 1 Gm. (2 tab-
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2 Gm. followed by 0.5 Gm. every 24 hours.
Dosage in children, according to weight; i.e.,
a 40 lb. child should receive *4 of the adult
dosage. It is recommended that these dosages
not be exceeded.
Tablets:
Each tablet contains 0.5 Gm. (7Ms grains) of sulfamethoxy-
pyridazine. Bottles of 24 and 100 tablets.
Syrup:
Each teaspoonful (5 cc.) of caramel-flavored syrup contains
250 mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
■Nichols, ft. L. and Finland, M.: J. Clin. Med. 49:410, 1957.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER, NEW YORK
900
Volume XLI V
N U II BF.R 8
EVERY WOMAN
WHO SUFFERS
IN THE
MENOPAUSE
DESERVES
"PREMARIN®
widely used
natural , oral
estrogen
AYERST LABORATORIES
New York, N. Y. • Montreal, Canada
5646
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
HOSPITAL FOR SALE: 30 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner to associate with
group in South Florida. No Ob or Surgery required.
Give full particulars of training, experience and refer-
ences. Write 69-249, P. O. Box 2411, Jacksonville,
Fla.
WANTED: General Practitioner qualified to do
surgery or surgeon willing to do general practice in
small town with excellent hospital. Salary or percent-
age to start; partnership after six months. Write
69-254, P.O. Box 2411, Jacksonville, Fla.
BRAND NEW AIR CONDITIONED AND
HEATED MEDICAL BUILDING in fast growing
North Miami has three openings. Prefer Board-certi-
fied (or eligible) internist, ophthalmologist, otolaryn-
gologist, dermatologist, or laboratory to complement
present occupants: pediatrician, surgeon, orthopedist,
obstetrician. All independent. See it at 1545 N.E.
123rd Street and phone PL 4-2744.
GENERAL PRACTITIONER: Present man de-
sires to leave for residency. Has well established
practice in central Florida. Would like to sell or
rent office and equipment. Write 69-255, P.O. Box
2411, Jacksonville, Fla.
PSYCHIATRIST: Desires situation in Florida.
Board eligible, Florida license. 39 years of age. Write
69-256, P.O. Box 2411, Jacksonville, Fla.
SPACE AVAILABLE: Medical building in Pom-
pano Beach. Has space for Pediatrician, OB-Gyn.,
and General Practitioner. Excellent location on At-
lantic Boulevard. Write L. O. Peterson, Mgr., 2701
Atlantic Blvd., Pompano Beach, Fla.
| OBITUARIES
Walter Duval Webb
Dr. Walter Duval Webb of St. Augustine
died in a local hospital on June 11, 1957, of coro-
nary heart disease. He was 84 years of age. Inter-
ment took place in Arlington National Cemetery.
Born in Mankato, Minn., on June 15, 1872,
Dr. Webb was graduated from Columbia Univer-
sity College of Physicians and Surgeons in New
York City in 1895. He was a veteran of the
Spanish- American War and World War I. He
entered the medical corps of the United States
Army in 1900; retired with the rank of major in
January 1909; returned to active duty from Feb-
ruary 1917 to September 1918; retired with the
rank of colonel under the Act of June 21, 1930;
and returned to active duty in December 1940 to
( Continued on page 906)
901
. Florida M.A.
'ebruary, 1958
a Major Breakthrough
in EDEMA—
in HYPERTENSION
(CHLOROTHIAZIDE)
EDEMA— 'DIURIL' is an entirely new, orally effec-
tive, nonmercurial diuretic-classed as the most
potent and most consistently effective oral agent avail-
able—with activity equivalent to that of the parenteral
mercurials. It has no known contraindications.
Indications: Any indication for diuresis is an indica-
tion for 'DIURIL'.
Dosage: One or two 500 mg. tablets of 'DIUPIL' once
or twice a day.
HYPERTENSION— 'DIURIL' improves and sim-
plifies the management of hypertension : it potentiates
the action of antihypertensive agents and often
reduces dosage requirements for such agents below
the level of distressing side effects.
Indications: Hypertensionof anydegreeof severity.
Dosage: One 250 mg. tablet 'DIURIL' two times
daily to one 500 mg. tablet 'DIURIL' three times daily.
Supplied: 250 mg. and 500 mg. scored tablets
'DIURIL' (Chlorothiazide), bottles of 100 and 1,000.
'DIURIL' is a trademark of Merck & Co., Inc.
MERCK SHARP & DOHME
Division of MERCK & CO., Inc., Philadelphia 1, Pa.
902
Volume X LI V
Number 8
cyUayc
'(HOAVU
cJ^te^a^
A few suggestions on bow to give
your patient a diet he can “stick-to”-
The Low
Sodium Diet
and a glass of
beer, with your
consent for a
morale-booster
Here are some things your patient can do
to season his Low Sodium Diet. Spices and
herbs, lemon and lime, variously flavored vine-
gars and some pepper are all he needs.
Thyme, marjoram and pepper add zest to
hamburger. Chicken’s delicious with lemon,
rosemary and sweet butter to baste. He can
try sweet butter with nutmeg on green beans,
savory on limas, tarragon with carrots, basil
with tomatoes. Onions boiled with whole clove
and thyme delight the taste of an epicure!
With these flavor tricks to add zest to his
meals — and a glass of beer* now and then, at
your discretion, your patient has a diet that’s
both good tasting and good for him.
*Sodium: 7 mg./lOO gm., 17 mg./B t>z. glass (Average of American Beers)
United States Brewers Foundation
Beet — America’s Beveraee of Moderation
o J *»0u
If you'd like reprints of 12 different diets, please write United States Brewers Foundation, 535 Fifth Avenue, New York 17, N. Y.
J. Florida M.A.
February, 1958
903
respiratory congestion
relief in minutes . . lasts tor
orally
hours
In the common cold, nasal allergies, sinus-
itis, and postnasal drip, one timed-release
Triaminic tablet brings welcome relief of
symptoms in minutes. Running noses stop,
clogged noses open — and stay open for 6 to
8 hours. The patient can breathe again.
With topical decongestants, “unfortu-
nately, the period of decongestion is often
followed by a phase of secondary reaction
during which the congestion may be equal
to, if not greater than, the original condi-
tion. . . The patient then must reapply
the medication and the vicious cycle is
repeated, resulting in local overtreatment,
pathological changes in nasal mucosa, and
frequently “nose drop addiction."
Triaminic does not cause secondary con-
gestion, eliminates local overtreatment and
consequent nasal pathology.
’Morrison, L. F.: Arch. Otolaryng. 59:48-53 (Jan.) 1954.
Each double-dose “timed-release" triaminic
Tablet contains:
Phenylpropanolamine hydrochloride 50 mg.
Pyrilamine maleate 25 mg.
Pheniraminemaleate 25 mg.
Dosage: 1 tablet in the morning, afternoon, and
in the evening if needed.
Each double-dose “ timed-release ”
tablet keeps nasal passages
clear for 6 to 8 hours —
provides “ around-the-clock **
freedom from congestion on
just three tablets a day
disintegrates to give 3 to 4
more hours of relief
Also available: Triaminic Syrup, for children and
those adults who prefer a liquid medication.
Triaminic
" timed-release "
tablets
|1
running noses
& 4* and open stuffed noses orally
SM1TH-DORSEY • a division of The Wander Company • Lincoln, Nebraska • Peterborough, Canada
904
Volume XLIV
Number 8
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or Vz teaspoonful
contains:
Pentylenetetrazol . .100 mg.
Nicotinic Acid 50 mg.
1. Levy, S„ JAMA.. 153:1260, 1953
2. Thompson, L., Procter R..
North Carolina M. J., 15:596. 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
J. Florida M.A.
February, 1958
905
for “This Wormy World
Pleasant tasting
‘ANTEPAR’
Q
PIPERAZINE
SYRUP - TABLETS • WAFERS
Eliminate PINWORMS IN ONE WEEK
ROUNDWORMS IN ONE OR TWO DAYS
PALATABLE • DEPENDABLE • ECONOMICAL
‘ANTEPAR’ SYRUP - Piperazine Citrate, 100 mg. per cc.
‘ANTEPAR’ TABLETS -Piperazine Citrate, 250 or 500 nig., scored
‘ANTEPAR’ WAFERS -Pip erazine Phosphate, 500 nig.
Literature available on request
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.
906
Volume XLI V
Number 8
' ,7” » ;
Tfailfrnactice
GOOD SENSE TRAVELS
ON WELL-WORN PATHS
|
Sfieciatljed Senvi.cc
rtta&ea (Min. doctan <m£en
THE |
MePICAJL PROTEGTIiVEfCPMPANy
Eprt-Watoe; Indiana,
Professional Protection Exclusively
since 1899
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. PLAZA 4-2703
s
L j
in very special cases
a very superior brandy...
specify
HEKNESSY
COGNAC BRANDY
84 Proof I Schieffelin & Co., New York
(Continued from page 900)
August 1946. During World War II he was head
of the medical department for Selective Service
in the State of Florida.
Upon entering the Army in 1898, Dr. Webb
served three years in the Philippines and also
served in Puerto Rico and Cuba. He was in
charge of reconstruction following the San Fran-
cisco earthquake, and at one time served on the
faculty of Georgetown University School of Medi-
cine in Washington, D. C., as professor of oral
surgery and lecturer in military surgery. In World
War I he was in command of the hospital unit
in Vichi, France, and an officer of the Legion
of Honor; Knight of France at Claremont Feran;
and was made a knight by General Danton. He
was a member of the Society of Cincinnati of New
York State.
This distinguished surgeon was a member of
St. Johns County Medical Society. He had held
membership in the Florida Medical Association
since 1924. He was a life member of the Ameri-
can College of Surgeons.
Surviving are the widow, Mrs. Esther Webb,
of St. Augustine; three daughters, Mrs. Margaret
Walton, of California, Miss Francie Webb, of
Arizona, and Mrs. Elizabeth Woody, of Richmond,
Va.; and two sons, Creighton Webb, of St.
Augustine, and Walter D. Webb Jr., of California.
Cleveland Jackson Price
Dr. Cleveland Jackson Price of Alford died at
Clay County Hospital in Fort Gaines, Ga., on Aug.
23, 1957, of heart disease following a long illness.
He was 68 years of age.
The son of Henry Wilson Price and Mary
Ann Jenkins Price, Dr. Price was born in Louis-
ville, Ala., on May 11, 1889. He received his
academic training at Alabama Polytechnic Insti-
tute in Auburn, Ala., and was awarded his medica’
degree by the Atlanta College of Physicians and
Surgeons, now Emory University School of Medi- 1
cine, in Atlanta on June 8, 1913.
Dr. Price entered the private practice of medi-
cine in Jackson County, Florida, in 1914 and
continued to practice there until ill health forced
him to retire in 1954. During World War I he
served as examining physician for Selective Serv-
ice.
Dr. Price was a member of the Jackson-Cal-
houn County Medical Society. He was a life mem-
ber of the Florida Medical Association, holding
new for angina
(PENTAERYTHRITOL TE TRAN ITR ATE) (hYOROXYZINE)
links
freedom from
anginal attacks
with a shelter of
tranquility
New Yoxk 17, New York
Division, Chas. Pfizer if Co., Inc.
In pain. Anxious. Fearful. On the road to cardiac
invalidism. These are the pathways of
angina patients. For fear and pain are inexorably
linked in the angina syndrome.
For angina patients— perhaps the next one who
enters your office— won’t you consider new
cartrax? This doubly effective therapy combines
petn (pentaerythritol tetranitrate) for lasting
vasodilation and atarax for peace of mind.
Thus cartrax relieves not only the anginal pain
but reduces the concomitant anxiety.
Dosage and supplied: begin with 1 to 2 yellow cartrax
“10” tablets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. When indicated, this may be increased for more
optimal effect by switching to pink cartrax "20” tablets
(20 mg. petn plus 10 mg. atarax.) For convenience, write
“cartrax 10” or “cartrax 20.” In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on
a continuous dosage schedule. Use petn preparations
with caution in glaucoma.
“ Cardiac patients who show significant manifestations of
anxiety should receive ataractic treatment as part of the
therapeutic approach to the cardiac problem.”1
1. Waldman, S., and Pelncr, L.: Am. Pract. St Digest Treat. 5: 1 075 (July) 1957.
•trademark
908
Volume XLI V
Number 8
honorary status at the time of his death, and also
held membership in the American Medical Associ-
ation.
Surviving are three daughters, Mrs. Clarence
Morgan, Fort Gaines, Ga., Mrs. William Joseph
Hoppers, Birmingham, Ala., and Mrs. John B.
McKibbon Jr., Gainesville, Ga. ; and by four
grandchildren, William Joseph Hoppers Jr., Leo-
nora Hoppers, Dawn McKibbon, and John B.
McKibbon, III.
Lee Wolfe Lerner
Dr. Lee Wolfe Lerner of Miami died suddenly
on July 4, 1957. He was 59 years of age.
Born in Quebec, Canada, on Aug. 3, 1897,
Dr. Lerner received his medical degree from Mc-
Gill University Faculty of Medicine in Montreal,
Canada, in 1919. Before locating in Miami in
1952, he practiced general medicine and general
surgery in New York City, where he was a mem-
ber of the Bronx County Medical Society and the
Medical Society of the State of New York.
Dr. Lerner was a member of the Dade County
Medical Association and since 1954 had held
membership in the Florida Medical Association.
He was also a member of the American Medical
Association and the American College of Surgeons.
The widow, Mrs. Ruth Lerner, of Miami, sur-
vives. Also surviving are a daughter, Carol, and
a brother and three sisters.
BOOKS RECEIVED
Dermatologic Formulary: New York Skin and
Cancer Unit. Frances Pascher, M.D., Editor. Ed. 2.
Pp. 172. Price, $4.00. New York, Paul B. Hoeber, Inc.,
1957.
This newly and completely revised second edition of
this Formulary from the New York Skin and Cancer
Unit, Service of Dermatology, of which Dr. Marion B.
Sulzberger is director, was impelled not only by continu-
ing demand after exhaustion of the first edition but
especially by the tremendous therapeutic advances of the
last three years. Dr. Sulzberger, who is George Miller
MacKee Professor of Dermatology and Syphilology, New
York University — Bellevue Medical Center, writes in the
Preface that one of the main purposes in publishing this
Formulary is to serve the practitioner by listing the most
tried and useful dermatologic prescriptions, together with
the briefest and simplest explanations of their uses, indica-
tions, and contraindications. An additional objective is
to supply a model dermatologic formulary from which
other hospitals, clinics, and institutions can, according
to their needs, select a longer or shorter list of standard
preparations for the care of the multitudinous sufferers
from skin diseases. He stresses that the preparations
included in this book are the product of the actual com-
posite experience gained by leading teachers of dermatol-
(Continued on page 916)
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St., New York 3.
Results with "... antacid therapy with DA A are essentially the same as . . . with
potent anticholinergic drugs.”
Alglyri
Dihydroxy aluminum aminoacetate, N.N.R.
In recent years, a number of new synthetic anticholiner-
gic drugs with numerous and varying side effects have
been investigated for treatment of peptic ulcer. However,
a double-blind study conducted recently by Cayer et al
suggests that the use of such anticholinergic drugs is
seldom necessary. The authors concluded that "The
percentage of 'good to excellent’ results obtained in
patients on continuous long-term antacid therapy with
DAA (74%) is essentially the same as that previously
noted in ulcer patients treated under similar conditions
with potent anticholinergic drugs alone.”
The authors’ choice of dihydroxy aluminum amino-
acetate (DAA) was based on the fact that "the tablet
form of DAA (is) more active than a variety of straight
aluminum hydroxide magmas.” They further commented
that "Because of the convenience of tablet medication
as compared with the liquid gel — a convenience which
in the use of other tablets is gained at the expense of
therapeutic effectiveness — dihydroxy aluminum amino-
acetate was used exclusively.”
Alglyn (dihydroxy aluminum aminoacetate) Tablets
are supplied in bottles of 100 tablets (0.5 Gm. per tablet).
□
BRAYTEN PHARMACEUTICAL COMPANY • Chattanooga 9, Tennessee
FROM INFECTION * FROM IRRITATION
* as adjunctive therapy only
THE FIRST TROCHE TO PROVIDE
THREEFOLD BENEFITS
PENftZETS'
TROCHES
NON-NARCOTIC ANTITUSSIVE EFFICACY
SHOWN TO APPROXIMATE THAT OF CODEINE
With the addition of a non-narcotic antitussive
to troche medication, ‘Pentazets’ provides
a new and extended therapeutic advantage in
this convenient form of treatment.
Treatment of the cough too, so often a
troublesome symptom of sore throat, combined
with wide-range antibiotic activity and
soothing analgesic benefit, now offers three fold
relief in a variety of throat irritations.
And ‘Pentazets’ are pleasant-tasting, too,
making them highly acceptable, especially
to children.
‘PENTAZETS’ contains:
• Homary famine— a new non-narcotic antitussive with cough
control shown to approximate that of codeine. • Bacitracin-
Tyrothricin-Neomycin — a combined antibiotic treatment
against many pathogenic organisms with little danger of
unfavorable side effects. • Benzocaine— a local anesthetic for
soothing relief to inflamed tissues. Being slowly absorbed,
it is especially beneficial for prolonged effect and benefit to
surrounding areas.
Supplied: Vials of 12.
Each ‘PENTAZETS troche contains:
Homarylamine hydrochloride 20 mg.
Zinc Bacitracin 50 units
Tyrothricin 1 mg.
Neomycin sulfate 5 mg.
(equivalent to 3.5 mg. neomycin base)
Benzocaine 6 mg.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
there’s pain and
inflammation here...
it could be mild
r severe, acute or
chronic, prima
ry fibrositis
early rheumatoid a
lore potent and comprehensive treatment
lan salicylate alone
isured anti inflammatory effect of low-dosage
irticosteroid' . . . additive antirheumatic action of
irticosteroid plus salicylate2 5 brings rapid pain
lief; aids restoration of function . . . wide range
application including the entire fibrositis syn-
ome as well as early or mild rheumatoid arthritis
ore conservative and manageable than full-
>sage corticosteroid therapy—
uch less likelihood of treatment-interrupting
je effects'"4 . . . reduces possibility of residual
jury . . . simple, flexible dosage schedule
ERAPY SHOULD BE INDIVIDUALIZED
Jte conditions: Two or three tablets four times daily. After
sired response is obtained, gradually reduce daily dosage
d then discontinue.
3acute or chronic conditions: Initially as above. When sat-
actory control is obtained, gradually reduce the daily
sage to minimum effective maintenance level. For best
,ults administer after meals and at bedtime.
scautions: Because sigmagen contains prednisone, the
ne precautions and contraindications observed with this
roid apply also to the use of sigmagen.
any
case
it calls for
tablets
Composition
meticorten'B) (prednisone) 0.75 mg.
Acetylsalicylic acid 325 mg.
Aluminum hydroxide 75 mg.
Ascorbic acid 20 mg.
Packaging: sigmagen Tablets, bottles of 100 and 1000.
References: X. Spies, T. D„ et al.: J A M. A. 159:645.
1955. 2. Spies. T. D.. et al.: Postgrad. Med. 17:1. 1955.
3. Getii, G., and Della Santa, L.: Minerva Pediat.
7:1456. 1955. 4. Guerra, F.: Fed. Proc. 12:326, 1953.
5. Busse. E. A.: Clin. Med. 2:1105. 1955. 6. Sticker.
R. B.: Panel Discussion. Ohio State M. J. 52:1037. 1956.
<~^Xc/ce
iet//u7
914
Volume XLI V
Number 8
Gnderson Surgieal Supply Go.
Established 1916
A GOOD REPUTATION
It takes years to build, but can be
quickly destroyed.
It must be carefully guarded.
“A good name is rather to be chosen
than great riches.”
Distributors of Known Brands of Proven Quality
TELEPHONE 3-4362
9th ST. & 6th AVE.. SO.
ST. PETERSBURG, FLORIDA
TELEPHONE 2-8504
MORGAN AT PLATT
P. O. BOX 1228
TAMPA 1, FLORIDA
MEMBER
COil/fki MjAUfL
ANTITUSSIVE . DECONGESTANT • A N T I H I ST A M I N I C
CowJoiMU :
• .
LABORATORIES
| NEW YORK 10. N. Y.
EjjdLtmprm^ (4cc.) cmEum .-
EXEMPT NARCOTIC
915
T. Florida M.A
February, 1958
Lifetime
Disability Income*
For Doctors in this State, WHO CAN QUALIFY
Pennsylvania Life Insurance Company....
WILL PAY YOU ... WHEN YOU ARE SICK
As long as a total disability, total loss of time, confinement indoors, and
regular medical attention continue from SICKNESS — EVEN FOR YOUR
ENTIRE LIFETIME!
WHEN YOU ARE HURT
As long as total disability, total
loss of time and regular medical
attention continue from accident
(double for certain specified
travel accidents).
Lump sum payment in lieu of the
monthly benefit if dismemberment
or loss of sight results within
ninety days from totally disabling
accident.
♦PAID FROM THE FIRST DAY OF MEDICAL ATTENTION
As long as Total Disability, Total Loss of Time and Regular Medical atten-
tion Continue Because of Accident or House-Confining Sickness —
EVEN FOR YOUR ENTIRE LIFETIME • Special Policy Renewal Agree-
ment • Triple Monthly Benefits While you are in the HOSPITAL for
as long as THREE MONTHS
EFFECTIVE DATE OF COVERAGES — EXCEPTIONS
This policy covers accidents from Noon of the
Policy Date and sickness originating more than
thirty days after the Policy Date, unless specific-
ally excluded, except — it even covers tubercu-
losis, heart disease and disease in the female
organs provided such conditions originate more
than six months after the Policy Date.
The Policy does not cover, and the premium
includes no charge for, loss which is caused by:
war or any act of war or while in military or
naval service of any country at war; suicide or
attempted suicide; mental derangement or dis-
orders; pregnancy, miscarriage or childbirth; travel
outside the United States, Alaska, Hawaii, Mexico
or Canada (unless otherwise extended by rider) or
aeronautics or air travel other than limited com-
mercial air line passenger travel.
(PX310)
PENNSYLVANIA LIFE INSURANCE COMPANY
1775 S.W. Third Avenue
Miami 36, Florida
I would like more information about your lifetime
disability income protection.
I understand I will not be obligated.
MAIL THIS COUPON
WHILE YOU ARE
STILL HEALTHY
J
Name....
Address
Age
916
Volume XLI V
Number 8
(Continued from page 90S)
ogy, who have since 1882 been treating sufferers from
skin diseases in the largest paid outpatient service of
dermatology in the world. It is to the knowledge and
experience of all these skin specialists, past and present,
emanating from almost every great school of dermatology
in the United States, the Americas, and Europe, that this
Formulary of today owes its scope and its substance.
Practitioners’ Conferences: Held at The Sew
York H ospital-Cornell Medical Center. Volume 6. Edited
by Claude E. Forkner, M.D., F.A.C.P. Pp. 378. Price,
$6.75. New York, Appleton-Century-Crofts, Inc., 1957.
The present volume of the Practitioners’ Conferences
constitutes the sixth in the series and continues the policy
of assembling in readily available form the best opinion
available in the New York area on the subjects con-
sidered. As in the past, an effort has been made to keep
these practical conferences on a clinical level but at the
same time to balance them with panel members who
represent the basic sciences. In this way these Confer-
ences have attempted to provide a challenge for the
clinician and a basis of understanding for the practicing
physician.
The 15 panels covered in this volume were on:
Should Patients Be Told the Truth About Serious Ill-
ness?; Trichinosis; Cancer of the Thyroid; Cancer of
the Prostate; Cancer of the Esophagus; Tumors of the
Lung; Portal Hypertension; Tumors of the Bone Other
Than Multiple Myeloma; Early Detection of Heart
Disease; Dermatophytosis, Tinea Capitis, and Monilia
Infections of the Skin; Poison Ivy and Contact Derma-
titis; Encephalitis and Parkinsonism; Endometriosis;
Consultations with Anesthesiologists, and Gout. The
panel members represented staff members of other hos-
pitals and medical schools than those of The New York
Hospital-Cornell Medical Center, thus promoting the
presentation of diversified opinions, and the Conferences
were focused on the physicians who were not members
of the Cornell Medical Center, providing them with the
advantages of a great teaching institution.
A Nurse Named Mary. By Alexander Matthews.
Pp. 155. Price, $3.00. New York, Pageant Press, Inc.,
1957.
This book is the heart-warming biographic account of
the life of Mary Lathrop Wright Matthews, who will be
remembered in Florida as Director of Nurses, Palm Beach
County Health Department, West Palm Beach, a post
she held for 16 years. Written after her untimely death
in 1955 by her husband, Alexander Matthews, who is
still a resident of West Palm Beach, the book tells the
story of a woman whose devotion to serving the sick
and helpless of all nations led her from the Kentucky
foothills to Boulogne, France, during World War I, and
from an isolated mission hospital in Shanghai, China,
to important pioneering work in this country in the
field of public health. The main portion consists of a
moving and highly engrossing diary kept by her while
serving as an Army nurse in France during World War
I. Included also are extracts from the 1926-1927 journal
she kept while teaching student nurses for the Episcopal
mission in Shanghai, and numerous public testimonials
to her competence in the public health field, in which she
was much revered.
The book is of particular interest to anyone interested
in nursing, and women everywhere, regardless of profes-
sion, should find the story of the intrepid Mary Matthews
a fine inspiration. The excerpts from her diary reveal
her as a woman with boundless energy, devotion to duty,
intelligence, and stoicism. More than that, it presents
the thoroughly human story of one heroic woman’s de-
votion to humanity, and as such should have universal
appeal and value.
TAKE A LOOK A1
NEW DIMETAN1
THE UNEXCELLEI
ANTIHISTAMINI
J Florida M A.
February, 1 9 5«
917
Ciba Foundation Colloquia on Ageing, Vol-
ume 3, Methodology of the Study of Ageing.
Editors for the Ciba Foundation, G. E. W. Wolstenholme,
O.B.E., M.A., M B., B.Ch., and Cecilia M. O’Connor,
B.Sc. Pp. 202. Illus. 47. Price, $6.50. Boston, Little,
Brown and Company, 1057.
This volume contains the proceedings of the third
colloquium in a series of three conferences organized by
the trustees of the Ciba Foundation to encourage labora-
tory and clinical investigations relative to the problems
of aging. In view of the many long term schemes for
the observation of changes with age in man and whole
animals that were under way or about to begin in vari-
ous centers, it was thought useful on this third occasion
to examine the methodology of such investigations.
A few of the many topics covered are: methodology
of the study of intelligence and emotion in aging;
methodological problems in the study of changes in hu-
man performance with age; use of inbred strains of
animals in experimental gerontology ; study of the aging
of cells; methods and limitations in studies of human
organ system function; and examples of reactions to
standard stimuli at different ages.
Ciba Foundation Colloquia on Endocrinology.
Volume 10. Regulation and Mode of Action of
Thyroid Hormones. Editors for the Ciba Foundation,
G. E. W. Wolstenholme, O.B.E., M.A., M.B., B.Ch., and
Elaine C. P. Millar, A.H.-WC., A.R.I.C. Pp. 311. Illus.
114. Price, $8.50. Boston, Little, Brown and Company,
1957.
During the last 10 to 15 years there has been enor-
mous activity in the field of thyroid investigation, and
for the first time the Ciba Foundation devotes a sym-
posium to it. This volume attempts to take stock of the
discoveries of this period by presenting formal papers
from leading investigators the world over. These papers,
and the informal discussions which follow, serve as a
clearing house of ideas on the latest concepts of regula-
tion of the thyroid gland on the one hand, and the
character and mode of action of its hormones on the
other.
One result of the spurt in thyroid research has been
some divergence of opinion about a number of problems.
The Ciba Foundation offers the participants an oppor-
tunity to air these differences and help resolve them by
an exchange of information and by discussion.
A Woman Doctor Looks at Love and Life.
By Dr. Marion Hilliard. Pp. 190. Price, $2.95. Gar-
den City, N. Y., Doubleday & Company, Inc., 1957.
Women may be creatures of mystery to a man, but
not to a wise and sympathetic doctor like Marion Hil-
liard, chief of obstetrics and gynecology at Women’s Col-
lege Hospital in Toronto, Canada. Dr. Hilliard has not
only restored thousands of women to physical health but
has also helped them to find the self knowledge which
leads to inner peace and successful, zestful living. Wheth-
er a woman is frightened or simply perplexed or bothered
by her problems, Dr. Hilliard gives her outspoken advice
and realistic answers from her uniquely authoritative
point of view- as both woman and doctor. In her book,
as in her office, she brings understanding to a woman,
not by preaching, but through lively discussion. She
shares her experiences. Then, through anecdotes and
case histories, she frankly discusses the haunting unspoken
fears that may ruin a life or wreck a marriage. Her
topics are: A Woman’s First Baby; What Should I Tell
My Children ? ; Adolescence ; Sex in Marriage ; Open
Letter to Husbands; Women’s Fears; The Greatest
Enemy — Fatigue; The Menopause; Old Age. Behind
Dr. Hilliard’s delightfully breezy, informal style of writ-
ing is a world of wisdom, which women of all ages will
gratefully recognize and eagerly accept.
(PARABROMDYLAMINE MALEATE)
UNEXCELLED
'OTENCY, UNSURPASSED THERAPEUTIC
[DEX AND RELATIVE SAFETY. MINIMUM
>ROWSINESS AND OTHER SIDE EFFECTS.
H. ROBINS CO., INC., RICHMOND, VIR-
INIA. ETHICAL PHARMACEU- I pjfB
ICALS OF MERIT SINCE 1878 MHm
918
Volume XL1 V
Number X
Whatever your first requi-
sites may he, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
vour printing problems by intelli-
gently assisting on all details.
QUALITY BOOK PRINTING
PUBLICATIONS ☆ BROCHURES
A lien s Invalid Home j
MILLEDGEVILLE, GA.
Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
Comfortable Convenient
Site High and Healthful
E. VV. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
J. Florida M.A.
February, 1958
919
BRAWNER’S SANITARIUM
ESTABLISHED 1910
Jas. N. Brawner, Jr., M.D. Albert F. Brawner, M.D.
Medical Director Associate Director
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Member
Georgia Hospital Association, American Hospital Association
National Association of Private Psychiatric Hospitals
P.O. Box 218
HEmlock 5-4486
APPALACHIAN HALL
ASHEVILLE
Established 1916
NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
920
Volume XI-IV
Number 8
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond. Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic-
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dk. Howard R. Masters
I)r. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
Westbrooks Sanatorium
RICHMOND ■ • • Established L$1L
VIRGINIA
-
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin. psychotherapy, occupational
and recreational therapy- — for nervous
and mental disorders and problems of
addiction.
Staff *’ALL V- ANDERSON. M.D., President
REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and J'ietcs Sent On Request - P. O. Box 1514 - Phone 5-3245
J. I'l.ORl DA M.A.
February, 1958
INDEX TO ADVERTISERS
921
• Abbott Laboratories 798a, 799, 800, 801, 802, 803
• Allen’s Invalid Home 918
• American College Chest Physicians 870
• Ames Co., Inc. 891
• Anclote Manor 922
• Anderson Surgical Supply Co. 914
• Appalachian Hall 919
• Averst Laboratories 900
• Ballast Point Manor 922
• Birtcher Corp. 882
• Brawner’s Sanitarium 919
• Brayten Pharmaceutical Co. 909
• Burroughs Wellcome & Co. 796, 881, 90S
• Carlton Corp. 908
• Convention Press 918
• Coca-Cola Co. 880
• Corn Products Refining Co. 874
• Daniel Rehabilitation Institute 879
• Dcsitin Chemical Co. 883
• Drug Specialties, Inc. 904
• Duvall Home 879
• Endo Laboratories 89 3
• General Electric Co. 879
• Charles C. Haskell & Co. Inc. 79S
• Highland Hospital, Inc. 918
• Hill Crest Sanitarium 921
• Lakeside Laboratories 793
• Lederle Laboratories 858, 859, 871, 887, 888,
889, 898, 899
• Eli Lilly & Co. 808
• Mead Johnson & Co. 895
• Medical Protective Co. 906
• Medical Supply Co. 892
• Merck Sharp & Dohme 884, 885, 901, 910, 911
° Miami Medical Center 923
• Parke-Davis & Co. 2nd Cover, 791
• Piedmont Auto & Truck Rental, Inc. 872
• Pennsylvania Life Insurance Co. 915
• Pfizer Laboratories 875
• Reed & Carnrick 873
• Rich Company, Inc. 896
• Riker Laboratories Third Cover
• A. H. Robins & Co. 794, 805, 916, 917
• Roerig & Co. 797, 877, 907
° Sanborn Co. 804
• Schering Corp. 806, 806a, 807, 912, 913
° Shelley Professional Products, Inc. 897
• Schieffelin & Co 906
° Julius Schmid 894
• G. I). Searle Company 869
• Smith-Dorsey 903
• Smith, Kline & French Labs. Back Cover
• E. R. Squibb & Sons , 798
• Surgical Supply Co. 890
° Tucker Hospital, Inc. 920
• S. J. Tutag 890
• Upjohn Co 894a
• U. S. Brewers Foundation 902
° Wallace Laboratories 878, 878a
• Westbrook Sanatorium 920
° Wine Advisory Board 876
• Winthrop Laboratories, Inc. 886, 914
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
Out-Patient Clinic and Offices
James K. Ward. M.D..
lames A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
Phone WOrth I - 1 151
922
Volume XLIV
Number 8
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
9 Modern Treatment Facilities
• Psychotherapy Emphasized
• Large Trained Staff
© Individual Attention
• Capacity Limited
9 Occupational and Hobby Therapy
9 Healthful Outdoor Recreation
9 Supervised Sports
9 Religious Services
9 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants in Psychiatry
SAMUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
5226 Nichol St
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9, Florida
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged casei
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto-
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
IDA M.A.
iry, 1958
SCHEDULE OF MEETINGS
923
ORGANIZATION
a Medical Association
a Medical Districts
lorthwest
iortheast
outhwest
loutheast
a Specialty Societies
my of General Practice
y Society
tiesiologists, Soc. of
Phys., Am. Coll., Fla. Chap.
. and Syph., Assn of
i Officers’ Society
trial and Railway Surgeons
al Medicine
id Gynec. Society
lal. & Otol., Soc. of
pedic Society
logists, Society of
:ric Society
c & Reconstructive Surgery
jlogic Society
iatric Society
logical Society
ons, Am. Coll., Fla. Chapter
gical Society
la —
ic Science Exam. Board
od Banks, Association
e Cross of Florida, Inc
e Shield of Florida, Inc.
icer Council
betes Assn
ital Society, State
irt Association
•pital Association
dical Examining Board
dical Postgraduate Course
se Anesthetists, Fla. Assn.
'ses Association, State
irmaceutical Assoc., State
>lic Health Association
deau Society
rerculosis & Health Assn
man’s Auxiliary
ican Medical Association
I. A. Clinical Session
ern Medical Association
ma Medical Association
ia, Medical Assn, of
Hospital Conference
eastern Allergy Assn
eastern, Am. Urological Assn.
eastern Surgical Congress
Coast Clinical Society
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville ....
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Donald F. Marion, Miami
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr„ Miami
William H. Everts, W. Pm. Bch
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax.
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax. ..
Howard M. DuBose, Lakeland
DeWitt C. Daughtrey, Miami
Mrs. Perry D. Melvin, Miami
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City ..
John A. Martin, Montgomery
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
E. T. McCafferty, Mobile, Ala.
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola ....
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Nathan J. Schneider, Jax
Frank Cline Jr., Tampa
Mrs. R. H. McIntosh, Port St. Joe
Mrs. Wendell J. Newcomb, Pensa.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss..
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
Theo. Middleton, Mobile, Ala
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Miami Beach, May 1958
yy yy yy yy
yy yy yy yy
>* yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
yy yy yy yy
Miami Beach, May 11, ’58
Miami Beach, May 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
yy yy yy yy
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
June 29, 1958
Jacksonville, May 18-21, ’58
Clearwater, April 25-26, ’58
Miami Beach, May 10-14, ’58
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Montgomery, Apr. 17-19, ’58
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy, Insulin, Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Member American Hospital Association
924
Number 8
Voeume XUV
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
WILLIAM C. ROBERTS, M.D., President ..Panama Cin
JERE W. ANNIS, M.D., Pres. -Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D..
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . .Jacksonville
SHALER RICHARDSON, M.D., Editor . .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama Cin
EUGENE G. PEEK JR., M.D... AL-58 Ocala
GEORGES. PALMER, M.D... A-58 Tallahassee
CLYDE O. ANDERSON, M.D... C-59 St. Petersburg
REUBEN B. CHRISMAN JR., M.D.. D-60. .Coral Gables
MEREDITH MALLORY. M.D...B-6! Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D. . . PP-59 ... St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) . Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory).. Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AL-58 Brooksville
First — ALPHEUS T. KENNEDY, M.D. 1 -58 Pensacola
Second— T. BERT FLETCHER JR., M.l). 2 59 Tallahassee
Third— LEO M. WACHTEL, M.D. 3-58 Jacksonville
Fourth— DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHER. M.D. 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D 6-58 ...Arcadia
Seventh — RALPH M. OVERSTREET JR., M.D.
7-58 tV. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
TOR PHYSICIANS AND ALLIED SPECIALISTS
I. ROCHER CHAPPELL, M.D., Chm. Orlando
THOMAS H. BATES, M.D. “A" Lake Citv
FRANK L. FORT, M.D “B” Jacksonville
ALVIN L. MILLS, M.D “C” Sf. Petersburg
IOHN D. MILTON, M.D “D” Miami
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D A-58 Tallahassee
IOHN I. CHELEDEN, M.D B 58 Daytona Beach
IOHN M. BUTCHER, M.D C-58 Sarasota
PAUL G. SHELL, M.D D-58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D. A-59 Pensacola
HENRY L. HARRELL, M.D. B 59 Ocala
IAMES R. BOLT WARE JR., M.D C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 VV. Palm Beach
Ml BRITT R. CLEMENTS, M.D A-60 Tallahassee
ROBERT E. ZELLNER, M.D. B 60 Orlando
WHITMAN c:. McCONNELL, M.D. C-60 St. Petersburg
RALPH S. SAPPENFIELD, M.D. D-60 Miami
HAROLD E. WAGER, M.D A-61 Panama City
CHARLES F. McCROIIY, M.D. 11-61 Jacksonville
IOHN S. STEWART, M.D. C-61 Fort Myers
DONALD F. MARION, M.D. D-61 Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
BARCLEY D. RHEA, M.D. A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D. B 61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm D-58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama Citv
WILLIAM S. JOHNSON, M.D C-59 Lakeland
GEORGE S. PALMER, M.D A-60 Tallahassee
1. K. DAVID JR., M.D. B 61 Jacksonville
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm AL-58 Orlando
WILLIAM W. TRICE JR., M.D....C-58 Tampa
JOHN V. HANDWERKER JR., M.D D-59 Miami
WALTER C. PAYNE JR., M.D A-60 Pensacola
W. DEAN STEWARD, M.D B 61 Orlando
C.ONSERl' AJTON OF VISION
CARL S. McLEMORE, M.D., Chm. AL-58 Orlando
HUGH E. PARSONS, M.D C-58 Tampa
CHARI ES C. GRACE, M.D. B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D. D 61 VV. Palm Beach
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm VV. Palm Beach
FRANCIS II. LANGLEY, M.D St. Petersburg
IOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D Orlando I
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 ...Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 „ W. Palm Beach
GEORGE H. GARMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama Cits
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
BLOOD
MATERNAL WELFARE
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
I EO E. REILLY, M.D. AL-58 Panama Cits
ROBERT B. McIVER. M.D B-58 Jacksonville
GRETCHEN V. SQUIRES. M.D. A-59 Pensacola
DONALD W. SMITH, M.D D-60 Miami
E. FRANK McCALL, M.D., Chm B-60 Jacksonville
WILLIAM C. FONTAINE, M.D. AL-58 Panama Cits
J. LLOYD MASSEY M.D A-58 Quincy
RICHARD F. STOVER, M.D. D-59 Miami
S. L. WATSON, M.D C-61 Lakeland
925
Florida M.A.
•"ebruary, 1958
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm AL.58 Orlando
DEWITT C. DAUGHTRY, M.D D-58 Miami
S. CARNES HARVARD, M.D C-59 Broohsville
MERRITT R. CLEMENTS, M.D A-60 Tallahassee
FLOYD K. HURT, M.D 15 61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL 1R., M.D. Chm. 15-60 Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD I5EESER JR., M.D C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D A-61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
PAUL J. COUGHLIN, M.D. AL-58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant Cits
WALTER E. MURPHRF.E, M.D. R 60 Gainesville
RAYMOND 15 SQUIRES, M.D. A 61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A 60 Tallahassee
HENRY H. GRAHAM, M.D. B-58 Gainesville
JAMES N. PATTERSON, M.D C-61 Tampa
EDWARD W. CULLIPHF.R, M.D D 59 Miami
HOMER F. MARSH, Ph D. Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm. A-60 Chattahoochee
NELSON H. KRAEFT, M.D AL-58 Tallahassee
WILLIAM L. MUSSER, M.D. B-58.. Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D. D 61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO I.. PARKS, M.I)., Chm. 15 61 Jacksonville
HENRY I. LANGSTON, M.D..... AL-58.. , Apalachicola
JOHN G. CHESNEY, M.D D-58 Miami
HAWLEY H. SEILER, M.D C-59 IIlTampa
HAROLD B. CANNING, M.D. A-60 Wexvahitchka
Special Assignment
1 . Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURS1
IURNER Z. CASON, M.D., Chm B-59 Jacksonville
LEO M. WACHTEL, M.D AL-58 Jacksonville
C. FRANK CHUNN, M.D C-58 Tampa
WILLIAM D. CAWTHON, M.D A 60 DeFuniah Springs
V. MARKLIN JOHNSON, M.D D 61 W. Palm Beach
C. W. SHACKELFORD, M.D., Chm. A 61
FRANK V. CHAPPELL, M.D. AL 58
A. BUIST LITTFRER, M.D. D-58
LINUS W. HF.WIT, M.D. C-59
LORENZO I.. PARKS, M.I). B 60
Panama City
Tampa
Miami
Tampa
Jacksonville
WOMAN’S AUXILIARY ADVISORY
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm. B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D AL-58 Pensacola
I. LLOYD MASSEY, M.D A- 5 8 Quincy
W. TRACY HAVERFIELD, M.D D 59 Miami
MASON TRUPP, M.I) C 60 Tampa
MERRITT R. CLEMENTS, M.D., Chm. A 60
JOHN H. TERRY, M.D. AL 58
WILEY M. SAMS, M.I). D 58
G. DEKLE TAYLOR, M.D. B-59
CHARLES McC. GRAY, M.I) C 61
..Tallahassee
Jacksonville
Miami
Jacksonville
Tam l>a
A.M.A. HOUSE OF DELEGATES
NECROLOGY
I. BASIL HALL, M.D , Chm AL-58 Tavares
WALTER W. SACKETT Jl!„ M.D. D 58 Miami
I.F.O M. WACHTEL, M.D. 15-59 Jacksonville
ALVIN L. STEBBINS, M.D A 60 Pensacola
I5AYMOND H. CENTER, M.D C-61 Clearwater
REUBEN 15. CI1R1SMAN JR., M.D., Delegate
FRANK D. GRAY, M.D., Alternate
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate
WALTER E. MURPHREE, M.D. Alternate
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate ....
RICHARD A. MILLS, M.D., Alternate
(Terms expire Dec. 31, 1959)
Coral Gables
Orlando
Tallahassee
Gainesville
Orlando
Fort l.auderilnle
NURSING
1HOMAS C. KENASTON, M.D., Chm. B-59 Cocoa
CARL M. HERBERT, M.D AL-58 Gainesville
HERBERT L. BRYANS, M.D A-58 Pensacola
N'ORVAI. M. MARR SR., M.D. C-60 St. Petersburg
I AMES R. SORY, M.I). D61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B-59 Jacksonville
JOHN J. BENTON, M.D AL-58 Panama City
GEORGE S. PALMER, M.D A-58 Tallahassee
EDWARD W. CULLIPHER, M.D D-60 Miami
FRANK H. I.INDFMAN JR., M.D. C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
PASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
WILLIAM J. HUTCHISON, M.D AL-58 Tallahassee
CHAS. L. FARRINGTON, M.D C-58 St. Petersburg
FHOMAS N. RYON, M.D. D-59 Miami
RAYMOND R. KILLINGER. M.D. B 61 Jacksonville
Special Assignment
I Industrial Health
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 lacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D, 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTEI5, M.D., 1936 Maple Valiev, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.I)., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D, 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SIIALER RICHARDSON, M.D., 1946 lacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D, 1948 Miami
WALTER C. PAYNE SR., M.I)., 1949 Pensacola
HERBERT E. WHITE, M.D, 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. MclVER, M.I).. 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 IV. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN D. MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy.* 1956 St. Petersburg
926
Volume XLIV
Number 8
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Alseroxylon less toxic than reserpine
. . alseroxylon is an antihypertensive agent
of equal therapeutic efficacy to reserpine in
the treatment of hypertension, but with
significantly less toxicity.”
Ford, R.V., and Moyer, J.H.: Rauwolfia Toxicity
in the Treatment of Hypertension: Some Observa-
tions on Comparative Toxicity of Reserpine, a
Single Alkaloid, and Alseroxylon, a Compound Con-
taining Multiple Alkaloids, Postgrad. Med., Janu-
ary, 1958.
just two tablets
at bedtime
Rauwiloid ®
'(alseroxylon, 2 mg.)
for gratifying
rauwolfia response
virtually free from side actions
When more potent drugs are needed, prescribe
Rauwiloid® + Veriloid®
alseroxylon 1 mg. and alkavervir 3 mg.
for moderate to severe hypertension.
Initial dose 1 tablet t.i.d., p.c.
Rauwiloid® + Hexamethonium
alseroxylon i mg. and hexamethonium chloride dihydrate 250 mg.
in severe, otherwise intractable hypertension.
Initial dose Vi tablet q.i.d.
Both combinations in convenient single-tablet form.
iOS ANGELES
J C-E
N E ''! YORK ACADEV.Y
MED I C E
2 E ! 0 3RD ST
NEW YORK H Y 20
To prevent emotional upsets in cardiovascular conditions
the tranquili zing agent remarkable
for its freedom from drowsiness and
depressing effect
Available: Tablets, Ampuls, Multipledose
vials, Spansule" sustained release capsules,
Syrup and Suppositories.
Smith Kline & French Laboratories, Philadelphia
‘Compazine’, by controlling anxiety and
tension, can prevent the emotional upsets
that so often play an exacerbating role
in cardiovascular conditions.
And, ‘Compazine’ can be depended upon
to have little, if any, hypotensive effect.
Compazine
★T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
OF THE
FLORIDA MEDICAL
ASSOCIATION
OFFICIAL PUBLICATION OF THE
FLORIDA MEDICAL ASSOCIATION
SPECIFICALLY
for petit trial
and psychomotor
ff 100 No. 52 si
KAPSEALS °
CELONTIN
I METHSUXIMIDE*
0.3 GRAM
Caution— Federal law
i prohibit* dupensin*
without prejcription.
-alpha, alpha-
B>eU>;lpt>tojlta«laifnJ4a
TI765U
Stoek 15-525-4
BJI IHJi'M'lUfM
L— — -
i
CELONTIN KAPSEALS
Clinical experience1’2’3 indicates that CELONTIN:
’provides effective control with minimal side effects in the treatment of
petit mal and psychomotor epilepsy;
•frequently checks seizures in patients refractory to other medications;
•has not been observed to increase incidence or severity of grand mal
attacks in patients with combined petit and grand mal seizures.
Optimal dosage of CELONTIN should be determined by individual
needs of each patient. A suggested dosage schedule is one 0.3 Gm.
Kapseal daily for the first week. If required, dosage may be increased
thereafter at weekly intervals, by one Kapseal per day for three weeks,
to maximum total daily dosage of four Kapseals (1.2 Gm.).
1. Zimmerman, E T., and Burgemeister, B.: Arch. Neurol, ir Pstjchiat. 72:720, 1954.
2. Zimmerman, E T., and Burgemeister, B.: J.A.M.A. 157:1194, 1955.
3. Zimmerman, E T.: Arch. Neurol. & Pstjchiat. 76:65, 1956.
the Parke-Davis family of anti-epileptics provides specificity
and flexibility in treatment for convulsive disorders
for grand mal and psychomotor seizures
DILANTIN9 Sodium (diphenylhydantoin sodium, Parke-Davis) is supplied in a variety of
forms — including Kapseals® of 0.03 Gm. and of 0.1 Gm. in bottles of 100
and 1,000.
PHELANTIN® Kapseals (Dilantin 100 mg., phenobarbital 30 mg., desoxyephedrine hydro-
chloride 2.5 mg.), bottles of 100.
for the petit mal triad
CELONTIN® Kapseals (methsuximide, Parke-Davis), 0.3 Gm., bottles of 100.
milontin® Kapseals (phensuximide, Parke-Davis), 0.5 Gm., bottles of 100 and 1,000.
MILONTIN Suspension, 250 mg. per 4 cc., 16-ounce bottles.
DETROIT 3 2, MICHIGAN
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
volume xliv, No. 9 ♦ March. , 1958
CONTENT S
Scientific Articles
Facial Fractures: Their Recognition and Management,
Bernard L. N. Morgan, M.D. 949
Recurrent Intussusception in a Six Year Old C'hild with Histoplasmosis
of Peyer’s Patches, Manuel G. Carmona, M.D., and
Marvin S. Allen, M.D. 955
Diabetes Screening in Polk County, Chester L. Nayfield, M.D., and
James A. Donaldson, M.D. 957
Hiccups as Sole Presenting Symptom of Myocardial Infarction,
N. Stuart Gilbert, M.D. 960
The Risk of Ascaris Infestation From the Use of Human Sludge as
Lawn Fertilizer, James O. Bond, M.D. 964
Improved Results in the Postcoital Test With Terramycin Vaginal
Suppositories, John M. Schultz, M.D. . 968
Abstracts
Drs. W. J. Knauer Jr., and H. J. Roberts 971
Editorials and Commentaries
Timely Telephone Topics 972
Scientific Program Planned for Annual Meeting, Bal
Harbour, May 10-14, 1958 973
Popularity of Midwinter Seminar Grows 975
Seminar on Internal Medicine 975
1957 Report of Ford Foundation 976
Newly Established Educational Council for Foreign Medical Graduates 976
General Features
Others Are Saying 977
Blue Shield
Blue Shield Yesterday, Today and Tomorrow, Jay C. Ketchum 984
My View of Florida Blue Shield, Robert E. Zellner, M.D. 978 *
State News Items 994
Component Society Notes lOOCfl
Marriages and Deaths 1004 |
Classified 1012 .
New Members 1014
Obituaries 1014 I
Woman’s Auxiliary 1035
Books Received 1041
Schedule of Meetings 1065 b|
Florida Medical Association Officers and Committees 1064»
County Medical Societies of Florida 1066
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price S5.00 a year: single numbers. 50 cents. Address Journal of Florid;
Medical Association, P.O. Box 2411. 735 Riverside Ave.. Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail 5
ing at special rate of postage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville
Florida, October 23, 1924
J. Florida M.A.
March, 1958
933
“Since we’ve had him on NEOHYDRIN he can walk
without dyspnea. I wouldn’t have believed it possible
a month ago.”
oral
organomercurial
diuretic
TAB LET
®
LAKESIDE
BRAND OF CHLORMERODRIN
sot.
934
Volume XLIV
Number 9
• debilitated
• elderly
• diabetics
• infants, especially prematures
• those on corticoids
• those who developed moniliasis on previous
broad-spectrum therapy
• those on prolonged and/or
high antibiotic dosage
• women — especially if pregnant or diabetic
the best broad-spectrum antibiotic to use is
MYSTECLIN-V
Squibb Tetracycline Phosphate Complex (Sumycin) and Nystatin (Mycostatin) Sumycin plus Mycostatin
for practical purposes, Mysteclin-V is sodium-free
for “built-in" safety, Mysteclin-V combines:
1. Tetracycline phosphate complex (Sumycin) for superior
initial tetracycline blood levels, assuring fast transport of
adequate tetracycline to the infection site.
2. Mycostatin— the first safe antifungal antibiotic— for its
specific antimonilial activity. Mycostatin protects
many patients (see above) who are particularly prone to monilial
complications when on broad-spectrum therapy.
Capaulea (250 mg./250,000 u.). bottles
of 16 and 100. Half-Strength Capaulea
(125 mK./125,000 u.), bottles of 16
and 100. Suapenaion (125 mg./125,000
u.). 2 oz. bottles. Pediatric Dropa (100
mg./ 100,000 u.), 10 cc. dropper bottles.
Squibb
©
Squibb Quality—
the Priceless Ingredient
MYSTECLIN-V PREVENTS MONILIAL OVERGROWTH
25 PATIENTS ON
TETRACYCLINE ALONE
25 PATIENTS ON r
TETRACYCLINE PLUS MYCOSTATIN
Before therapy
After seven days
of therapy
Before therapy
After seven days
of therapy
• • • • •
• • • © o
• •••
• • • • <9
• • • © o
• • • ©
• ••©:>
•
• •• • •
Monilial overgrowth (rectal swab) None $ Scanty 0 Heavy
Childs, A. J.: British M. J. 1:660 1956.
•MfSTECUN, * •MTCOSTATIH-.* aNO ’SUMYCIN'
SQUK
J. Florida M.A.
March, 1958
935
a superior psychochemical
for the management of both
minor and major
emotional disturbances
• more effective than most potent tranquilizers
• as well tolerated as the milder agents
• consistent in effects as few tranquilizers are
Dartal is a unique development of Searle Research,
proved under everyday conditions of office practice
It is a single chemical substance, thoroughly tested and found particularly suited
in the management of a wide range of conditions including psychotic, psycho-
neurotic and psychosomatic disturbances.
Dartal is useful whenever the physician wants to ameliorate psychic agitation,
■ whether it is basic or secondary to a systemic condition.
In extensive clinical trial Dartal caused no dangerous toxic reactions. Drowsiness
and dizziness were the principal side effects reported by non-psychotic patients,
but in almost all instances these were mild and caused no problem.
Specifically, the usefulness of Dartal has been established in psychoneuroses with
emotional hyperactivity, in diseases with strong psychic overtones such as ulcera-
tive colitis, peptic ulcer and in certain frank and senile psychoses.
Usual Dosage • In psychoneuroses with anxiety and
tension states one 5 mg. tablet t.i.d.
• In psychotic conditions one 10 mg. tablet t.i.d.
936
Volume XLIV
Number 9
probably the easiest-to-use x-ray table in its field
'■Mi'
1
Instant swing-through from fluoroscopy to
radiography (and vice versa). Self-guid-
ing to correct operating distance. Nothing
to match up . . . you do it without leaving
the table front.
Horizontal, vertical, interme-
diate, or Trendelenburg posi-
tions by equipoise handrock
(or quiet motpr-drive).
Choice of rotating or
stationary anode x-ray
tubes. Full powered
100 ma at 100 KVP.
certainly the simplest ^automatic x-ray control ever devised
! _
» -
■T> •
know why? look . . .
1 On this board you select the bodypart you want to x-ray
2 Set its measured thickness
3 Press the exposure button
That's all there is to it. No time, KV, or MA adjusting to do.
No charts to check, no calculations to make.
housed in this
handsome
upright
cabinet
Obviously as canny an x-ray investment as you can make
Modest cost
Excellent value
Prestige "look"
Top Reputation (significantly, “Century" trade-in value has long been highest in its field)
MIAMI 35, FLA., 1363 Coral Way
Jacksonville 7, Fla., 1023 Mary Street
St. Petersburg, Fla., 601 Rutledge Bid®
Orlando, Fla., 1711 Oakmont Street
W. Palm Beach, Fla., 305 South Flagler Drive
T. Florida M.A.
March, 1958
937
respiratory congestion
relief in minutes . . lasts for
orally
hours
In the common cold, nasal allergies, sinus-
itis, and postnasal drip, one timed-release
Triaminic tablet brings welcome relief of
symptoms in minutes. Running noses stop,
clogged noses open — and stay open for 6 to
8 hours. The patient can breathe again.
With topical decongestants, “unfortu-
nately, the period of decongestion is often
followed by a phase of secondary reaction
during which the congestion may be equal
to, if not greater than, the original condi-
tion. . . The patient then must reapply
the medication and the vicious cycle is
repeated, resulting in local overtreatment,
pathological changes in nasal mucosa, and
frequently “nose drop addiction.”
Triaminic does not cause secondary con-
gestion, eliminates local overtreatment and
consequent nasal pathology.
'Morrison, L. F.: Arch. Otolaryng. 59:48-53 (Jan.) 1954.
Each double-dose "timed-release” TRIAMINIC
Tablet contains:
Phenylpropanolamine hydrochloride 50 mg.
Pyrilamine maleate 25 mg.
Pheniramine maleate 25 mg.
Dosage: 1 tablet in the morning, afternoon, and
in the evening if needed.
Each double-dose “timed-release”
tablet keeps nasal passages
clear for 6 to 8 hours —
provides “ around-the-clock ”
freedom from congestion on
just three tablets a day
disintegrates to give 3 to 4
more hours of relief
Also available: Triaminic Syrup, for children and
those adults who prefer a liquid medication.
Triaminic
" timed-release "
tablets
running noses . .
4.4
and open stuffed noses orally
SMITH-DORSEY • a division of The Wander Company • Lincoln, Nebraska • Peterborough, Canada
938
Volume XLIV
Number 9
Pleasant tasting
‘ANTEPAR!
brand
PIPERAZINE
SYRUP - TABLETS - WAFERS
Eliminate PINWORMS IN ONE WEEK
ROUNDWORMS IN ONE OR TWO DAYS
PALATABLE • DEPENDABLE • ECONOMICAL
‘ANTEPAR* SYRUP - Piperazine Citrate, 100 mg. per cc.
‘ANTEPAR* TABLETS ~ Piperazine Citrate, 250 or 500 mg., scored
‘ANTEPAR* WAFERS ” Piperazine Phosphate, 500 mg.
Literature available on request
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.
“care of
the man
rather than merely
his stomach”
MilpatJi
Mil town* O anticholinergic
two-level control of
gastrointestinal dysfunction
at the central level The tranquilizer Miltown® reduces anxiety and tension.1- 3- 6- 7
Unlike the barbiturates, it does not impair mental or physical efficiency.5-7
at the peripheral level The anticholinergic tridihexethyl iodide reduces
hypermotility and hypersecretion.
Unlike the belladonna alkaloids, it rarely produces dry mouth or blurred vision.2-4
indications: peptic ulcer, spastic and irritable colon, esophageal
spasm, G. I. symptoms of anxiety states.
eaoh Milpath tablet contains:
Miltown.® (meprobamate WALLACE) 400 mg.
(2-methyl-2-/z-propyl-l, 3-propanediol dicarbamate)
Tridihexethyl iodide 25 mg.
(3-dlethylamino-l-cycIohexyl-l -phenyl- 1-propanol-ethiodide)
dosage: 1 tablet t.i.d. at mealtime
and 2 tablets at bedtime.
available: bottles of 50 scored tablets.
references: l. Altschul. A. and Billow, B .: The clinical use of meprobamate. (Miltown®). New York J. Med. 57: 2361,
July 15, 1957. 2 Atwater, J. S. : The use of anticholinergic agents in peptic uleer therapy. J. M. A. Georgiu 4*5:421, Oct. 1956.
3. Borrus. J. C\: Study of effect of Miltown (2-methyl-2-«-propyl-l. 3-propanediol dicarbamate) on psychiatric states.
J. A M. A. 757:1596, April 30. 1955. 4 Oayer. 1> : Prolonged anticholinergic therapy of duodenal ulcer. Am. J. Digest. Dis
/:301, July 1956. 5. Marquis. I). G . Kelly, E. I,., Miller. J. G.. Gerard, R. W. and Rapoport. A : Experimental studies of
behavioral effects of, meprobamate on normal subjects. Ann. New York Acad. Sc. 67:701, May 9, 1957. 0 Phillips, R. E. :
Use of meprobamate (Miltown®) for the treatment of emotional disorders. Am. Pract. & Digest Treat. 7:1573. Oct 1956
7. Selling. L. S : A clinical study of Miltown®. a new tranquillzing agent. J. Clin. & Ex per. Psychopath. 17:7. March 1956
8. Wolf. S. and Wolff. H. G.: Human Gastric Function. Oxford University Press, New York. 1947.
WALLACE LABORATORIES.New Brunswick, N. J.
\\
*as adjunctive therapy only
THE FIRST TROCHE TO PROVIDE
THREEFOLD RENEFITS
PENTAZETS
TROCHES
NON-NARCOTIC ANTITUSSIVE EFFICACY
SHOWN TO APPROXIMATE THAT OF CODEINE
With the addition of a non-narcotic antitussive
to troche medication, ‘Pentazets’ provides
a new and extended therapeutic advantage in
this convenient form of treatment.
Treatment of the cough too, so often a
troublesome symptom of sore throat, combined
with wide-range antibiotic activity and
soothing analgesic benefit, now offers three fold
relief in a variety of throat irritations.
And ‘Pentazets’ are pleasant-tasting, too,
making them highly acceptable, especially
to children.
‘PENTAZETS’ contains:
• Homarylamine— a new non-narcotic antitussive with cough
control shown to approximate that of codeine. • Bacitracin-
Tyrothricin-Neomycin — a combined antibiotic treatment
against many pathogenic organisms with little danger of
unfavorable side effects. • Benzocaine— a local anesthetic for
soothing relief to inflamed tissues. Being slowly absorbed,
it is especially beneficial for prolonged effect and benefit to
surrounding areas.
Supplied: Vials of 12.
Each ‘PENTAZETS’ troche contains:
Homarylamine hydrochloride 20 mg.
Zinc Bacitracin 50 units
Tyrothricin 1 mg.
Neomycin sulfate 6 mg.
(equivalent to 3.5 mg. neomycin base)
Benzocaine 6 mg.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
942
Volume XLIV
Number 9
NOW... A NEW TREATMENT
i
CARDILATE
rm
‘Cardilate' tablets shaped for easy retention
in the buccal pouch
. . the degree of increase in exercise tolerance which sublingual ery-
throl tetranitrate permits, approximates that of nitroglycerin, amyl
nitrite and octyl nitrite more closely than does any other of the approxi-
mately 100 preparations tested to date in this laboratory.”
"Furthermore, the duration of this beneficial action is prolonged suffi-
ciently to make this method of treatment of practical clinical value.”
Riseman, J. E. F., Altman, G. E., and Koretsky, S.:
Nitroglycerin and Other Nitrites in the Treatment of
Angina Pectoris, Circulation (Jan.) 1958.
Cardilate' brand Erythrol Tetranitrate SUBLINGUAL TABLETS, 15 mg. stored
BURROUGHS WELLCOME & CO. (U.S.A.) INC.. Tuckahoe. New York
J. Florida M.A.
March, 1958
943
there is one tranquilizer clearly indicated ill peptic llICBT...
•Tests in a series of 25 patients show that
there is “a definite and distinct lowering
[of both volume of secretions and of free
hydrochloric acid] in the majority of
patients. . . . No patients had shown any
increase in gastric secretions following ad-
ministration of the drug.”1
Now you have 4 advantages when
you calm ulcer patients with atarax:
1. atarax suppresses gastric secretions;
others commonly increase acidity.
2. atarax is “the safest of the mild tran-
quilizers.”2 (No parkinsonian effect
or blood dyscrasias ever reported.)
3. It is effective in 9 of every 10 tense
and anxious patients.
4. Five dosage forms give you maximum
flexibility.
supplied: 10, 25 and 100 mg. tablets, bottles of
100. Syrup, pint bottles. Parenteral Solution,
10 cc. multiple-dose vials.
references: 1. Strub, I. H. : Personal coramu-
nication. 2. Ayd, F. J.f Jr.: presented at Ohio
Assembly of General Practice, 7th Annual
Scientific Assembly, Columbus, September 18-
19. 1957.
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
944
Volume XLIV
Number 9
of infant feeding
Standard formulas for PREMATURES
Breast milk is satisfactory for the feeding of
prematures in spite of the low protein and
mineral and high fat content. But eventual
formula feeding should provide a high protein
and carbohydrate to satisfy the rapid-growing
needs of the premature and low fat content
because of limited digestive capacity.
Feedings of small prematures are most effec-
tively administered by the indwelling poly-
thene nasal catheter and of large prematures,
by bottle with small nipples.
The first six feedings should be a sterile 5%
solution of Karo Syrup at 2 to 3 hour intervals;
for subsequent feedings, breast milk or for-
mula should be added in gradually increasing
amounts according to tolerance and require-
ments, as indicated in the table below.
Initial feeding schedules
for premature infants
(Feedings Started After 36 Hours and Continued
at 2 to 3 Hour Intervals)
FEEDINGS
COMPOSITION
QUANTITY
First Six
5% Karo
2-5 ml.
7th and 8th
2 parts 5% Karo
1 part breast milk
or formula
6-10 ml.
9th and 10th
1 part 5% Karo
1 part breast milk
or formula
8-16 ml.
11th and 12th
1 part 5% Karo
2 parts breast milk
or formula
10-18 ml.
Subsequently
Breast or formula feeding
12-20 ml.
ADVANTAGES
OF KARO1 IN INFANT
FEEDING
Composition: Karo is a su-
perior maltose-dextrin mixture
because the dextrins are non-fer-
mentable and the maltose is
rapidly transformed into dextrose
which requires no further digestion.
ConCCntTCitlOn. Volume for
volume Karo furnishes twice as
many calories as similar milk
modifiers in powdered form.
Purity: Karo is processed at
sterilizing temperatures, sealed
for complete hygienic protection
and devoid of pathogenic or-
ganisms.
Low Cost: Karo costs l/5th as
much as expensive milk modifiers
and is available at all food stores.
j**'** Medical Division
CORN PRODUCTS REFINING COMPANY
2 7 Battery Place, New York 4, N. Y.
.T. Florida M.A.
March, 1958
945
IN ALL DIARRHEAS . . . REGARDLESS OF ETIOLOGY
comprehensive control CREMOMYCIN
SULFASUXIDINE.t PECT I N - K AOL 1 N - N EO M YC I N SUSPENSION
SOOTHING ACTION . . . Kaolin and pectin coat and soothe the inflamed mucosa, ad-
sorb toxins and help reduce intestinal hypermotility.
BROAD THERAPY . . . The combined antibacterial effectiveness of neomycin and
Sulfasuxidine is concentrated in the bowel since the absorption of both agents
is negligible.
LOCAL IRRITATION IS REDUCED and control is instituted against spread of infective
organisms and loss of body fluid.
PALATABLE creamy pink, fruit-flavored CREMOMYCIN is pleasant tasting, readily
accepted by patients of all ages.
* Sulfasuxidine is a trade-mark of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc.. PHILADELPHIA 1, PA.
946
Volume XLIV
Number 9
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or V2 teaspoonful
contains:
Pentylenetetrazol .. 100 mg.
Nicot-inic Acid 50 mg.
1. Levy, S., JAMA., 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J., 15:596, 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL.
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
external
healing;
standard for ocular Infections
(Sulfacetamide Sodium U.S.P— 5 and 15 cc. dropper bottles)
(15 cc. dropper bottle)
('/a oz. tube)
for simultaneously combating
inflammation, allergy, infection
(0.5% prednisolone acetate and 10% sulfacetamide sodium —
5 cc. dropper bottle)
(0.5% prednisolone acetate, 10% sulfacetamide sodium and
0.25% neomycin sulfate— V6 oz. tube)
for ocular
allergies
(0.2% prednisolone
acetate and
0.3% Chlor-Trimeton®—
5 cc. dropper
bottle)
SCHERING CORPORATION
BLOOMFIELD, NEW JERSEY
Volume XLIV
Number 9
OUAll
The non-narcotic analgesic with the potency of codeine
DARVON (Dextro Propoxyphene
Hydrochloride, Lilly) is equally as po-
tent as codeine yet is much better
tolerated. Side-effects, such as nausea
or constipation, are minimal. You will
find ‘Darvon’ helpful in any condition
associated with pain. The usual adult
dose is 32 mg. every four hours or 65
mg. every six hours as needed. Avail-
able in 32 and 65-mg. pulvules.
DARVON COMPOUND (Dextro Pro-
poxyphene and Acetylsalicylic Acid
Compound, Lilly) combines the antipy-
retic and anti-inflammatory benefits of
‘A.S.A. Compound’* with the analgesic
properties of ‘Darvon.’ Thus, it is useful
in relieving pain associated with recur-
rent or chronic disease, such as neural-
gia, neuritis, or arthritis, as well as acute
pain of traumatic origin. The usual adult
dose is 1 or 2 pulvules every six hours
as needed.
Each Pulvule 'Darvon Compound’ provides:
‘ Darvon ’ 32 mg.
Acetophenetidin 162 mg.
‘A.S.A.’ ( Acetylsalicylic Acid, Lilly) 227 mg.
Caffeine 32.4 mg.
•‘A.S.A. Compound' (Acetylsalicylic Acid and Acetophenetidin Compound, Lilly)
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U. S. A.
820260
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, March 1958 No. 9
Facial Fractures: Their Recognition
And Management
Bernard L. N. Morgan, M.D.
JACKSONVILLE
Fractures of the facial bones are on the in-
crease, due in large part to the automobile. It is
estimated that they occur in 4 per cent of all
automobile injuries. That figure means a total of
1,200 in Florida alone last year. When other
causes such as athletics, domestic injuries and
industrial accidents are included, it is apparent
that these are injuries of some importance (fig.
1).
Diagnosis of these injuries is often confusing
to the physician. To be sure, the cardinal symp-
toms and signs of fractures are present, namely,
pain, displacement of bony continuity, abnormal
movements, and the like, but the problem here is
complicated by the excessive soft tissue swelling
and the frequency of severe lacerations or head
injuries which take precedence in treatment. Of-
ten, roentgenograms are the final diagnostic aid,
but here again the interpretation of the roent-
genograms is not easy to one inexperienced in this
problem. An endeavor is here made to simplify
the problem of diagnosis and conclude with a few
words on treatment.
Diagnosis
An appreciation of the anatomy of the facial
bones is invaluable (fig. 2). The facial bones are
thin with numerous foramina and air cells and
sinuses. These characteristics play a large part
in determining the lines of fracture whereas the
sponginess cushions most severe blows from in-
juring the cranial contents. Surgeons like to
classify these fractures according to location.
The facial skeleton is divided into horizontal
thirds, upper, middle and lower. The middle third
is subdivided into central and lateral elements.
The major fractures follow closely this division
and are governed by the direction and force of
the blow.
Mandibular fractures are usually well recog-
nized. The common sites of fracture are well
Read before the Florida Medical Association, Eighty-Third
Annual Meeting. Hollywood, May 7, 1957.
known, namely, the condylar or subcondylar re-
gion, the symphysis or the angle. The causative
factor is nearly always a direct blow, and the
direction of the blow determines to large extent
the site of the fracture. The mandible is a re-
silient V-shaped bone, and if it is fractured at
any point and there is displacement present, then
there must either be a second fracture or a dis-
location of one of the condyles.
Recognition of fractures of the mandible is
usually straightforward. The most obvious symp-
tom is pain, which is usually localized at the site
of fracture. A tender swelling is often palpated,
and sometimes crepitus at the fracture line can
be detected. An important diagnostic sign in this
and all other fractures of the jaws is malocclu-
sion. A tear in the gum may be seen at the site
of fracture. Severe pain and trismus occur be-
cause of the action of the powerful muscles at-
tached to the mandible. This is in contradistinc-
tion to the midfacial fractures, in which bruising
and disfigurement are out of all proportion to the
pain.
Midfacial fractures fall into the anatomic
areas shown in the diagram (fig. 2).
Fractures of the outer third are those of the
zygoma. If caused by a sharp object and received
at the side, the arch will be fractured and dis-
placed inwards. Oftentimes the depression on the
side of the face is visible and readily palpable
subcutaneously. If the inward angulation is
severe, it impinges on the temporal fossa, narrow-
ing it and producing anything from mild trismus
to complete mechanical blockage to movement
of the jaw.
If the patient is hit on the cheek, the body of
the zygomatic bone fractures. It may collapse egg
shell fashion into the maxillary antrum, or the
entire eminence may displace as a pyramidal
block. When the latter, there are always three
fracture lines, along the zygomatic arch, near the
zygomatic frontal suture, and along the infra-
orbital rim. There is always pronounced soft tis-
950
MORGAN: FACIAL FRACTURES
Volume XLIV
Number 9
sue swelling. In the first type of injury flattening
of the side of the face may be recognizable and
palpable. In the second type, palpation with the
fingernail along the bony ridges will reveal a tend-
er irregularity or displacement at the fracture
lines. The lower fracture line passes through the
infraorbital foramen and causes contusion or
avulsion of the nerve, associated with peripheral
anesthesia of the upper lip and teeth on the same
side. This is an important diagnostic sign. The
degree of displacement varies. If severe, there is
loss of support of the orbital floor, and diplopia,
especially on lateral movements, is apparent.
Central middle third fractures are those in-
volving the nose and the maxilla. Nasal fractures
occurring alone are due to localized blows. The
nasal bones and the septum are usually involved,
rarely the frontal or maxillary processes. The
nose may be flattened or displaced to one side
or the other. The diagnosis is usually self evident
and the extent of displacement more evident on
clinical than on radiologic examination.
T. F-.y-i \ M.A.
March, 1958
MORGAN: FACIAL FRACTURES
951
Fig. 2. — Normal anatomy of the midfacial bones
showing common sites of fracture and the classification
zones.
Maxillary fractures are the most complicated.
The maxilla may fracture above the teeth when
the blow is received on the mouth. The fragment
shears off from the side walls of the antrum just
above the root of the teeth and lies loose in the
mouth. Occasionally, this lower fragment is com-
plicated by a second fracture in the sagittal plane
so that it lies loosely in two halves. Diagnosis is
not difficult. The patient has an open bite. In-
traoral examination shows the malocculsion and
may reveal a laceration of the palate. If the up-
per jaw is grasped with the fingers, it can be
moved independently of the maxilla. This is an
important diagnostic sign in middle third injuries.
In the most severe injuries one is dealing
with a complex of fractures. This is the patient
who shows the dish-face appearance. The entire
middle third of the face is pushed in, although
in less severe cases the outer third malar bones
are not displaced. On roentgen studies (fig. 6) the
nasal bones are separated and splayed, there is
bilateral malar fracture and horizontal fracture
of the alveolar process of the upper jaw. In mak-
ing the diagnosis prior to roentgen examination,
it is helpful to remember the findings in the sim-
ple injuries and aggregate these. To summarize,
a multiple injury will show open bite, mobility of
the maxilla, broadening of the nasal bones, loss
of the normal contour of the cheeks and total
anesthesia of the midportion of the face.
Roentgenograms play a most important part
in diagnosis, and a few words concerning their
interpretation may be in order. The most valu-
Fig. 3. — A normal Waters projection. This view
shows the outline of the facial bone.
able projection is the Waters (fig. 3). This view
outlines the facial bones without undue overlap-
ping. Points to note are the orbital rims, the
zygomatic arches, the nasal bones and the normal
translucency of the antrums. Fractures in the
vicinity of the antrums are associated with
hemorrhage, which shows up as an opacity on the
roentgenogram (fig. 4).
Treatment
Initial efforts are directed to the management
of complicating lacerations and head injuries. If
Fig. 4. — Fracture of the left malar region illustrat-
ing the antral opacity, the fracture lines through the
orbital rim and the depression of the infraorbital mar-
gin.
952
MORGAN: FACIAL FRACTURES
Volume XLIV
Number 9
the general condition permits, it may be possible
to proceed with immediate reduction and fixation
of the fractures, but as a rule no great urgency
exists, and a. delay of several days is of no great
consequence. An exception is fractures of the
mandible. In these latter, pain is common from
movement at the fracture site, and the jaw should
be supported early.
The aim of treatment is the reduction of any
displacement and fixation until union has oc-
curred. The technic will vary with the type and
site of fracture.
In zygomatic fractures involving the arch,
the fragments can often be hooked back into posi-
tion with a towel clip passed through the cheek.
If more extensive, and there is pronounced dis-
placement of the zygoma, an incision is made in
the temple through the temporal fascia, and an
elevator is passed beneath the displaced fragment.
The displaced block of bone is then elevated into
place. It usually repositions like a keystone and
remains stable. If the antral wall is flattened, it
may be necessary to open the antrum and reposi-
tion the fragments with a sound or finger. Stabil-
ity may require antral packing for about 10 days.
Treatment of fractures of the jaw is governed
by the presence or absence of teeth. If teeth are
present, interdental fixation by arch bars and
rubber bands is simple and effective. The use of
the bands permits readjustments of pull to correct
Fig. 5. — Case A. Upper photos show prereduction appearance three days after injury. Lower picture is
patient’s appearance three weeks after the operative reduction. The view to the right illustrates the arch
bars and rubber band traction.
J. Florida M.A.
March, 1958
MORGAN: FACIAL FRACTURES
953
Fig 6. Case A. a. — Preoperative x-ray. b. c. — After reduction showing the internal wire fixation in
position.
misalignment of teeth. Usually four to six weeks
immobilization is adequate. When no teeth are
present in the lower jaw, fixation can be readily
obtained by direct wiring of the fragments. This
is accomplished easily through a small curved
incision beneath the chin and over the fracture
line.
Nasal fractures are easily disimpacted with an
elevator passed into the nasal cavities and then
molded into position between thumb and index
finger. Intranasal packing and external splinting
are often necessary for three to four days post-
opera tively.
The major problem is that of multiple middle
third fractures. The breaks are often so extensive
that there is no rigid support upon which to sta-
bilize. My experience suggests that open reduc-
tion and internal fixation give excellent results
with an easy convalescence. The advantages of
direct wiring of fragments are the accuracy of
repositioning and stability, especially when the
wiring is attached to uninjured areas such as the
frontal bone. The technic is not unduly difficult,
it is not hazardous, and the patient is ambulatory
the following day, unhindered by plaster head
caps, cheek wires and other forms of external
fixation. An illustrative case follows:
A 35 year old woman was injured in an automobile
accident. A front seat passenger, she was thrown into
the windshield and received severe facial lacerations as
well as facial fractures. The lacerations were sutured
immediately, and she was transferred five days later for
treatment of the facial fractures. There was complete
separation with inward displacement of the middle third
of the facial skeleton (figs. 5 and 6). This was reposi-
tioned and stabilized by internal wire fixation supple-
mented by arch bar splintage of maxilla to mandible.
Good reduction and stability were obtained. Convales-
cence was rapid, and she was discharged one week later.
She is shown (fig. 5) two weeks following the fixation.
Although there still remained considerable bruising, the
patient was ambulant and able to attend to her house-
work.
Summary
An attempt is made to simplify the problem
of diagnosis of fractures of the facial bones. This
is based on an anatomic classification which has
a practical clinical application. The methods of
treatment described, based to large extent on open
reduction and internal fixation, have as an aim
a minimum of postreduction discomfort and dis-
ability for the patient. A typical severe injury is
illustrated to support these beliefs.
800 Lomax Street.
Discussion
Dr. Clifford C. Snyder, Miami: It is difficult to
mention all phases of this problem, but Dr. Morgan has
covered his subject well. In addition one might say
that usually the fracture problem per se is not the emer-
gency that an adequate airway or serious bleeding pre-
sents. Once the patient’s respiratory exchange is satisfac-
tory and major bleeding points are controlled, other
traumatic complications should be looked for, such as
soft tissue injury, nerve severance, parotid duct injury,
ocular perforation, fractured skull or other bone damage.
If there is soft tissue avulsion or irregular skin lacera-
tions, these may be closed at the time of the facial frac-
ture treatment or repaired later. Debridement and cleans-
ing of wounds and simple repair are always acceptable.
In cases in which the eyelids, lips, nose or ears are dam-
aged, one may concentrate on meticulous approximation
if the patient’s condition permits. Flematomas must be
prevented. If a main branch of the facial nerve is in-
jured, it should be repaired, but terminal branches are
left alone. When the parotid salivary duct is severed,
there is no better time to approximate it than at the
time of initial surgery. Whenever an ocular injury is
present, an ophthalmalogist should be called immediately.
I utilize the same methods that Dr. Morgan employs
in treating the facial bone fractures. My acquaintance
with the Adam’s method of wiring for maxillary fractures
eliminates any plaster head dressing, though the latter is
practiced by many surgeons.
Diet is an important subject in regard to after-care
because solid foods not only are difficult to take but also
954
MORGAN: FACIAL FRACTURES
Volume XLIV
Number 9
may cause complications. A free liquid intake with
added protein and vitamin supplementation serves the
purpose adequately.
Dr. Joseph E. O’Malley, Orlando: I wish to thank
Dr. Morgan for the opportunity to review this fine
paper.
Facial fractures are indeed on the increase, particu-
larly so with the increasing popularity of the two wheel
motor-driven vehicles such as the motor scooter. Three
of my most recent and severe cases occurred in teenagers,
traveling at a high rate of speed and completely un-
protected on scooters. There is usually massive avulsion
of the facial tissues associated with multiple facial frac-
tures in this type of injury and oftentimes total loss of
portions of the facial skeleton.
This paper gives an excellent review of the important
factors in diagnosis of the most commonly encountered
fractures. Regarding fractures of the mandible in par-
ticular, I should like to emphasize the importance of
dental occlusion. One should familiarize oneself with
correct occlusion as this serves as a guide in the reduc-
tion of fractures and provides a positive index for re-
establishing the masticatory power of the teeth. When
occlusion is re-established, the bone fragments are in good
functional alignment. This is important from a diag-
nostic standpoint, for in some instances, undisplaced
fractures at the angle, particularly, can be devoid of
clinical findings unless considerable force is applied to
create pain or crepitus. The only aid in diagnosis prior
to roentgen examination is the patient’s statement that
his teeth do not seem to come together properly.
It is not surprising how often a fracture of the zy-
gomatic bone is overlooked and treatment neglected.
Dr. Morgan has emphasized that edema and discoloration
far overshadow pain in fractures of the middle plane of
the face, and this factor is a considerable hindrance in
diagnosis when associated with multiple facial lacerations.
Pronounced periorbital edema makes palpation about
the rim of the orbit most difficult, and one must rely
on roentgen examination in the absence of trismus, pro-
nounced facial depression and diplopia. If diplopia is
elicited on examination, one should always suspect a
fracture at the frontozygomatic suture, allowing the later-
al canthus of the eye to be displaced downward.
I certainly agree with Dr. Morgan that the various
maxillary fractures are the most complicated and, when
associated with single or multiple fractures of the mandi-
ble, can be a real challenge to the surgeon from both a
functional and cosmetic standpoint. His review of the
useful diagnostic signs was most adequate and, if follow-
ed, should reveal a fracture in this area.
The important factors in treatment were well cover-
ed, and I should like to add one method in the manage-
ment of the markedly comminuted and displaced fracture
of the mandible in the dentulous and certainly in the
edentulous patient. Reduction and satisfactory immobil-
ization can be accomplished by the use of a stout Kirs-
chner wire driven by a high speed electric drill through
the marrow cavity of the mandible on all fractures of the
mandible other than those of the coronoid process or
within the temporal mandibular joint itself. It has been
my practice to use this method under direct vision by
means of a small incision directly over the site of frac-
ture, driving the wire out through the distal fragment
and back into the proximal fragment. This procedure
does not require any immobilization between the maxilla
and mandible, a consideration which is particularly im-
portant in the aged and debilitated, allowing them to
eat normally and maintaining adequate nutrition as the
fracture heals. The main objection to this procedure
in the past has been the possibility of permanent injury
to the inferior alveolar nerve. This can be prevented
Dy drilling the wire under direct vision with a minimum
of trauma to the marrow cavity and most accurate
repositioning of the fragments.
Dr. Morgan’s method of reduction and immobiliza-
tion of the fragments of the maxilla is an excellent one,
and I agree that direct wiring of the fragments is the
method of choice to obtain accuracy of repositioning and
stability.
Dr. Georce W. Robertson III, Miami: Dr. Mor-
gan has presented most adequately a problem of which
we see a great deal. Unfortunately, recognition of many
of the facial fractures occurs too late to effect a primary
repair. The fracture is often marked by edema, hema-
toma, or ecchvmosis, and not until swelling has disap-
peared is the deformity usually visualized or the diplopia
noted.
As in many fields of medicine, a high index of sus-
picion is necessary to make the diagnosis. Although the
plastic surgeon generally has this index, it is necessary
to continue to stress the facial fracture problem to the
traumatic surgeons and the neurosurgeons in order to
treat these problems primarily. The primary repair is
simpler and less involved than the later introduction of
grafts or implants for the improvement of the deformity.
Correction
On page 810 of the February issue of The Journal, the cut used in reproducing
Figure 1 is reversed, with what should be the top shown as the bottom. The illustra-
tion, Figure 1, is a part of the paper ’'Transplantation of the Ureters Into an Isolated
Ileal Loop,” by J. Harold Newman, M.D.
J. Florida M.A.
March, 1958
955
Recurrent Intussusception in a Six Year Old
Child With Histoplasmosis of Peyer’s Patches
Manuel G. Carmona, M.D.
AND
Marvin S. Allen, M.D.
HOLLYWOOD
The purpose of this paper is to review the
diagnostic problems encountered and to report a
single but unusually interesting case of recurrent
intussusception with complete recovery following
two operations.
Report of Case
A six year old white male child was admitted to
Memorial Hospital in Hollywood on Jan. 22, 1956 as a
private patient of one of us (M.G.C.), complaining of
abdominal pain of three hours’ duration. The father
of the child stated that the pain developed around the
epigastrium and later moved on down to the right lower
quadrant of the abdomen. The pain was steady; at
intervals it appeared to get worse and then ib would
subside again. At the peak of the pain, the patient
would vomit stomach contents. There had been no ir-
regularities in bowel movements; the last bowel move-
ment was normal and took place the morning he entered
the hospital. He had experienced no fever, no chills
and no symptoms referable to the urinary tract.
The child had had measles and chickenpox. Aside
from these diseases, he has enjoyed good health until
the present time.
The ■ parents were divorced, and the child was in
custody of the father, a police officer in this area. The
remainder of the family history was irrelevant.
The child was examined by one of us (M.G.C.) in
the emergency room at Memorial Hospital. The examina-
tion gave essentially negative results except for moderate
tenderness and a slight rigidity in the abdomen, limited
to the right lower quadrant and most pronounced over
McBurney’s point. There were no palpable masses or
organs. Examination of the remainder of the abdomen
gave negative results, as did rectal examination, and
there was no mucus or tarry stool on the gloved finger.
A blood count showed 17,000 white blood cells with
76 segmented forms, 3 stabs forms, 20 lymphocytes and 1
eosinophil. The urinalysis gave entirely negative evidence.
A .presumptive diagnosis of acute appendicitis was
therefore made, and the patient was operated upon
shortly after he was admitted to the hospital. The abdo-
men was explored through a right McBurney’s incision,
and on opening of the peritoneal cavity about 300 cc.
of bloody fluid was expressed. The ileum was distended,
and on following it proximally, it was found to be tele-
scoped through the ileocecal valve for a distance of
about 1 foot. The McBurney’s incision was enlarged,
and the intussusception was reduced manually, without
too much difficulty, in the usual manner by pushing
gently on the intussuscipiens. When reduced, the bowel
wall was found to be grossly hemorrhagic with much
clotted blood underneath the serosa. By means of hot
saline packs directly over the areas of hemorrhage, the
viability of the bowel was determined. The bowel was
watched for a period of about 30 minutes, at the end
of which time it was put back into the peritoneal cavity.
No prophylactic procedures to prevent future recurrence
of the intussusception were carried out. The appendix
was somewhat swollen and indurated and it was re-
moved for fear an acute suppuration might ensue. The
wound was repaired in layers, using No. 1 chromic catgut,
and black silk for the skin.
The pathologic report was: “(f) Acute appendicitis;
the appendix was found edematous from early acute in-
flammation. (2) Pinw.orm infestation; the lumen was
packed with pinworms.”
The postoperative course was uneventful. While the
child was in the hospital, one of us (M.S.A.) of the
Pediatric Service of Memorial Hospital gave the child a
course of Antepar to get rid of the pin worms. Blood
counts and urinalysis were repeated, giving results within
normal limits. Throughout the postoperative period the
child received Combiotic, 2 cc. every 12 hours for a period
of three days and then 2 cc. daily until he was discharged
from the hospital on the seventh postoperative day. His
father was told that at any time in the future, should
the child experience abdominal pain, he should be taken
to the doctor immediately as intussusception was known
to recur.
While at home the child got along well. He tolerated
his diet and was having normal bowel movements and
enjoying complete recovery.
Seventeen days after the first operation, the child
became suddenly ill about 11:30 p.m. This time he was
complaining of severe intermittent abdominal pains and
vomiting. He was brought back to the emergency room
of the hospital, and one of us (M.G.C.) was again called
to see the patient. The pain had now been present for
one and a half hours and was in both the epigastrium and
the right lower quadrant. It came in acute episodes,
during which the child would sit up on the stretcher,
tap his abdomen hard and at times grab it, crying in
severe pain and doubling his legs up on his abdomen.
Then he would start vomiting clear stomach contents. The
pain would last two or three minutes and then sub-
side; the child would then be able to lie down again.
Examination again was essentially negative except for
the abdomen. There was moderate tenderness of the en-
tire lower portion of the abdomen, especially in the right
lower quadrant under the recent McBurney’s scar. No
masses were palpable. There was moderate rigidity of the
right rectus muscle. The tenderness was worse on deep
pressure. Rectal examination again gave negative results,
and there was no blood on the gloved finger. Bowel
sounds were normal. A blood count showed 13,200
white blood cells with 59 segmented forms and 41 lym-
phocytes, 4,610,000 red blood cells, and a hemoglobin
estimation of 10.2 Gm. The urinalysis gave negative
evidence.
A clinical diagnosis of recurrent intussusception was
made. Inasmuch as the pain was only present for an
hour and a half and since an ileocecal intussusception
had been found 17 days previously, it was contemplated,
therefore, that the recurrence might be in the same area.
The radiologist was called, and within two hours of the
onset of symptoms a barium enema with low pressure
was performed, in the hope that if the intussusception
had recurred at the same site, it could be reduced by
hydrostatic pressure. Much to our surprise, the entire
colon filled well, down to the ileocecal valve and it was
declared normal by the radiologist. The terminal ileum
did not fill. Following the evacuation of the barium
From the Surgical Service of Memorial Hospital, Hollywood.
956
CARMONA AND ALLEN: RECURRENT INTUSSUSCEPTION
You: m e XLIV
Number 9
enema, the child felt somewhat relieved and for a while
appeared symptom-free. At this particular interval, we
thought that perhaps the intussusception had reduced
itself rapidly by the enema before the radiologist had a
chance to observe it.
The child was taken to his room and given parenteral
fluids and supportive measures. About two hours after-
wards, the episode of pain recurred, but it was not as
severe as it had been when the child was first seen in
the emergency room. The pain continued, but the in-
tervals between episodes were much more prolonged. A
decision was made, however, to operate again, as it was
considered that an ileoileal intussusception, which could
not be detected by barium enema, could just as well
be taking place.
The child was operated on under cyclopropane-ether
anesthesia, and just as the anesthetist was getting ready to
administer the anesthetic, he had a convulsion on the
operating table, which was quickly controlled by sedation.
The abdomen was explored through a right lower rectus
incision, and on opening of the peritoneal cavity about
400 cc. of bloody fluid was readily removed by suction.
An ileoileal intussusception was found taking place about
2 feet from the ileocecal valve. This time the intussuscep-
tion could not be reduced, and a bowel resection was
therefore undertaken with removal of about 2 feet of
gangrenous ileum. The bowel continuity was restored by
an end to end anastomosis. The patient received 500 cc.
of blood during the operative procedure.
The pathologist’s report this time was: “(1) Gan-
grenous intussusception, ileum; (2) acute enteritis; (3)
histoplasmosis (?). The Peyer’s patches were found to be
involved with an acute hemorrhagic inflammation involv-
ing the patch and overlying mucosa. In the reticuloendo-
thelial cells of the Peyer’s patches there were masses of
pale refractile bodies precisely resembling Histoplasma
capsulatum.” The organisms were subsequently identified
by special staining with Schiff stain.
The postoperative course was stormy. Immediately
postoperatively, convulsions developed, but gradually re-
sponded to sedation. The temperature went up to 103.3
F. rectally, the pulse rate was 160, respirations were 24,
and the blood pressure was 190 systolic and 130 dias-
tolic. Continuous nasal-gastric suction was maintained;
nasal oxygen and parenteral fluids were administered.
Various sedatives were tried including Luminal Sodium
intramuscularly, and it was found the child could best be
controlled by repeated small doses of Demerol. The vital
signs gradually improved as well as the hypertension,
and beginning on the third day following surgery, he was
given 0.5 ounce of clear fluids by mouth every hour with
the Gomco pump turned off. The usual measures of
broad spectrum antibiotics were given prophylactically as
well as blood, and parenteral fluids were given in appro-
priate amounts for a child of his age in order to main-
tain adequate blood volume and proper chemical balance.
Once he began taking fluids by mouth, he gradually im-
proved and was allowed out of bed as soon as his con-
dition warranted it.
Histoplasmin skin tests as well as bone marrow studies
for histoplasmosis, performed postoperatively, gave nega-
tive results. Once he was out of bed, the patient re-
covered quickly and was dismissed from the hospital on
Feb. 21, 12 days following surgery.
It is now over nine months since the last operation,
and the child has been symptom-free. When last seen in
the office, he had completely recovered.
Discussion
Intussusception in a child at the age of six
years is indeed a rare occurrence. A review of
the literature reveals that the incidence of intus-
susception at this age is less than 2 per cent.1-!
Gross' in his book on pediatric surgery reported
a series of 702 cases of intussusception, in which
nine of the patients were reported at the age of
five to six years, and in none was the disease re-
current at that age. Santulli and Ferrer2 re-
ported 80 per cent of their patients were under
one year of age.
The presence of H. capsulatum in the Peyer’s
patches raises an interesting point as to the pos-
sible etiology of the intussusception in this case.
The organism was identified by the specific stain
of Schiff ; however, the skin tests and bone
marrow studies by sternal puncture failed to show
generalized histoplasmosis. Although the child
had a gangrenous intussusception, it is noteworthy
that no masses could be felt on physical exam-
ination of the abdomen, bowel sounds were nor-
mal, and there was no bloody mucus on rectal
examination.
Whether the intussusception will again recur is
problematic. The child is being carefully watched,
and the father has been instructed to report any
type of abdominal pain immediately to the phy-
sician.
Summary
A case of ileocolic intussusception recurring
as an ileoileal intussusception in a six year old
boy with histoplasmosis of the Peyer’s patches of
the ileum, treated successfully by surgery, is
reported.
References
1. Gross, Robert E. : The Surgery of Infancy and Childhood:
Its Principles and Techniques, Philadelphia, VV. B. Saun-
ders Company, 1953.
2. Santulli, T. V., and Ferrer, J. M. Jr.: Intussusception: An
Appraisal of Present Treatment, Ann. Surg. 143:8-17 (Jan.)
1956.
3. Ferrer, J. M. Jr.: Symposium on Surgical Emergencies;
Intussusception in Children and Adults; Critical Review
with Addition of 38 New Cases, S. Clin. North America
30:515-528 (April) 1950.
4. Dennis, C. : Resection and Primary Anastomosis in Treat-
ment of Gangrenous or Non-reducible Intussusception in
Children; Safe, Simple, One Layer Silk Anastomosis, Ann.
Surg. 126:788-796 (Nov.) 1947.
1938 Harrison Street (Dr. Carmona).
/. Florida M.A.
March, 1958
957
Diabetes Screening in Polk County
Chester L. Nayfield. M.D.*
AND
James A. Donaldson, M.D.**
WINTER HAVEN
In the past five years there has been an in-
creasing interest in multiphasic screening projects
including as many as 12 tests.1 These have been
carried out predominantly in large cities or in
isolated industrial areas. Studies have been run
by health departments,- community3 and general
hospitals,4 industrial health plans,5 and individ-
ual physicians.0 The purpose of this paper is to
discuss the project in Polk County where a pre-
dominantly Negro and low income white popula-
tion being tested for syphilis was also screened
for diabetes.
The Polk County Health Department, with
the cooperation of the Florida State Board of
Health and the Polk County Medical Association,
planned a countywide blood testing survey for
syphilis. It was decided to draw an additional
sample of blood on all patients over 30 years old
to be screened for elevated blood glucose. This
addition to the survey was intended to determine
whether or not enough asymptomatic diabetes was
present and whether or not response to referrals
to private physicians was adequate to justify rec-
ommending this addition for other countywide
blood surveys.
Preliminary to the survey, community pro-
grams were organized to which prominent Negroes
as well as a few white public officials were invited.
The purpose of the survey was explained, motion
pictures on diabetes and syphilis were shown,
and questions were answered. In addition to these
programs, posters urging blood testing were placed
in all areas to be tested. Radio and newspaper re-
leases gave the reasons for the tests as well as
the location of the blood testing stations. There
were three teams, each consisting of a nurse and
a clerk. Each station was manned by one of these
teams and was equipped with a card table, chairs,
and a sign indicating that blood specimens for
testing would be taken there. A sound truck drove
through each area playing records and making
spot announcefnStits urging people to have their
blood tested and giving the locations of the blood
'Director, Polk County Health Department, Winter Haven.
''Senior Assistant Surgeon (R>. United States Public Health
•Service, assigned to Polk County Health Department.
testing stations, most of which were in front of
popular business establishments. Blood specimens
were taken from 4 to 8 p.m. on weekdays and
from 10 a.m. to 5 p.m. on Saturdays. No attempt
was made to have patients in a fasting state.
The blood specimens for diabetes screening
were taken in Sheppard blood-taking tubes to
which thymol and sodium fluoride had been added.
The blood was obtained from the tubing of the
serology tube so that only one venipuncture was
necessary for both tests. The blood was tested
at the Florida State Board of Health Laboratory
in Jacksonville with the Clinitron, a mechanical
laboratory apparatus which screens blood sugar
at 130 mg. per hundred cubic centimeters of blood
by the Wilkerson-Heftman method at the rate of
120 determinations an hour. A blood glucose
determination by the Somogyi-Nelson method was
mad^ on all blood that screened positive.
All patients with elevated blood glucose were
given appointments at one of the seven County
Health Department offices. During the first part
of the retesting, those who gave no history of
having diabetes were merely checked with a fast-
ing blood sugar, but those tested later wrere given
100 Gm. of dextrose in water by mouth and two
hours later a second specimen for blood glucose
determination was drawn.
All patients with previously diagnosed diabetes
were referred back to their physician, and a rec-
ord of their survey blood glucose level as well as
a fasting blood glucose level was mailed to him.
All persons without a previous history of diabetes
who had a tentative diagnosis of diabetes made
on the basis of retesting with a fasting blood sugar
or modified glucose tolerance test were referred
to their own physician, and a record of all blood
glucose determinations was mailed to him. A fol-
low-up was made about four months after the
retesting was begun to determine whether or not
persons with previously diagnosed diabetes as well
as those with newly diagnosed diabetes had re-
ported to their physician, whether they had re-
turned to him regularly, and whether they were
on a diet, taking insulin, or both.
958
NAYFIELD AND DONALDSON: DIABETES SCREENING
Volume XLIV
Number 9
Results of Survey
The results of the blood testing for syphilis
have been published elsewhere.7 The survey was
made from Sept. 8, 1955 to Oct. 16, 1955. As is
seen in table 1, 2,670 persons were screened for
diabetes, and 40 had blood glucose levels above
130 mg. per hundred cubic centimeters of blood.
As noted in table 2, 15 of those with a positive
reaction to the screening test were already known
to have diabetes, but had not been under a phy-
sician’s care recently. Of the 25 who were not
known to have diabetes, 23 were retested. The
other two could not be tested; one had moved to
Georgia without leaving a forwarding address, and
the other had died.* Of the 23 with no history
of diabetes who were retested, in 13 the reaction
remained positive.**
Table 1
Persons screened having blood glucose levels above
130 mg. per hundred cubic centimeters of blood 40
Persons screened having levels below 130 mg. 2,630
Total tested 2,670
Table 2
Known to have diabetes IS
Not known to have diabetes 25
Not retested 2
Negative after retest 10
Positive after retest 13
Total screened positive 40
Criteria for Diagnosis on Retest
Although it had been planned to use a fasting
blood sugar of 130 mg. per hundred cubic centi-
meters of blood or a blood sugar two hours after
oral dextrose of 140 mg. as the upper limit of
normal, there was no difficulty in the diagnosis
of most cases as the blood sugar was much higher
than this. As is seen in table 3, there were only
two cases in which the fasting blood sugar was
below 130 mg., but diabetes was considered to be
present on the basis of a blood sugar above 140
mg. (157 and 174 mg.) two hours after oral dex-
trose.
The patient in one of these cases was the son
of a nonsurvey diabetic person accidently dis-
covered and previously mentioned. His private
physician thought he did not have diabetes and
that the elevated two hour glucose was caused by
cirrhosis. The patient was requested to have a
*The patient died at the age of 47 of a cerebrovascular acci-
dent. Her routine urinalysis on admission to the hospital was
negative for sugar, but no blood glucose determination was
made.
**In addition, the mother of one of the patients presented
her son’s appointment card, was tested and was found to have
previously undetected diabetes. She was not counted in the
purvey.
complete glucose tolerance test, but failed to do
so. In the other case, diabetes was diagnosed by
a private physician, and insulin therapy was in-
stituted. Thus, of the 13 patients who satisfied
our criteria for the presumptive diagnosis of dia-
betes on retest, in 12 the diagnosis was confirmed
by their private physicians (table 4) and in one
was challenged but not definitely refuted.
Follow-up Problems
There were many problems encountered in
following up this survey. Because of the size of
the county, there are seven Health Department
offices. Although all patients to be retested were
asked to come to one of two retesting sessions, the
response was poor, and individual appointments
had to be made in many cases. Even then, many
patients did not keep their appointments, and
much time was wasted waiting for them. In-
cluding travel time, as much as eight hours was
spent retesting a single patient.
Many patients had not given addresses com-
plete enough to permit the investigator to find
them, and consequently a painstaking search was
necessary to locate them. As was noted, the thor-
oughness of the investigator resulted in retesting
all but two persons whose reaction was positive
in the survey.
Four Month Follow-up
To evaluate whether or not the patients with
known diabetes or with previously unknown dia-
betes had benefited from the survey, a follow-up
was made about four months after the retesting
was begun. All 27 patients (15 previously known
diabetic patients and 12 physician-confirmed new
diabetic patients) were contacted. Of those with
previously undiagnosed diabetes, all 12 had re-
ported to their private physicians or to the Dia-
betes Clinic at the Polk County Hospital. All
but three of them had seen their physicians within
the past month. Nine were on a diet and taking
insulin, two were on diets but not taking insulin,
and one was not on a diet nor taking insulin.
The one patient on no diet and not taking insulin
was, according to her physician, advised to be on
a strict diet.
Of the 15 previously known diabetic patients,
10 had returned to their private physicians or to
the County Hospital. One had contacted her phy-
sician by phone, but four had made no attempt
to return to treatment. Six were on a diet and
taking insulin; three were on a diet, but were not
J. Florida M.A.
March, 1958
NAYFIELD AND DONALDSON: DIABETES SCREENING
959
Table 3
Case
Age
Race
Survey
Sex Blood
Glucose
in Milligrams
Fasting
Blood
Glucose
in Milligrams
Fasting
Blood
Glucose
in Milligrams
Modified
Glucose Tolerance
Blood Glucose Two
Hours After Dextrose
in Milligrams
Diagnosis
Confirmed
by Private
Physician
1
70
N
F
228
137
371
Yes
2
37
N
F
343
214
Yes
3
43
N
M
171
106
157
No
4
36
N
F
2S1
286
240
457
Yes
S
73
W
F
180
*
Yes
6
SO
N
F
263
180
442
Yes
7
41
N
F
149
274
386
Yes
8
48
N
F
157
249
360
Yes
9
67
N
M
266
240
QNS
Yes
10
63
N
F
290
257
Yes
11
66
N
F
200
214
Yes
12
49
N
F
206
280
Yes
13
65
N
F
243
114
174
Yes
* Not retested in the Health Department. Diagnosed by a private internist after the survey, but before the patient could be
retested.
taking insulin; one was taking insulin, but was
not on a diet; and five were not on a diet nor
taking insulin. It will be seen from this follow-up
that those with newly diagnosed diabetes were
cooperative in reporting to their physicians and
in following his instructions regarding diet and
insulin. Of the previously known diabetic pa-
tients, however, only two thirds returned to treat-
ment. The return of 10 uncontrolled diabetic
patients to medical care is certainly of significance,
and they should be added to the 12 newly dis-
covered diabetic patients in evaluating the accom-
plishments of the survey.
#
Table 4
Diagnosis of diabetes by private physican 12
Diagnosed not diabetes 1
Total Positive on retest 13
Summary
A countywide blood-screening program for
diabetes was carried out on 2,670 adults. An
intensive follow-up campaign resulted in 10 of 15
previously known diabetic patients and in all 12
of the newly discovered diabetic patients return-
ing to their private physicians or to the County
Hospital for diabetic management. Many prob-
lems encountered in following up a survey of this
type are discussed.
References
1. Breslow, L. : Multiphasie Screening in California, J. Chronic
Dis. 2:375-383 (Oct.) 1955.
2. Holmes, E. M. Jr., and Bowden, P. W.: Screening for
Asymptomatic Disease by Health Departments, J. Chronic
Dis. 2:384-390 (Oct.) 1955.
3. Trussed, R. E. : Hospital Outpatient Department in Detec-
tion of Nonmanifest Disease, J. Chronic Dis. 2:391-399
(Oct.) 1955.
4. Kurlander, A. B.; Iskrant, A. P., and Kent, M. E.: Screen-
ing Tests for Diabetes; A Study of Specificity and Sensitiv-
ity, Diabetes 3:213-219 (May-June) 1954.
5. Collen, M. F., and Linden, C. : Screening in a Group Prac-
tice Prepaid Medical Care Plan as Applied to Periodic
Health Examinations, J. Chronic Dis. 2:400-408 (Oct.) 1955.
6. Rutherford, R. N., and Banks, A. L. : Value of Yearly
Physical Survey in Adult Female, J. A. M. A. 160:1289-
1292 (April 14) 1956.
7. Ackerman, J. H., and Donaldson, J. A.: Syphilis in Polk
County — Report of 1955 Blood Testing Survey. To be pub-
lished in The Journal of the Florida Medical Association.
8. Parkhurst, L. W., and Betsch, W. F. : Incidence and Diagno-
sis of Diabetes Mellitus in Diagnostic Clinic, M. Clin. North
America 39:1571-1577 (Nov.) 1955.
229 Avenue D., N. W. (Dr. Nayfield).
960
Volume XLIV
Number 9
Hiccups as Sole Presenting Symptom
Of Myocardial Infarction
X. Stuart Gilbert, M.L).
MIAMI
In 1939, Weiss1 reported his observations in
three cases of coronary artery occlusion com-
plicated by hiccups. Swan and Simonson2 con-
firmed the presence of this complication in myo-
cardial infarction, and related their application of
phrenic nerve crush as a therapeutic measure.
Perchuk and Liveson3 had similar experiences,
two of their cases displaying gastrointestinal
hemorrhage as well as hiccups. A perusal of the
literature, however, reveals no reference to hiccups
as the sole presenting symptom of coronary artery
occlusion.
Report of Case
The patient was a 65 year old Negro man with a his-
tory of congestive heart failure which responded to
digitalis and mercurials. He was first seen on June 14,
1956, for a complaint of hiccups which awoke him from
sleep four days previously. He appeared exhausted and
complained of pronounced weakness because of this siege.
Only slight dyspnea and orthopnea were evident. The
neck veins were distended 3 plus, and a positive liver
reflux was present. The chest was clear bilaterally. The
heart was enlarged to the left with the point of maxi-
mal impulse at the anterior axillary line in the fifth
interspace. The pulse rate was 90, and the rhythm was
sinus in character. A rough systolic murmur was heard
at the apex, and P-2 was greater than A-2. The blood
pressure was 90 systolic and 60 diastolic. The liver
and spleen were not palpable. There was a 2 plus pitting
edema of both lower extremities. He was given digoxin,
Mercuhydrin, a salt-low diet, and 100 mg. rectal supposi-
tories of Thorazine.
Five days later, on June 19, the hiccups were still
present. An electrocardiogram was taken at this time
because of the patient’s previous history of congestive
heart failure. The tracings disclosed the presence of an
acute anterolateral myocardial infarction (fig. 1). The
patient was treated with anticoagulants and 25 mg. doses
of Thorazine intramuscularly upon his admission to the
hospital. Laboratory studies revealed a nonprotein nitro-
gen of 45 mg. per hundred cubic centimeters; the Was-
sermann reaction was negative; urinalysis showed no
sugar, a trace of albumin, occasional granular and hyaline
casts, 2 to 6 white blood cells, and no red blood cells.
The hemoglobin estimation was 8.99 Gm. ; the red blood
cell count was 3,690,000, and the white blood cell count
was 8,800, with polymorphonuclear leukocytes 78 per cent
and lymphocytes 22 per cent.
Eleven days after the onset of hiccups, there was no
evident response to Thorazine or sedation. On June 21,
the patient was given 5 mg. of prednisone every eight
hours with gratifying improvement at the end of 24 hours,
and almost complete abatement in the next 48 hours.
The dose of the drug was gradually reduced within a
period of 10 days, during which period the patient re-
ported occasional short periods of hiccups, which ceased
spontaneously within a few minutes after onset. On
June 26, a repeat tracing disclosed the subacute phase
of the previous infarction and, in addition, a decided ac-
centuation of Qi, which is probably indicative of the
posterior progression of the infarcted area (fig. 2).
Discussion
Painless myocardial infarction has been noted
by many observers, with a greater reported in-
cidence in the Negro race. The occurrence of
hiccups without obvious etiology, therefore, merits
electrocardiographic investigation for coronary
artery disease.
Diaphragmatic tic is probably due to a reflex
mechanism in anterior infarction because of the
close interconnection between the superficial and
deep cardiac plexuses on the one hand, and the
cervical segments of the spinal cord, the sympa-
thetic ganglions, and the vagus on the other.
When the under surface of the heart becomes in-
farcted, the mechanism of hiccup production is
most likely one of direct phrenic nerve or dia-
phragmatic irritation. P'igure 3 represents a trac-
ing taken on June 26, in which Q waves were in-
scribed in the left infracostal region in the mid-
clavicular and midaxillary lines. It is my opinion
that this represents infarction on the diaphrag-
matic surface of the heart, and that hiccups oc-
:urred because of the localized inflammatory re-
action and edema irritating the diaphragm and
the rich underlying phrenic plexus.
The decision to administer prednisone in this
instance to counter the hiccups was suggested by
the work of Prinzmetal and Kennamer.4 These
authors were able to convert complete heart block
associated with posterior myocardial infarction to
sinus rhythm within 12 hours after the adminis-
tration of ACTH. It was postulated that the
corticotropin suppressed the inflammation and
edema surrounding the auriculoventricular node
and the bundle of His. In addition, the work of
Hepper, Pruitt, Donald and Edwards5 amply
Opposite Page
Fig. 1. — Electrocardiographic tracing taken on June
19, 1956, which displays acute anterolateral infarction
pattern.
Lead I
Lead VI
Lead II
Lead aVl
Lead V3
Lead V4
Lead I
Lead VI
Lead aVl
Lead V4
Lead V5
J". Florida M.A.
March, 1958
GILBERT: HICCUPS AS SYMPTOM OF MYOCARDIAL INFARCTION
963
Fig. 3. — Lower left: Infracostal area in midclavicular line. Lower right: Infracostal area in anterior
axilliary line. Q waves probably indicate infarction on diaphragmatic surface of the heart. Upper left: Rep-
resents lead V-8. Upper right: Is V lead at vertebral co.amn.
attests to the safety of steroid administration in
acute myocardial infarction. Cortisone was ad-
ministered to dogs with experimentally produced
coronary artery ligation. Although microscopic-
ally detected delays were noted in the four to six
day old infarcts, there was no measurable differ-
ence in the healing of the infarcts at the end of
60 days between the cortisone treated animals and
the controls.
Summary
A case is presented which displayed hiccups as
the only presenting symptom of myocardial
infarction.
Tracings taken over the left infracostal region
in the midclavicular and midaxillary lines in-
Opposite Page
Fig. 2. — Electrocardiographic tracing taken on June
26, 1956, which shows subacute phase of anterolateral
infarction.
scribed Q waves. This result may be indicative
of infarction over the diaphragmatic surface of
the heart.
Hiccups in myocardial infarction may occur
by a reflex mechanism in anterior involvement,
and by direct irritation of the diaphragm or
phrenic nerve plexus in posterior infarcts involv-
ing the under surface of the heart.
Steroid therapy may be a valuable treatment
adjunct in hiccups due to myocardial infarction
with involvement of the diaphragmatic surface of
the heart.
References
1. Weiss, M. M.: Hiccup as Complication of Acute Coronary
Artery Occlusion, Ann. lnt. Med. 13:187-188 (July) 1939.
2. Swan, H. R., and Simoson, L. H.: Hiccups Complicating
Myocardial Infarction, New England J. Med. 247:726-728
(Nov. 6) 1952.
3. Perchuk, E., and Liveson, A.: Unusual Complications of
Acute Coronary Occlusion: Gastrointestinal Hemorrhage and
Hiccup, New York J. Med. 55:1175-1 179 (April 15) 1955.
1. uiet'ii, VI.. ; ml Ken inmei . K. : I* mergence Treatment
of Cardiac Arrhythmias, J. A. M. A. 154:1049-1054 (March
27) 1954.
5. Hepper, N. G.; Pruitt, R. ,D.; Donald, D. E., and Edwards,
J. E. : Effect of Cortisone on Experimentally Produced
Myocardial Infarcts, Circulation 11:742-748 (May) 1955.
1465 South Miami Avenue.
964
Volume XLIV
Number 9
The Risk of Ascaris Infestation From the
Use of Human Sludge as Lawn Fertilizer
James 0. Bond, M.D.
JACKSONVILLE
The modern methods of handling the ancient
problem of disposal of human waste stand at the
apex of achievements in public health. The solu-
tion of this problem, however, has created a both-
ersome satellite of smaller problems relating to the
presence of still infectious agents in the final prod-
ucts of the modern sewage disposal plant. It
will be the purpose of this paper to report the
results of a special study on one of these prob-
lems.
A recent report has shown that the modern
sewage treatment process does not necessarily
completely destroy all pathogenic organisms. Yi-
luses of the Coxsackie group, tubercle bacilli and
even typhoid bacilli can be detected in the effluent
by suitable procedures.1 In 1918, Dr. Homer
Venters, a public health laboratory worker in
Tampa, demonstrated ascaris ova in 44 per cent
of 200 specimens of sludge from Imhoff Tanks.2
During the second World War, Cram and his co-
workers3 surveyed the sludge from 16 munici-
palities and 17 army camps in the United States.
No cysts or ova of parasites were found in the
specimens from the municipalities, but one third
of those from the army camps contained viable
ascaris ova.
Keller and Hide,4 two South African investi-
gators, carefully defined the role of sewage sludge
as a possible source of ascaris infestation when
this sludge was used as fertilizer on municipal
sewage farms. They demonstrated ascaris ova in
the sludge from three separate disposal plants
ranging from 749 to 7,805 ova per gram dry
weight. The percentage of viable ova in each spec-
imen examined ranged from 72.3 per cent in the
raw sludge to 42 per cent in the sludge that had
dried for 42 days. The extreme resistance to dry-
ing of ascaris ova was demonstrated by the pres-
ence of viable ova in a sample which contained
only 5 per cent moisture after drying an unknown
length of time. The sewage treatment process
had remarkably little effect on either the total
numbers of ascaris ova per gram dry weight of
sludge, or their viability. They concluded that
Epidemiologist, Bureau of Preventable Diseases, Florida
State Board of Health.
heat treatment is necessary to convert sewage
sludge into a safe fertilizing material.
As is well known, heat-treated sewage sludge
has been used extensively in commerical fertilizer
in the United States. The growth of small urban
and subdivision sewage disposal plants in Florida,
however, has led to the use of plain dried sludge
for lawn and garden fertilizer, often primarily as
an aid to the disposal plants in ridding them of
their accumulated sludge.
The municipal sewage disposal plant in Tam-
pa contracts this sludge to a local nurseryman,
who in turn retails it as lawn fertilizer. During the
summer this arrangement was initiated, however,
a local pediatrician, Dr. Lewis T. Corum, treated
a child with severe ascariasis and. in a careful
history, obtained the interesting information that
the child had had contact with sludge obtained
from this source and used on the family lawn as
fertilizer. This paper is a report on the subsequent
investigation to determine whether this sludge
was a source of ascaris infestation in this commu-
nity.
Description of Investigation
Specimens of sludge were obtained at approxi-
mately biweekly intervals from the Tampa Mu-
nicipal Sewage Disposal Plant. This is a primary
sewage treatment plant in which sludge is re-
moved from the settling basins, allowed to digest
at 80 to 90 F. for approximately 30 days and
distributed to beds for drying up to 21 days. After
determination of moisture content, the specimens
were examined for ascaris ova by the standard
zinc flotation method and by quantitative Stoll
counts. These examinations were made by the
Disposal Plant Laboratory (for moisture) and
the Tampa Branch of the Florida State Board
of Health Laboratory (for ascaris ova counts).
Three specimens each were taken from the raw,
the digested, and the drying sludge. This dried
sludge was the only source of plain commercial
sludge for lawn fertilizer in Tampa at that time.
No special viability cultures were made, but esti-
mates of viable eggs were made by visual inspec-
tion of the ova from each specimen examined.
J. Florida M.A.
March, 1958
BOND: RISK OF ASCARIS INFKSTATION FROM SLUDGE
965
The second major part of the investigation
was to determine whether or not the children ex-
posed to the sludge, used as lawn fertilizer, were
actually infected by the ova known to be present.
Two groups of children, who were alike in all
respects except exposure to sludge as lawn ferti-
lizer, were studied for prevalence of ascaris in-
festation. Names of households using sludge as
fertilizer were obtained from the retail dealer.
Control households were selected from the City
Directory. All interviews and examinations were
carried out without knowledge as to the identity
of the child in either the sludge or control group.
The stool specimens submitted by children under
age 15 were examined for parasitic ova by the
standard zinc flotation method.
Results of Study
Table 1 gives the results of the examinations
of sludge for ascaris ova. Under the columns
headed “Ascaris Ova/ml” the “O” indicates no
ova were present on either zinc flotation or quan-
titative Stoll counts. Less than 100 per milliliter
was reported when ova were present on zinc flota-
tion, but insufficient to appear on the Stoll count.
Over 100 per milliliter was given as the actual
Stoll count. It is seen that ova were present in at
least one of the three specimens of dried sludge
submitted on each date shown, and 400 per milli-
liter was the maximum found. Visual inspection
indicated that from 10 to 50 per cent of the ova
were viable.
Table 1. — Ascaris Ova and Moisture Content of
Sludge, Tampa Municipal Sewage Disposal Plant
November 1955 - January 1956
Type of Sludge
c
o
Raw
Digested
Drying
O 03
+-> <V
G >-
</> 'G
c a
a Si
<V G
•c £
£
a j 3
£
« £
u2
U 03
a \
O o3
03
u d
Q ft
w
i- O
Oh S
<6
>-H O
J2 >
<o
</) ►>
<o
11/9/55
94.5
0
91.3
-100
56.3
-100
94.5
0
91.3
100
56.3
300
94.5
0
91.3
-100
56.3
400
11/28/55
95.1
0
92.3
0
36.7
0
95.1
0
92.3
0
36.7
-100
95.1
0
92.3
-100
36.7
0
12/14/55
94.9
0
92.1
0
36.7
0
94.9
-100
92.1
0
36.7
0
94.9
0
92.1
-100
36.7
-100
1/12/56
94.6
0
37.3
-100
34.1
-100
94.6
0
37.3
-100
34.1
100
94.6
0
37.3
0
34.1
0
1/27/56
95.3
-100
92.4
-100
43.3
-100
95.3
0
92.4
-100
43.3
-100
95.3
0
92.4
-100
43.3
-100
-100 denotes that ova were present on gross zinc flotation,
hut in insufficient numbers to permit counting by the Stofl
count method.
Table 2. — Completed and Incompleted
Investigations in a Survey of Tampa Households
for Intestinal Parasites
Sludge Group Control Group Total
No. % No. % No. %
Initial households
154
100 168*
100
322
100
Completed
investigations
110
71.4
95
56.5
205
63.6
Incomplete
investigations
44
28.6
73
43.5
117
36.4
Reasons For Incomplete
Investigations
Total
44
100
73
100
117
100
Not home
23
52.3
38
52.1
61
52.1
No such address
2
4.5
25
34.2
27
23.1
No children
18
40.9
6
8.2
24
20.5
Not interested
1
2.3
3
4.1
4
3.4
Unknown
0
0
1
1.4
1
0.8
* Includes 14 added addresses to original control list.
The fact that a smaller number or no ova were
found in the digested and raw sludge was in-
terpreted as being due to the high moisture con-
tent which would operate as a dilution factor.
This same observation was made in a similar study
in South Africa.1 Uneven distribution of the ova
in the raw sludge would also increase the prob-
ability of obtaining repeated negative samples.
Information was obtained on the interview
investigation form to determine whether the two
groups examined were reasonably similar in all
respects except exposure to sludge. Table 2 shows
the percentage of completed investigations made
on the original households, and the reasons for
incomplete investigation. It is noted that 71.4
per cent of the sludge households had completed
investigations compared with 56.5 per cent of
the controls, and the reason for the fewer com-
pletions in the latter was the large number with
no such addresses. It is also noted that there
were more families with incomplete investigations
in the sludge group because of the fact that there
were no children. This is probably so since the
sludge households had a large number of older
retired couples who had the time and money nec-
essary to take extra care of their lawns. House-
holds without children were not pressed for com-
pletion of the interview questionnaire.
Figure 1 shows the comparability of the oc-
cupants of the households with completed investi-
gation forms by age and sex. The grouping for
age of the children was made to fit the ages we
considered to be the natural periods when ascaris
might or might not be acquired. Unknown ages
were included in the 35 plus group. The occur-
rence of selected characteristics within the two
groups, which might influence the prevalence of
966
BOND: RISK OF ASCARIS INFESTATION FROM SLUDGE
Volume XLIV
Number 9
U)
SS
J
<1
50
3
0
5
45
Q
40
1
11
as
0
a
3o
as
25
2
3
z
20
IS
IO
5
O
AGES
FI6UQE-I
OCCUPANTS OF SLUP6E <&r- CO NT POL MOUSE MOLDS
By ase &-5EX
-J
UJ 0
?|
(7) (j
1
I.'.'l
0-2
3-S>
10-14 15-24
MALES
0-2
25-34 *35+
INflUJO&S L>NLWO.VInI AGES
3-9 10-14 1524
FEMALES
25-34
parasites, was studied. There was no significant
difference in the occurrence of young children,
septic tank sewage disposal, poor storm drainage,
city water supply, or prior parasites in the family
between the two groups. Neither sludge nor con-
trol children gave a history of having had or
been treated for ascaris within the six month
period prior to interview. This extended over the
period of time when they were exposed to the
sludge and could have become infected and treat-
ed prior to the survey.
Of the 109 children in the sludge households
interviewed, 33.0 per cent did not submit stool
specimens for examination. Of the 113 children
in the control group, 28.4 per cent were not ex-
amined. It was concluded that these unexamined
children would not have changed the final results
had they been examined, since they were essen-
tially alike in as many characteristics as we could
examine from the survey interview questionnaire.
Table 3 gives the results of the laboratory
examinations on the stool specimens submitted.
The total number of children in the sludge-ex-
posed group was 109, and in the control group
113. Of the 109, 73 or 67.0 per cent submitted
specimens for examination, and one positive as-
caris stool was found. Of the 113 control children,
81 or 71.6 per cent submitted specimens for ex-
amination, and no ascaris ova were found. The
one positive ascaris stool was from a two year old
white male child. This single positive has no
statistical, and we believe no actual, significance
in demonstrating a difference in risk of ascaris
infection between the two groups of children.
Table 3. — Results of Laboratory Examinations
for Intestinal Parasites, Tampa Survey, 1955
Sludge
Group
Control
Group
Total
Total children in
investigated homes
109
113
222
Number children
submitting specimens
73
81
154
Laboratory findings:
No parasites
67
67
134
Ascaris
1
0
1
Hookworm
0
2
2
Pinworm
4
8
12
Other (E. coli,
E. nana, Giardia)
1
4
5
Discussion
It is believed that the results of the investiga-
tion show that whereas viable ascaris ova were
present in the sludge sold as lawn fertilizer in
Tampa, it did not produce a significant risk of
infection to the children so exposed. It is thought
that no obvious bias was present to alter the
J. Florida M.A.
March, 1958
BOND: RISK OF ASCARIS INFESTATION FROM SLUDGE
967
comparability of the two groups of children whose
stools were examined for the parasites. There is
the possibility of false negative laboratory tests
on a single stool from an infected child, but this
possibility should be equally distributed between
the two groups. The combined total of all para-
sitic ova found in the two groups indicated a
slightly higher experience with parasites in the
control as compared with the sludge group. The
combined parasitic index of 12.9 per cent for the
total 154 children is approximately that expected
from previous experience in school surveys of
similar populations, and is evidence against any
significant number of false negative examinations.
Collateral evidence that the low prevalence
of ascaris found in this survey is accurate was
obtained by a brief survey of the sludge from
three subdivision sewage disposal plants in this
area. Out of a total of 21 specimens examined,
over a two month period, only four gave positive
evidence of ascaris ova. and only one viable egg
was seen in each of the four positive specimens.
Since from 1 to 2 cubic yards of sludge were
spread on the lawns, assuming 100 ova per milli-
liter, approximately 7,650,000 ova were added to
each lawn of which 10 to 50 per cent were viable.
This estimate would compare with from 350,000
to 1,000.000 ova deposited each day from a
moderately infected child. Apparently either the
ova are rapidly inactivated by sunlight, as sug-
gested by the South African investigators, or the
habits of these particular children are not such
that would lead to excessive ingestion of con-
taminated dirt. It is also possible that a single
or very few viable ova were ingested. Due to
the fairly short stay of individual ascaris worms
in human hosts (ascaris is often called “the un-
happy parasite”), they may have been acquired
and shed prior to the time of the survey.
These observations, plus the usual absence of
serious illness in all but the most severe ascaris
infestation, should eliminate any undue alarm
over sludge used as lawn fertilizer being a real
public health hazard. The fact, however, that it
presents a potential risk of ascaris transmission
cannot be denied. Heat sterilization, before retail
distribution, may do much to relieve public ap-
prehension, and would insure that even this neg-
ligible risk to the public is eliminated. Tempera-
tures of 65 C. are reported as lethal for ascaris
ova after contact for three minutes, and these
would presumably be the minimum requirements
for such sterilization.
Conclusion and Summary
Viable ascaris ova in the range of 100 per
milliliter were shown to be present in sewage
sludge sold as lawn fertilizer in Tampa.
An epidemiologic survey demonstrated that
there was no significant difference in the prev-
alence of ascaris in a group of children exposed
to this sludge as compared with a group of con-
trol children living one block away from their
respective homes. The sewage sludge used as
lawn fertilizer was shown to be a potential but
not an actual source of ascaris infestation in this
community.
Heat sterilization of the sludge for a minimum
of three minutes at 65 C. would eliminate this
potential hazard.
Appreciation is expressed to ail entire team of public health
workers without whose assistance this study would not have
been possible. A total of 25 persons was involved directly
in carrying out the study. They include Drs. Frank V. Chappell
and Clack I). Hopkins and staff of the Hillsborough Coun*v
Health Department, Dr. Lorenzo L. Parks and staff, Mr. H. D.
Venters and start". Dr. Albert V. Hardy and staff and Mr.
David B. Lee and staff, all of the Florida State Roard of
Health; and Mr, C. M. Courson and staff of the Tampa Munici-
pal Sewage Disposal Plant.
References
1. Kelly, S. M.: Clark, M. E. and Coleman, M. B. : Demon-
stration of Infectious Agents in Sewage, Ant. T. Pub. Health
45:1438-1446 (Nov.) 1955.
2. Venters, H. D.: Unpublished personal communication.
3. Cram, E. B. : The Effect of Various Treatment Processes on
Survival of Helminth Ova and Protozoan Cysts in Sew-
age. Sewage Works Journal, 15:1119-1138 (Nov.) 1943.
4. Keller, P., and Hide, C. O. : Sterilization of Sewage Sludges;
Incidence and Relative Viability of Ascaris Ova at Sew-
age Disposal Works in Johannesburg Area, South African
M. J. 25:338-342 (May 19) 1951.
5. Wilson, H. : Some Risks of Transmissions of Disease Dur-
ing Treatment. Disposal, and Utilization of Sewage, South
African Branch Institute of Sewage Purification, 1944.
1217 Pearl Street.
968
Volume XLIV
Number 9
Improved Results in the Postcoital Test
With Terramycin Vaginal Suppositories
John M. Schultz, M.D.
MIAMI
The postcoital examination of the cervical
mucus should be a part of every routine investiga-
tion of the sterile couple. It is the only means by
which the actual penetration of the sperm into the
cervical canal can be established.
Previous investigators1-3 have shown that the
cervical mucus undergoes cyclic changes and that
there is an optimal time for sperm penetration
through the mucus. Variations in the appearance
of the mucus are not uncommon, and moderate
viscosity with a reduced volume is not incompat-
ible with pregnancy, although a high fertility in-
dex is usually associated with the production of
abundant, clear, acellular, low viscosity mucus.
The appearance of the mucus in infertile women
may be the same as that of fertile women. Fur-
thermore, even severe abnormalities and function-
al disturbances such as tubal closure or cystic
ovaries need not be reflected in disturbances of
cervical secretion. Again, one may find the mucus
to be scanty, viscous and cellular, or moderately
profuse but cloudy, with leukocytes on microscop-
ic examination, in subfertile or sterile women. The
mucus may have the consistency of a thick jelly.
This type of mucus never protrudes into the va-
gina and may be difficult to aspirate. In some
women, only a small quantity of mucus is present
at any time of the cycle, or the cervix may con-
tain the mucopurulent type of mucus associated
with endocervicitis.
This paper attempts to show that with the
use of Terramycin vaginal suppositories there has
been an improvement in the cervical mucus and
a resultant improved postcoital test. From Aug. 1,
1952, to January 1954, the plain Terramycin
vaginal suppository was used. Since January 1954
an improved tablet, Terramycin with polymixin,
has been used. This preparation has lessened the
number of complicating fungus infections that
have occurred.
Clinical Instructor, Department of Obstetrics-Gynecology,
University of Miami School of Medicine, and Director, In-
fertility Clinic, Jackson Memorial Hospital, Miami.
1 erramycin Vaginal Suppositories used in this study were
provided by ( has. Pfizer & Co. through the courtesy of Dr.
M, William Amster,
Material and Method
A total of 320 infertile couples were seen in
private practice from Aug. 1, 1952, to Dec. 31,
1955. These couples were investigated with com-
plete infertility studies which included history
and physical examination of both partners, semen
analysis, tubal insufflation and/or hysterosalpingo-
gram, endometrial biopsy, postcoital examination
and examination of the cervical mucus relative
to Spinnbarkeit, arborization and retractility. A
total of 457 postcoital examinations was per-
formed on 134 patients who required treatment
in an attempt to improve the test. Fifty-two pa-
tients were treated with the plain Terramycin
vaginal suppository, and 82 patients were treated
with Terramycin with polymixin vaginal supposi-
tories.
Patients Med with Terramycin Vaginal Suppositories.
from ,8/1/52-12/31/55
No. of
Patients
No. of
Treated
Patients
No. of
P-C
Tests
Pts. Treated
with
Terramycin
(Plain)
Pts. Treated
with
Terramycin with
Polymyxin
320
134
457
52
82
^Table 1
From Aug. 1, 1952, to Dec. 31, 1954, 122 pa-
tients were studied for infertility. Seventy pa-
tients (57 per cent) had a good postcoital test
and did not require treatment. Fifty-two patients
were treated in this group to improve the post-
coital test with Terramycin vaginal suppositories.
They had a total of 146 postcoital examinations.
There were nine patients (17 per cent) in whom
itching and burning in the vagina with vaginal
discharge developed. Vaginal smears revealed the
presence of either trichomoniasis or moniliasis.
All were relieved by stopping the treatment, by
cool cornstarch baths, and by vinegar douches.
The postcoital tests were planned for the
optimal time based on Spinnbarkeit examinations.
J. Florida M.A.
March, 195S
SCHULTZ: IMPROVED RESULTS IN POSTCOITAL TEST
969
Patients Treated with Terromycin Vaginal Suppositories.
from 8/1/52 -12/31/53
No of
Patients
No. of
Treated
Patients
No. of
P-C
Tests
No. of
Reactions
%
122
52
146
9
17%
‘Table 2
basal body temperature charts and the menstrual
history. All 52 patients at the time of the first
postcoital examination had numerous leukocytes
in the mucus, no sperm, or an occasional dead or
sluggish spermatozoon per high power field. Many
of the other characteristics of poor mucus were
also present such as scantiness, high viscosity, and
thick jelly-like material. Many of the patients
had no obvious cervicitis or endocervicitis, while
others had varying degrees of cervicitis.
From Jan. 1, 1954, to Dec. 31, 1955, 198 pa-
tients were studied as previously described for
infertility. One hundred and sixteen patients had
good postcoital tests, while 82 patients had poor
tests and required therapy. In this group of
treated patients, Terramycin with polymixin vag-
inal suppositories were used. This tablet was an
improvement over the plain Terramycin vaginal
suppository in that there were fewer reactions.
Nine patients (11 per cent) had itching, burning,
vaginal discharge and vulvar rash. Relief from
symptoms was obtained, on ceasing therapy, by
cool cornstarch baths and vinegar douches. A
total of 311 postcoital tests were made in this
group.
Patients fooled with Terromycin with Polymyxin Vbqinol Suppositories
from 1/1/54- 12/31/55
No of
Patients
No. of
Treated
Patients
No. of
P-C
Tests
No. of
Reactions
%
198
82
311
9
11%
Table 3
The postcoital tests were performed two to 24
hours after intercourse; the most frequent time
interval was from four to seven hours after coitus.
These were planned by basing the probable ovula-
tory period with the use of basal body tempera-
ture charts, Spinnbarkeit examinations, and re-
tractility tests of the cervical mucus.
The specimens of the cervical mucus were col-
lected with a Knight nasal biopsy forceps. This
particular clamp was used because of its ease in
reaching the level of the internal os and its con-
cave tip in which the mucus would collect. Spec-
imens of the mucus were collected at the level of
the external os and the internal os, and were im-
mediately studied microscopically for spermatozoa.
All patients received Terramycin (100 mg.)
vaginal suppositories and were instructed to in-
sert one tablet vaginally each morning for 10
days high in the vaginal canal. They were told
not to douche. The postcoital test was repeated
the following month. It was necessary to repeat
the treatment more than once in a number of pa-
tients.
Cervical Mucus
The cervical mucus was considered improved
after therapy if it was clear, abundant, contained
few or no leukocytes under microscopic examina-
tion, and had a high Spinnbarkeit ratio. It was
considered not improved if it remained cellular,
thick, and scanty.
Sperm Migration
It is difficult to classify numerically a good or
poor postcoital test in this series, since the hus-
band’s sperm count is an important factor. Ob-
viously, if a semen analysis revealed a sperm
count of 150 million per cubic centimeter with
90 per cent motility at one hour, we would find
more spermatozoa per high power field in the
postcoital test as compared to a sperm count of
30 million per cubic centimeter with 60 per cent
to 70 per cent motility at one hour. These patients
were not selective, but seen consecutively with
varying sperm counts from 20 million to 250 mil-
lion per cubic centimeter. In general, a good post-
coital test was so termed if there were at least
five to 10 active motile sperm per high power field.
Sperm migration was classified as poor if none
were found or an occasional mildly active sperm
was seen per high power field. In many instances
there were between 50 and 100 sperm per high
power field with excellent motility, while in others
between 2 and 5 sperm per high power field with
good motility were present.
Results
The results in the series of patients (122) seen
from Aug. 1, 1952, to Dec. 31. 1953, have been
analyzed, since enough time has elapsed for eval-
970
SCHULTZ: IMPROVED RESULTS IN POSTCOITAL TEST
Volume XLIV
Number 9
uation. Seventy patients (57 per cent) had a
good postcoital examination and did not require
any therapy to improve the test.
Results with Terramycin Vaginal Suppositories
from 8/1/52- 12/31/53
No of
Patients
Patients
Not
Requiring
Therapy
Patients
Retiring
Therapy
Improved
%
Not
Improved
%
122
70
52
34
65%
18
35%
‘Table 4
Fifty-two patients (43 per cent) had poor post-
coital examinations and required treatment. Im-
provement was noted in 34 patients (65 per cent),
and 18 patients did not improve.
Number of Pregnancies.
122 Patients
from 8/1/52- 12/31/53
No. of
Patients
No of Patients
Pregnant
<y
/o
No of
Improved
P-C
Tests
—
No of
Patients
Pregnant
%
122
54
44%
34
17
50%
60 Pregnancies
6 Miscarriages
3 Not yetdeliveml
No. of
Non -improved
P-C
Tests
No. of
Patients
Preqnant
%
18
4
22%
‘Table 5
Fifty-four patients (44 per cent) of the 122
patients studied and treated became pregnant.
Eighteen patients did not have improved post-
coital tests after therapy. Four patients became
pregnant (22 per cent). Of the 34 patients who
had improved postcoital tests, 17 patients (50 per
cent) became pregnant. Case 1 is an illustration.
Case 1. — The patient was a 38 year old nullipara with
seven years of sterility. Her husband, by a previous mar-
riage, had three children and was SO years of age. His
semen analysis was 49 million per cubic centimeter with
SO per cent motility at two and one-half hours and good
progression. Tubal insufflation revealed patent tubes;
endometrial biopsy showed secretory endometrium. On
Sept. 13, 1952, a postcoital test on day 14 after two and
one-half hours revealed at the level of the external os
an occasional dead sperm per high power field with
numerous leukocytes and scanty mucus. At the level of
the internal os there were no sperm per high power field
and the same condition of the mucus. She was given
Terramycin vaginal suppositories for 10 days. The post-
coital test was repeated on October 17 on day 15 of the
cycle and showed the same picture as had previously
been seen.
Again she was given another course with Terramycin
vaginal suppositories. On November 14, a postcoital test
on day IS after four and one-half hours showed 10 to
15 sperm per high power field with very few leukocytes
at the level of the external os and at the level of the
internal os 25 to 50 sperm per high power field with ex-
cellent motility and no leukocytes. The postcoital test
was once more repeated on December 10 (no therapy
had been given prior to this examination) on day 13
after six and one-half hours. At the level of the external
os there were between 10 and 15 motile sperm per high
power field and at the level of the internal os between
five and 10 motile sperm per high power field. The
mucus was clear and acellular. The reaction to the
Aschheim-Zondek test on Feb. 24, 1953, was positive,
and the patient delivered a 7 pound 8.5 ounce male on
October 12.
Fourteen of the husbands in this series had
sperm counts under 40 million per cubic centi-
meter. Five of the wives became pregnant. An
example is the following case.
Case 2. — The patient was a 25 year old nullipara with
duration of infertility of four and one-half years. Her
husband, aged 27, had a sperm count of 30 million per
cubic centimeter with 66 per cent normal forms, 70 per
cent motility at three hours, and good progression. Tubal
insufflation showed patency; endometrial biopsy revealed
secretory endometrium A postcoital test on May 8, 1953,
on day 13 after six and one-half hours showed the mucus
to be thick, viscous and cloudy, and it contained numerous
leukocytes. No sperm were seen at the level of the ex-
ternal os and internal os. The patient was given Terra-
mycin vaginal suppository therapy.
The postcoital test was repeated on August 3 on day
11 after four hours and again the specimen showed no
sperm, a moderate number of leukocytes, and mucus
still somewhat scanty and slighty cloudy. She was given
another course of Terramycin vaginal suppositories, and
the postcoital test on November 19 on day 13 after five
hours showed 25 to 50 sperm per high power field at
the level of the external os and 10 to 15 sperm per
high power field at the level of the internal os with good
motility. The mucus was clear and abundant, and con-
tained practically no leukocytes. Her last menstrual
period was March 30, 1954, and there was a positive re-
action to the Aschheim-Zondek test on May 23. She
delivered a healthy normal male weighing 8 pounds and
15 ounces on Jan. 19, 1955.
Comment
The postcoital test is regarded as a means of
determining the compatability between sperm and
cervical mucus. Conception requires the coopera-
tion of various factors. Improving the postcoital
test is merely one of these factors. It must be
emphasized that the patients in this series re-
ceived other types of therapy in addition to the
Terramycin vaginal suppositories to help bring
about conception.
Terramycin vaginal suppositories were used
until January 1954. The plain Terramycin vag-
inal suppositories were discontinued and replaced
by an improved tablet. Terramycin with polymix-
in. This tablet reduced the incidence of local re-
actions and the recurrence of fungus infections.
Conclusion
Sixty-five per cent of the patients in the series
here presented showed improvement in the post-
J. Florida M.A.
March, 1958
ABSTRACTS
971
coital examination following Terramycin vaginal
suppository therapy.
Seventeen per cent had complications of vag-
inal discharge, itching and vulvar rash with Terra-
mycin vaginal suppositories. Only 1 1 per cent
had the aforementioned complications using Ter-
ramycin with polymixin vaginal suppositories.
The pregnancy ratio is much higher in those
patients with a good postcoital examination as
compared to patients with a poor postcoital test.
References
1. Barton, M., and Wiesner, B. P. : Sims Test, Lancet 2:563-
565 (Oct. 28) 1944.
2. Barton, M., and Wiesner, B. P. : Receptivity of Cervical
VTn^’is to Snerm^tozoa. Brit. M. J. 2:606-610 (Oct. 26) 1946.
3. Williams, W. W., and Simmons, F. A.: Intracervical Sur-
vival of Spermatozoa, Am. J. Obst. & Gynec. 43:652-662
l April) 19-42.
504 Huntington Building.
ABSTRACTS
The Surgical Treatment of Exophthal-
mic Ophthalmoplegia. By W. J. Knauer, Jr.,
M.D. Am. J. Ophth. 43:58-66 (Jan.) 1957.
The purpose of this paper is to describe the
treatment of exophthalmic ophthalmoplegia by
means of a modified technic of lateral orbital
decompression and to discuss some of the indica-
tions for performing this relatively benign proce-
dure. Illustrative cases are described in which
this operation was performed seven times on five
patients at the Wilmer Ophthalmological Insti-
tute. There was an average decrease in exoph-
thalmos of 7 mm. in these cases; the maximum
recession obtained was 11 mm. and the minimum,
4 mm.
In summary, the author observes that exoph-
thalmic ophthalmoplegia is a syndrome, the exact
pathogenesis of which is unknown. It can pro-
duce proptosis, ocular palsies, diminished or com-
plete loss of vision, and, in severe cases, loss of
the globe. It has been shown that adequate orb-
ital decompression can be obtained either via the
lateral or transcranial approach, although the lat-
ter is the more formidable. In many cases of this
type, the general policy of watchful waiting has
resulted in a number of ocular cripples and lost
eyes. Late orbital decompression results in cos-
metic improvement only and has no effect on the
extraocular muscle palsies. There is experimental
and clinical evidence which suggests that the
changes in the extraocular muscles may be in part
secondarily induced by the increased orbital pres-
sure or exophthalmos.
Assuming that an adequate trial of medical
treatment has failed, it is suggested that patients
with exophthalmic ophthalmoplegia in whom
there develop signs of extraocular muscle palsies
or evidence of visual impairment undergo a de-
compression, preferably through the less formid-
able but adequate lateral approach.
Gastrointestinal Wheat Allergy; Two Re-
cent Experiences. By H. J. Roberts, M.D.
J. Allergy 27:523-530 (Nov.) 1956.
This report is presented primarily as a clinical
and therapeutic study in view of the renewed in-
terest in wheat allergy, particularly as this phe-
nomenon relates to the sprue and celiac syn-
dromes. It was prompted by the recent obser-
vation of two patients who demonstrated profound
improvement of severe gastrointestinal disability
only after a wheat-free diet had been instituted.
After reviewing the issues of gastrointestinal
and wheat allergy as they pertain to the recent
literature, the author reports the two cases in
which the patients experienced prompt remission
of symptoms on wheat-free diets. In the first case,
severe primary sprue had been present which had
become refractory to vitamin B]2, folic acid, and
cortisone acetate. After the institution of this
dietary regimen, the patient remained symptom-
free. Both the hypocalcemia and steatorrhea re-
verted to normal one month after the diet was
started. The temporary beneficial effects of steroid
therapy previously noted in sprue may be ascribed
to the interference with this hypersensitivity state.
The patient in the second case exhibited a se-
vere gastrointestinal allergy to wheat manifested
by diarrhea, a pronounced eosinophilia, and ab-
dominal pain. A complete clinical and hematologic
remission was also experienced in this case on a
wheat-free diet, even though he was exposed to
wheat flour dust during the course of his occupa-
tion as a baker. A specific sensitization to gluten
or another of the products of wheat digestion is
inferred.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
972
Volume XLIV
Number 9
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
STAFF —
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
SHALER RICHARDSON, M.D., Editor
Editorial Consultant
Managing Editor
Ernest R. Gibson
Mrs. Edith B. Hill
Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman ... .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr. M.D Orlando
Joseph J. Lowf.nthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
Timely Telephone Topics
Alan's, and especially the physician’s, adapta-
tion to the telephone has resulted in the develop-
ment of innumerable, and occasionally, diverse
technics designed toward management of this nec-
essary, but oftentimes inconvenient, mode of com-
munication. None of these technics is perfect.
Indeed, it is apparent that none can possibly be
devised which might be considered even a close
approximation to perfection. The auditory elec-
tronic connection between an ill and anxious pa-
tient with all his multiform ambivalent feelings
and a physician who may have the internist’s em-
pathy, the surgeon’s imperturbability or the psy-
chiatrist’s equanimity has all of the component
parts necessary to produce reactions all the way
from mutual gratification to explosive rejection.
Practically all physicians have found it neces-
sary to establish a buffer in the form of a recep-
tionist between themselves and the world outside
their offices. Some even double this buffer system
through the additional aid of their office nurse.
The efficiency of these systems is usually in direct
proportion to the adaptability of the personali-
ties of the component members. While most often
effective, these arrangements can, at times, re-
sult in patient dissatisfaction.
Surprisingly enough, a number of physicians
find that their most time-consuming and trouble-
some calls come from members of their own pro-
fession. With the exception of psychiatrists, prac-
tically all doctors immediately recognize and re-
spond to calls from fellow physicians. By the
very nature of our profession we, of necessity,
have become masters of “verbal diuresis.” We
cannot seem to subdue the native instinct to com-
municate to others all of the knowledge at our
command concerning any subject from gout to
the best method of recovering from the left-
handed sand trap on number sixteen. Little do
we realize how much of an advantage we have
over our unhappy victim who usually has a sen-
sitive patient at his deskside and cannot properly
ventilate his feelings regarding the increase in
dues at the country club.
There are a number of corrective measures
which can be taken in an attempt to regulate this
little plastic-encased, expensive, expressive, jang-
ling, provoking, irritating, loving, tender, quarrel-
J. Florida M.A.
March, 1958
EDITORIALS AND COMMENTARIES
973
some, pretty, means and/or happy product of
science. First, and foremost, we physicians have
to set the example, so to speak, by being precise
and to the point in our telephone conversations
with others — especially with other physicians
during office hours. Secondly, the buffer recep-
tionists and nurses can be further utilized to
screen unnecessary calls. Lastly, but certainly
not the least importantly, education of the general
public must be carried on. Along this latter line,
we can continue to use the time-honored methods
of receptionist instructions to callers supplemented
by our own occasional chastisement of the lambs
who insist on talking to the “GREAT PHYSI-
CIAN” for the most important scheduling of an
appointment for a check on his or her most
“HORRIBLE” blood pressure. Additional avenues
of instruction could easily be sponsored by the
medical societies through articles in local news-
papers. On a national level it does not appear
amiss to ask our pharmaceutical friends to help
us educate the public on telephone courtesy
through use of short blocked-off notes or even
discussion paragraphs along with their lay maga-
zine advertisements.
As the old, old saying still is expressed —
physicians come and go, but the telephone is here
to stay. While we are still around, please let us
really try to make our marriage to it last.
Scientific Program Planned for Annual Meeting
Bal Harbour, May 10-14, 1958
The Eighty-Fourth Annual Meeting of the
Florida Medical Association will take place in a
new setting this year, the Hotel Americana at
Bal Harbour, just north of Miami Beach. It is
scheduled for May 10 to 14, with Saturday, May
10, and the morning and evening of Sunday,
May 11, reserved for meetings of specialty
groups. The first session of the House of Dele-
gates convenes on Sunday afternoon, and in ac-
cordance with a ruling of the Board of Governors,
no other meetings are to be scheduled at that
time.
The arrangements in general follow the sched-
ule carried out at the convention in Hollywood
last year. The innovation at that time of sched-
uling two scientific assemblies only, and both on
Tuesday, will be repeated this year. This plan
gives members who can attend on but one day
the opportunity to be present for the scientific
assemblies and to enjoy the chief social events,
scheduled for Tuesday night.
The First Scientific Session, with Dr. George
T. Harrell Jr. presiding, will open at 9:30 a.m.
on Tuesday and continue until 12:30. Three
medical papers will be presented in the fol-
lowing order: “Hearing Loss in Persons of Ad-
vanced Age” by Dr. Abraham R. Hollender and
Dr. Otto S. Blum of Miami Beach; “An Analysis
of the Causes of Blindness in Florida” by Dr.
Nathan S. Rubin of Pensacola; and “False Posi-
tive Pregnancy Tests Caused by Sparine and
Thorazine” by Dr. Gerard H. Hilbert of Pensa-
cola. After recess, the remainder of the morning
session will be devoted to a panel covering recent
advances in modern methods of diagnosis and
therapy, with Dr. Richard Reeser Jr., of St.
Petersburg, presiding. Dr. David Hume, Chair-
man of the Department of Surgery of the Medical
College of Virginia, will serve as moderator.
Participating in the panel will be Dr. David A.
Newman of Palm Beach, Dr. Michael M. Gilbert
of Miami and Dr. Robert G. Cushman of Jack-
sonville. Dr. Newman’s subject is “Reversal of
Intractable Cardiac Edema.” The title of Dr.
Gilbert’s paper is “The Use of Carbon Dioxide
in the Treatment of Postconcussion Syndromes.”
Dr. Cushman will discuss “The Application of
Aspiration Technics as a Diagnostic Tool.”
Dr. Donald F. Marion will preside at the
Second Scientific Session, beginning at 2 p.m.
Two papers on surgical subjects will open the
program: “Physiologic Basis for Ulcer Surgery”
by Dr. Edward R. Woodward of Gainesville, and
“Ventricular Aneurysm” by Dr. Richard G. Con-
nar of Tampa. Following the afternoon recess,
a panel will present the medical and surgical
aspects of diseases of the chest. Dr. Franz H.
Stewart of Miami will preside, and Dr. David
T. Smith, Chairman of the Department of Bacte-
riology of Duke University School of Medicine,
will serve as the moderator. The panel members
and their subjects will be: Dr. George H. Hames
974
EDITORIALS AND COMMENTARIES
Volume X LI V
Number 9
Drs. Abraham R. Hollender,
Miami Beach; Nathan S. Rubin,
Pensacola, and Gerard H. Hilbert,
Pensacola (left to right).
Drs. David A. Newman, Palm
Beach; Michael M. Gilbert, Mi-
ami, and Robert G. Cushman,
Jacksonville (left to right).
Below: Drs. George H. Hames, Lantana; William
W. Stead, Gainesville; John G. Chesney, Miami, and
Hawley H. Seiler, Tampa (left to right).
I Florida M.A.
March, 1958
EDITORIALS AND COMMENTARIES
975
of Lantana, “Differential Diagnosis of Pulmonary
Tuberculosis;” Dr. William White Stead of
Gainesville, “Office and Bedside Evaluation of
Pulmonary Function;” Dr. John G. Chesney, Dr.
DeWitt C. Daughtry and Dr. Harold C. Spear
of Miami, “Surgery in the Relief of Dyspnea of
Ventilatory Origin;” and Dr. Hawley H. Seiler
of Tampa, “Pulmonary Surgery in Infants and
Children.”
The complete program for the Annual Meet-
ing will appear in the April issue of The Journal.
The excellent scientific program, the distinguish-
ed guest speakers at other sessions, the important
matters to come before the House of Delegates
and the many attractions of the Miami area
should assure an unusually large attendance.
Popularity of Midwinter
Seminar Grows
The Twelfth Annual PTniversity of Florida
Midwinter Seminar in Ophthalmology and Oto-
laryngology attracted the largest attendance this
annual gathering at Miami Beach has ever had.
Held at the Americana Hotel the week of Jan.
27, 1958, this popular Seminar had 440 regis-
trants from 38 states and from Canada, which
had a representation of five. The Florida Society
of Ophthalmology and Otolaryngology was well
represented this year with 68 members in attend-
ance.
This outstanding event in Florida’s excellent
program of postgraduate medical education was
arranged to allow ample opportunity for after-
noon recreation and evening entertainment. The
featured social event was the annual informal din-
ner on Wednesday night, January 29, at the
headquarters hotel, which was preceded by a
cocktail party for the visitors from throughout
the nation.
As is the custom, the program for the first
three days of the week was devoted to Ophthal-
mology and for the last three days to Otolaryngol-
ogy. The faculty consisted of Dr. Frank D.
Costenbader of Washington, D. C., Dr. John H.
Dunnington of New York City, Dr. Peter C.
Kronfeld of Chicago, Dr. W. Howard Morrison
of Omaha, and Dr. C. L. Schepens of Boston,
lecturing on Ophthalmology; Dr. Aram Glorig
of Los Angeles, Dr. Jerome Hilger of St. Paul,
Dr. Alexander S. McMillan of Boston, Dr. Samuel
Martin of Gainesville, and Dr. James Maxwell of
Ann Arbor, Mich., lecturing on Otolaryngology.
Seminar on Internal Medicine
On April 3-5, 1958 the University of Florida
College of Medicine will inaugurate at the medical
college in Gainesville a series of postgraduate
education seminars. The first seminar is to be de-
voted to a discussion of recent advances in the
understanding and management of patients with
kidney, thyroid and respiratory disorders. This
meeting should be of interest to physicians in
general practice and specialists who are seeing
patients with medical illnesses. Selected topics
of clinical import will be presented, and ample
time will be provided for discussion of individual
problems in patient management.
Guest speakers will include Drs. George Sch-
reiner, Georgetown University Medical Center,
and Henry Heinemann of the Presbyterian Hospi-
tal, New York City, whose subject is renal disord-
ers; Drs. William H. Beierwaltes of the University
of Michigan Medical School, Ann Arbor, and J. E.
Rail of the National Institutes of Health,
Bethesda, Aid., who will discuss the thyroid gland;
and Drs. William Stead and Arthur Otis of the
University of Florida College of Medicine, who
will lecture on respiratory disorders. Dean George
T. Harrell Jr. also will deliver a lecture on uri-
nary tract infections. Other members of the Uni-
versity medical college who will participate in this
seminar will be Drs. Mannie Suter, Chairman, De-
partment of Bacteriology; J. L. Edwards, Chair-
man, Department of Pathology; Samuel P. Mar-
tin, Chairman. Department of Medicine; Thomas
H. Maren, Chairman, Department of Pharmacol-
ogy; and William C. Thomas Jr., Department
of Medicine.
Topics to be included in this seminar are:
Renal Disorders: Newer concepts in the
pathogenesis and management of patients with
acute tubular necrosis; symptomatic electrolyte
disturbances in patients with chronic renal disease;
renal function — practical assessment and correla-
tion with pathologic derangement; management
of patients with acute and chronic infections of
the urinary tract; recognition of patients with
hypertension due to unilateral renal disease.
Thyroid Disorders: Factors in thyroxin for-
mation and release by the thyroid gland; limita-
tions in the application of newer methods of as-
sessing thyroid function; pathogenesis and man-
agement of benign and malignant tumors of the
thyroid; diagnostic dilemmas in histologic studies
of diseased thyroid glands; recent developments
in the pathogenesis of thyroiditis and the possible
976
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 9
application of autoimmune mechanisms to other
endocrine disorders; the necessity for critical
evaluation of patients with the “hypometabolic
state;” hypopituitarism, and often unrecognized
though not infrequent cause of hypothyroidism.
Respiratory Disorders; Disturbed physiology
in patients with chronic respiratory disorders;
advantages and limitations of newer technics
used in the treatment of patients with pulmonary
emphysema; critical selection and use of drugs in
patients with respiratory infections; useful aids
in the differential diagnosis in patients with chest
disorders.
Advance registration should be made with the
Division of Postgraduate Education, College of
Medicine, University of Florida, Gainesville.
There will be a fee of $25 for attendance at this
seminar.
1957 Report of Ford Foundation
The Ford Foundation made new grants and
appropriations totaling $83 million for education
and other programs of national importance dur-
ing the last fiscal year, according to the 1957
annual report issued recently. The report covers
the period from Oct. 1, 1956 to Sept. 30, 1957.
Actions during 1957 brought to more than $1
billion the Foundation’s grants and appropria-
tions since it was established in 1936. The largest
single grant was $24.5 million to expand national-
ly the Woodrow Wilson fellowship program to
combat the shortage of college teachers.
Flenry T. Heald, completing his first year as
president of the Foundation, said in the report
that “the cornerstone of the Foundation’s philos-
ophy and program is the belief that through edu-
cation society can realize its fullest potential for
material abundance, intellectual enlightenment,
and moral growth.
“Higher education is beset today by finan-
cial difficulties greater than those of any other
period in American history. They are the result
of a set of circumstances imposed upon higher
education by the society it serves, and hence
they become the responsibility of that society.”
Mr. Heald cited as pressures on higher educa-
tion the larger number seeking education, the
demand for more years of education, the ex-
panding fund of knowledge, and the United States’
role as leader of the free world.
The year was marked by the ascendency of
certain Foundation programs and the completion
of others. Among opening grants made was one
on the Problems of the Aging. One feature of this
new program was a grant of $24,000 to the Uni-
versity of Florida for research into the adjust-
ment problems of persons who move to new
communities for retirement.
Three programs completed by final payments
from the special 1955 and 1956 appropriations of
$550 million were $260 million for college faculty
salaries, $200 million for extension of services
in private, voluntary hospitals, and $90 million
for improvement of instruction in 45 privately
controlled medical schools. Fifty-six privately
supported hospitals in Florida received payments
ranging from $5,000 to $87,000, the payments
for the year amounting to $1,115,300 and the
total grants to $2,365,900. Among the privately
supported medical schools, the University of
Miami received a payment of $400,000, com-
pleting a total grant of $900,000.
Although the purpose of the Ford Foundation
is to serve society and, by extension, to advance
human welfare, Mr. Heald said, no foundation
or combination of foundations can solve the com-
plex problems and plaguing needs of mankind.
“The most a foundation can do is to make a start,
or indicate a route, or call attention to an idea.
If the direction is right and the method sound,
if a solution seems possible, then the people them-
selves— individually or collectively through their
voluntary agencies or governments — will finish
the job.” In this role the Ford Foundation has
indeed made and is making a magnificant con-
tribution at home and abroad.
Newly Established Educational Council
For Foreign Medical Graduates
After almost three years of planning, the
Educational Council for Foreign Medical Gradu-
ates is now in operation at 1710 Orrington Ave.,
Evanston, 111. It will distribute to foreign medi-
cal graduates around the world authentic infor-
mation regarding the opportunities, difficulties
and pitfalls involved in coming to the United
States on an exchange visitor or exchange student
visa in order to take training as an intern or
resident in a United States hospital, or coming
on an immigrant visa with the hope of becoming
licensed to practice.
Another function will be to make available
to properly qualified foreign medical graduates
while still in their own country a means of ob-
taining ECFMG certification (a) to the effect
J. Florida M.A.
March, 1958
OTHERS ARE SAYING
977
that their educational credentials have been
checked and found meeting minimal standards
(18 years of formal education, including at least
four years in a bona fide medical school), (b)
that the command of English has been tested and
found adequate for assuming an internship in an
American hospital, and (c) that the general
knowledge of medicine as evidenced by passing
of the American Medical Qualification Examina-
tion is adequate for assuming an internship in
an American hospital. In addition, it will pro-
vide hospitals, state licensing boards, and special-
ty boards which the foreign medical graduate
designates, the results of the three way screen-
ing available.
This newly organized council will not serve
as a placement agency either for interns or resi-
dents. Placement arrangements must be made
by the foreign medical graduate directly with the
hospital of his choice. It will not attempt to
evaluate the teaching program or inspect or ap-
prove any foreign medical school. Its program
is based not upon evaluating the school from
which the candidate graduated but upon evaluat-
ing the professional competence of the individual.
Also, it will not act as an intercessor for foreign
medical graduates having problems under discus-
sion by state boards of medical licensure or spe-
cialty boards. If the foreign medical graduate
asks that the results of his three way screening
be sent to a designated board, this will be done,
but the ECFMG has no right and no desire to
review the decisions of the properly constituted
As one leaves his internship or residency and
hangs out his shingle to signify that he is entering
into the practice of medicine, the neophite then
begins to wonder about how to set up an office.
Like every soap 99 9/10 are pure and have
seldom if ever charged for their services. How
does he know what to charge; should he inquire
about the charge of others in the community;
take the various fee schedules from Blue Shield;
industrial commission or medicare or perhaps he
should read Medical Economics, Newsweek, and
try to hit a happy medium.
Establishment of fees according to some
should be set rigid rules regardless of the finan-
cial standing of the patient. Others feel that al-
most all charges should take into consideration
state licensing boards and American specialty
boards.
Sponsors of the new agency are the American
Hospital Association, the American Medical As-
sociation, the Association of American Medical
Colleges and the Federation of State Medical
Boards of the United States. Providing funds to
support it through the first two years of its exist-
ence are the sponsoring agencies, the Kellogg
Foundation and the Rockefeller Foundation. The
Executive Director is Dr. Dean F. Smiley, former
Secretary of the Association of American Medical
Colleges.
The ECFMG’s Examination Committee will
select the items for two examinations a year from
the National Board of Medical Examiners’ pool
of questions. The National Board of Medical
Examiners will use as many of its 50 presently
constituted United States examination centers as
will be required and will establish examination
centers abroad in numbers as found required to
meet the need. The National Board of Medical
Examiners will proctor the examination, score
and analyze the results, and turn them over to the
ECFMG’s Examination Committee for final
evaluation and action.
The target date for the first American Medi-
cal Qualification Examination for foreign medical
graduates already in this country was set for
February or March 1958, and the second one is
scheduled for August or September of this year.
The latter will also be available to foreign medi-
cal graduates abroad.
the person’s ability to pay. Perhaps these float-
ing schedules would be possible and necessary
for large fees that result from surgery, long hos-
pitalization periods or in time of real hardship
or the so called catastrophe illness.
The average physician must depend on the
two to ten dollar fee that comes from office, home
and hospital calls. It is kind of difficult to
charge different fees for the same service one
offers in the office. For this reason each physician
stabilizes his own fees so that in general he
charges the same amount for his office procedures.
Time, knowledge and skill are the physician’s
main commodity. He has little else to sell. If he
prescribes and sells medicine or sells shots the
physician is entirely within his right. Perhaps
OTHERS ARE SAYING
The Art of Setting Fees
978
BLUE SHIELD
Volume XLIV
Numbkr 9
better, shouldn’t we feel that the doctor is selling
his knowledge of diseases, skill and therapeutics.
Charges are difficult to set up as a rigid fee
schedule. No one likes rules and unfortunately
they are made to be broken. It certainly is not
good for public relations for one to give a simple
shot for five dollars and then have the patient
ask why Doctor Cheaper charges only two dollars
for this same shot. It is hard to tell the patient
that you have made a special study of this mat-
ter; that you autoclave each syringe and needle
before use; that you use only high grade ‘injecta-
bles, syringes and needles. Still in the patient’s
mind is the difference between two and five
dollars.
Some place in each medical society there
should be a committee that should establish min-
imal fee schedules for office calls and treatments,
home calls, which vary with distance and time
of day or night, and last of all, a minimal stand-
ard for hospital calls and procedures.
Only through this medium can we as a Socie-
ty establish good relationships with the public
that we serve, and, only incidentally, rely upon
for our livelihood.
The Bulletin
Sarasota County Medical Society
November 1957
BLUE
My View of Florida Blue Shield
Robert E. Zellner, M.D.
ORLANDO
in casting around and talking to a number of my
friends, that the ideas which I had were fairly
common, I thought that the way I felt was rea-
sonably representative.
Member of Florida Medical Association Advisory Committee
to Blue Shield
When Dr. Babers asked me to appear on this
program, I wondered why. After hearing the ar-
ray of talent that appeared today, 1 wonder even
more why, but I have finally come to a conclu-
sion. The other night my son, who is in the
eighth grade, came home with a book called
‘‘The Education of T. C. Mits.” I had never
heard of Mr. Mits, but the title of the book in-
terested me. 1 opened it and much to my surprise
found that it was an arithmetic book. I then
looked back to see what the education of T. C.
Mits was, and it turned out that T. C. Mits is
an abbreviation for “The Common Man in the
Street.” So, I think that after all this array,
the program committee wants on the program
one common man in the street, and that is I.
Something like 18 months ago, Dr. Langley
asked me to serve on the Association’s Advisory
Committee to Blue Shield. It was one of few
jobs I have been asked to do that I accepted
readily and with pleasure. I had formed some
definite conclusions about Blue Shield, and if
anybody was going to help straighten it out, T
wanted to have a hand in it. Because I found,
The two addresses in this issue of The Journal are the
third and fourth in a series. The first two were published
in the February issue: “Opening and Explanatory Remarks,”
by Dr. Henry j. Babers Jr., and “Blue Shield From the
Layman s Viewpoint,” by Judge Ben C. Willis. All the
addresses were delivered at the meeting of Active Members
of Florida Blue Shield held Dec 7, 1957 in Jacksonville
Early Conclusions
There were several conclusions to which I
had come:
One of them was that Blue Shield is no longer
necessary. It was organized back in 1945 in this
state, primarily for the indigent, and the indigent
nowadays hardly exist any more. Everybody is
paying his bills, everybody has a big automobile,
even if he is paying for it on time; so these indi-
gents, that we were concerned about just do not
come in our offices anymore. Most of us are col-
lecting most of the money that is on our books.
Another reason why it is no longer necessary is
that when Blue Shield was organized, there was
no adequate insurance coverage for medical and
surgical expense; but we now have the commer-
cial companies offering all kinds of policies for
such expense. And, after all, this is America, we
believe in free enterprise, we are all free agents
ourselves, we pay taxes in our community, and
we do not want to see a nonprofit organization
moving in. If the commercial insurance com-
panies can operate at a profit, then they should,
and we would get out of this nonprofit business.
A third reason why I thought Blue Shield was
obsolete is that we have defeated Claude Pepper
now, and we have a man that we thought a few
years ago was better than Claude, and socialized
medicine is no longer a threat; so we just do not
need Blue Shield any more.
J. Florida M.A.
March, 1958
BLUE SHIELD
979
A second conclusion to which I had come
was that if we are going to keep Blue Shield, it
should sell to indigents only. Why should we get
out in the commercial market and compete for
groups financially able to pay their own way?
Our job is to take care of these people in the
indigent groups, and help them to help pay us.
We are the people who are helping to take care
of them for nothing; so when we make it pos-
sible for them to pay through insurance for care
they would otherwise have gotten for nothing,
in effect, we are scratching our own backs. If,
however, we are going to sell, let us sell to those
people only.
The third conclusion to which I had come
was that the Blue Shield management is no longer
interested in the medical profession. Mr. Schro-
der started out with us in a small organization.
He has built it, along with the medical profession,
into a multimillion dollar organization. It is a
pretty big concern, and it is characteristic of the
bureaucrat that if he can make it bigger, make
more money, it gives him more prestige and
makes him a bigger figure on a national basis. I
felt that the directorship of Blue Shield no longer
represented me. I was confident that most of the
directors must have made their pile before the
war, or, what was worse still, during the war.
While I am doing all right, I have not bought my
first Cadillac yet; and I still find that while I
have myself insured against every contingency,
my family and I manage to live it up and at the
end of the year I do not have anything left. I am
still making my first million and I did not feel
that this representation which we have on the
board of directors was. So, if there was going
to be any change in Blue Shield, then I wanted
to have a hand in making it.
Changed Viewpoint
Today, 18 months later, I think possibly the
reason I am on this program is that I am like an
alcoholic who joined Alcoholics Anonymous. The
committee made a sucker out of me in that I
have had to eat humble pie, and rather than
thinking Blue Shield is no longer necessary, I am
convinced that it is now more necessary than it
ever has been before. I did not know just how
necessary until I heard Mr. Ketchum and Dr.
Good today. First, I think that the existence of
Blue Shield shows that we care, that the medical
profession cares. We have been accused of doing
nothing, being negativists, always being against
and maintaining the status quo; but this is posi-
tive action which we have actually taken, and it
shows that we are interested in solving a problem
which is going to be solved one way or another.
Secondly, there has been a tremendous change
in the attitude and the atmosphere of the Ameri-
can Public in so far as buying things is concerned.
This has been alluded to already. Everybody
pays for anything he buys now at so much a
month. I am no exception. I bought a house not
long ago and I was not at all concerned about
what it was going to cost. I wanted to know
what my mortgage payment was going to be each
month. 1 think the rest of us are pretty much
in the same boat. I would like to point a finger
at my own county medical society, which now
lets members pay its dues twice a year. We are
on an installment plan. Everything that we buy
nowadays is on the installment plan, and people
are now buying their medical care on a prepaid
basis. So, what we are doing is simply collecting
the fees in advance and then apportioning them
among the profession.
Another reason why I think Blue Shield is
necessary is that it sets the pace for the com-
mercial companies. Who knows what would hap-
pen if this brake were removed? These companies
are saying, “This is as good as Blue Shield and
it costs less.” “This is better than Blue Shield be-
cause such and such.” It actually is setting a
pace for these companies and to show you how
important these commercial companies consider
the type of policy which Blue Shield sells, most
of you remember, I know, that just recently the
Florida Power and Light Company down on the
southeast coast proposed a commercial service
plan. I can just imagine what representation
any one of you men would have had if you had
decided that the fee schedule was not equitable.
You are one voice, one man against this commer-
cial carrier, and have absolutely nothing to say
about it. However attractive it was to begin
with, no one knows what it would be next year
or five years from now. We have absolutely no
control over any commercial carrier, which is not
true of Blue Shield. It is adequately demon-
strated by this chart here giving names of the
directors that we do control Blue Shield. As I
look over these names I do not know who is driv-
ing the big cars, but I see one fellow over here,
George Palmer, who was a year behind me in
college. I do not know if he has a rich uncle, but
I imagine he is buying his groceries on the in-
980
BLUE SHIELD
Volume XLJV
N U MBER 9
stallmen t plan as I am. I look at several others
here, and there may be some wealthy ones among
you, but if there are, I do not think they made
it in medicine. It seems to me that we have a
pretty good representation of Mr. T. C. Mits.
I would like to read a statement here to show
you this is not simply a local problem. This was
written by Dr. Morris K. Carothers of Oregon.
I do not know Dr. Carothers, but I think this
is a statement which could well have been written
by any one of us. “I think there is no doubt
that most physicians would infinitely prefer to
be left alone to practice their profession to the
best of their ability and in the light of their con-
science and not be forced to participate in the
perplexing problems now being imposed by the
very existence of health insurance. For the exist-
ence of insurance has of itself, increased the
amount of medical care that is rendered.” We all
know that this is true and that people are not
only seeking medical care because it does not
mean money comes out of their pockets today,
but the existence of this type of insurance is
enabling them to have better medical care than
they have ever had before.
“The difficulty is, of course,” Dr. Carothers
continued, “that while there is only so much mon-
ey in the treasury of the health insurance com-
panies, there is an unlimited amount of services
to be rendered and almost all of it can be theo-
retically justified. It is the belief of many who
have studied these problems that the traditional
devices of casualty insurance companies, namely
the deductibles and co-insurance provisions, will
not, of themselves, be sufficient to provide ade-
quate controls upon a spiraling cost of medical
care. At least in the present frame of mind of
the public, it does not seem likely the contracts
can be sold with deductible and co-insurance
features high enough to act as a sufficient con-
trol. Since there are more and more funds being
poured into health insurance plans and coming
under the control of business men administering
these plans, there are going to be increasing
problems of the relationship of these so-called
third parties to both the patients and the doctors.
Many of us believe that it is essential that physi-
cians take an active and constant interest in these
matters. We believe that the balance that must
be found between economic reality and medical
idealism is one that can be found only with the
participation of physicians in the decision mak-
ing. Physicians must be in the inner councils.”
As you can see, we are in the inner council,
as has been brought out before by the composi-
tion of the board of directors. I have mentioned
here that 1 think these men are doing a good job.
I also have to eat more humble pie. I have had
to change my mind about Mr. Schroder. I had
some harsh thoughts although I have not said
them all out loud. Some of the harsh ones I
thought, but I would like to take those back, the
ones I said out loud as well as the mental reserva-
tions. I think he has done a fine job and I think,
too, that his forbearance and his self control
with people like me, uninformed, opinionated, and
positive, making statements, unsubstantiated,
are as remarkable as they are rare. I think that
he has much more self control than I would have,
and 1 want to say publicly that I have had to
change my mind and that I was entirely wrong.
Earlier, I made the point that Blue Shield
should be sold to indigents only. In the first
place, this cannot be done. As has been brought
out before, there is a higher rate of utilization of
these services by indigents, and Blue Shield, by
having a community rate, does in effect what we
as doctors do in our offices. We charge some
people more in order to charge other people less.
If we only insured the indigent people, then the
rates that would necessarily have to be charged
would be substantially higher than the indigent
could afford. Consequently, we must insure some
of these preferred risk groups in order to get the
community rate at a level the people can afford.
The commercial companies have no interest in
the social aspect of the medical needs of low
income people. Nor are they interested in the
doctor. The one interest which they have is in
marketing a product which can make a profit.
Admittedly, this is a praiseworthy motive, but this
leaves the doctor holding the bag when he takes
care of people who cannot afford to be sick and
who cannot afford or qualify for commercial in-
surance. By skimming off the cream, the young
people, the people who are healthier, those who
are better fed, and those who have better preven-
tive medicine, commercial carriers are able to
charge a rate less than Blue Shield; but they
carefully avoid the very people who need insur-
ance most.
There is another reason, before I pass it over,
why I think that it is necessary for us to have
Blue Shield. Almost 90 per cent of the funds
collected by Blue Shield are returned to the
physician. There is almost a 10 per cent main-
]. Florida M.A.
March, 1958
BLUE SHIELD
981
tenance charge, or handling charge. I had a book
put out by the insurance industry about four
years ago. I think it is called Best’s or something
like that. Such books are hard to get hold of be-
cause they are restricted to insurance company
executives. One of them inadvertently left a copy
in my office. It contained some information which
I was glad to have. At that time, there was not
a single commercial insurance company in the
United States which returned as much as 60
cents on the dollar to medical and surgical
policyholders. White Cross, for example, paid
back something like 40 cents out of every dollar
that it collected. You can see what happens. If
there is any money to be made out of caring for
sick people, I do not think it should be made by
stockholders, or by banks or by insurance compa-
nies. I think it should be made by the people who
are rendering these services. It is the doctor alone,
not the banks, the insurance companies, or other
investment concerns, who pays for the indigent’s
medical care. It is only reasonable, then, that
money collected for doctor bills should reach the
doctor’s pocket. Blue Shield and Blue Cross dis-
tributed to the doctors and hospitals in Florida
last year the sum of 15 million dollars, which was
90 per cent of the premium collected. If we ex-
pand that up to 100 per cent, that means that they
actually collected about 16.25 million dollars, of
which we and the hospitals got back 15 million,
more money than was distributed in this state by
any other insurance company. That includes
money paid out on all types of insurance; life,
hospital, health and accident, and everything else.
They distributed, here, 15 million dollars among
us. Just suppose that had all been done only by
commercial companies. Then the amount that
they would have had to collect from the people of
Florida, rather than 16.25 million, woud have
been around 30 million dollars, a good part of
which would have been distributed among stock-
holders. If anybody is going to make money off
my services, I want to be that person. There,
then, is one of the other reasons why I think that
Blue Shield is so necessary to the medical profes-
sion.
Another point which I made about my objec-
tions to Blue Shield was that it was no longer
interested in the medical profession. I referred
to this earlier and I am convinced after attend-
ing their board meetings and watching them work
that these people are interested. Most of them
are doctors, and they have the same problems
that we have. The others are lay people of un-
questioned repute whose only compensation for
serving on the Blue Shield board is what personal
satisfaction they get from doing a worth while
service for the community, the same compensa-
tion any one of us gets for serving on the com-
munity chest, Red Cross, or other such organiza-
tions. One of the things that I have found in
serving on this committee is that in a highly con-
troversial area, neutrality itself is suspect. There
is no such thing as a neutral; it is “you are a
friendly neutral on what side,” or “you are un-
biased in which direction.” I know I suspected
all these people, and because I have changed my
mind about some of these things, with more
information, I find that I myself am becoming
suspect. I have been told, “You have sold out to
Blue Shield.” I think Dr. Babers has already
alluded to my hard head, and I sincerely believe
that I am harder to brainwash than that. I
sincerely believe, too, that any one of you gentle-
men subjected to the same education here as Mr.
Mits and I have been would come out pretty
much in the same mind.
Problems
I have come to some conclusions about what
should be done with Blue Shield and I have just
about decided, after hearing today’s talks, that
I may be wrong on this score, too. The more
I learn the less I know. There are some things
that seem wrong with Blue Shield, some things
inherent in its makeup, which, although not ac-
tually wrong, predispose it to trouble. We have
in effect, comparing Blue Shield with commercial
companies, a democracy versus dictatorship. We
know that it is an easy matter for Russia to
suppress news. We have had a good example of
how we can make monkeys of ourselves with the
Vanguard mess yesterday and the day before.
We do not know how many times the Russians
fouled up before they put their satellites in the
air. They do not have to explain those things
to their people. Somebody decides, and that is it.
In this country, however, we have to persuade
people. We have to persuade them we are doing
the right thing. I heard Edward Benes, who,
you will remember, was the prewar premier of
Czechoslovakia, say in this country, during the
so-called cold war stage in 1939 and 1940, that
the Nazis destroyed Czechoslovakia by utilizing
those very things of which the Czechoslovakians
were proudest, those things based on the Ameri-
can constitution: the right to assemble, freedom
982
BLUE SHIELD
Volume XLIV
Number 9
to bear arms, freedom of speech; and by mis-
using them, they were able to destroy them. He
was not suggesting that those things should be
curtailed here or elsewhere. He was suggesting,
however, that with freedoms of that sort come
certain responsibilities to hold certain elements in
check.
We have the same situation here. T can not
conceive of the Metropolitan Life Insurance Com-
pany or, less still, of the Bankers Life & Casualty
Company calling a hundred or more doctors to-
gether to ask what they think about their policies.
The very fact that a meeting of this sort would
be held should indicate the interest of Blue Shield
and indicate the difficulties that Blue Shield has.
Any employer can go to Metropolitan today, or
Prudential, and tell them what he wants. Suppose
he has a company that has a thousand employees
he wants insured. He tells them what he wants,
and three days later they can give him a contract.
We found in the Medical Economics Committee
in negotiating with various companies for the
Health and Accident plans for the Florida Medi-
cal Association that when one is dealing with a
half million dollars, he can buy what he pleases.
You do not ask them for a contract; you tell
them what you want. That is about the premium
(half million dollars) that would be developed in
this Florida Medical Association Plan per an-
num, which is small potatoes compared to Blue
Shield.
So, when you deal with that kind of money,
you can buy what you want, except from Blue
Shield and Blue Cross. They walk into a com-
pany and say, “This is it. Take it or leave it.”
“Why?” the employers want to know. Because
this is what the doctors say we can sell, they are
told. The very makeup of Blue Shield makes it
difficult for it to meet the changing situations
which it has to face. Is that all wrong? Should
the doctor’s feelings be ignored just because the
commercial companies have no interest in them?
Should we change the whole setup to meet com-
petition? I think it should be changed some, to
make it possible for Blue Shield to meet some of
these situations, but not changed so much that
the doctors voices are stilled, or are not impor-
tant. Nor should it be changed so much that such
a meeting as this would no longer be necessary
or desirable.
Another problem which faces Blue Shield is
the divergent opinions among the doctors. I have
on my desk something like a hundred letters
which have come in the last month in response to
the questionnaire which we sent out. We run into
this sort of thing: “What is wrong with Blue
Shield is that it is paying too much; it is paying
for unnecessary things in the office. It has no
business paying for office cervical cauteries, office
warts, things of that sort. What I would like it to
do is have you pay more for the big things. It
has no business paying for little stuff.” Turn the
next page, and here is another one. “What is
wrong with Blue Shield is it does not pay for of-
fice care. You are loading up the hospital with
people who do not belong there simply because
doctors are admitting them to have diagnostic
work-ups.” All of such comments are made in
perfect sincerity and equally perfect ignorance.
A statement about the hospitals being loaded up
because of misuse of hospitalization insurance is
something which we suspect, and something that
is exceedingly hard to prove. I pick out the one
or two cases that I know about and draw gener-
alizations that everyone but me is loading up the
hospitals. This halo only has one size and it only
fits one head, and each of us suspects the other
fellow of being just a little bit crooked.
A fourth thing that I think is wrong is the
influence of the specialty groups. I do not know
to what we could attribute this. I do know that
since the war, at the state meeting, instead of all
going to the annual meeting of the Association,
many of us have started going on Saturday, go-
ing to our own specialty groups and heading out
for home. Instead of being physicians, we have
become surgeons, orthopods, pediatricians, anes-
thesiologists, obstetricians, and internists. We no
longer are members of the Florida Medical As-
sociation; we are members of our own specialty
groups, and, to say the least, we all have a fairly
narrow point of view when it is confined to that
particular group. I think it is absolutely essential
that once more we become physicians, that we
become greatly interested in the problems of
medicine, rather than the problems of surgery,
the problems of orthopedics, or the problems of
any specialty group. We must take an interest in
this thing in so far as it affects all of us, because
if one of us sinks, all of us sink. We have here
in this state a problem that is not confined to
Florida, the matter of adequate payment for med-
ical services. It is a problem which must be solv-
ed, because we cannot have any segment of the
J. Florida M.A.
March, 1958
BLUE SHIELD
983
medical profession which is not wholeheartedly
behind Blue Shield.
There is one other difficulty 1 would like to
mention, the rigidity of Blue Shield. There are
many things which apparently should be changed
which it cannot change. Some of its severest
critics are saying, “You should not pay for this,
you should not pay for that.” I know any one of
you could sit down here and in a few minutes
write out a formula for tube feeding that would
meet the necessary nutritional requirements, pro-
vide all the carbohydrate, all the protein, all the
vitamins, all the minerals, all the things that
would be absolutely necessary to keep a person
in the best of health, but who would want to eat
the stuff? You have to put it down with a tube,
or else nobody is going to eat it. I am sure that
given an hour or so, I could write out an insur-
ance policy which would be exactly what my pa-
tients would need, something which would suit
them well; but they are just like me in this re-
spect. They like to eat turkey dinner, too, and do
not want to be fed something that is good for
them but which does not taste good. I am sure
most of you drive automobiles with much unneces-
sary chrome and gingerbread on them. You buy
them, and pay twice what they are worth, because
of a stripe across the top or down the side, or a
button on this side of the steering wheel instead of
that side. There may be no difference in the auto-
motive construction of the automobile, but you
change your model because the hub caps look
different from last year’s model. Blue Shield has
to be competitive. It has to offer some things in its
contract which are really tomfoolishness, simply
because these people, who after all are the ones
who are going to decide just how good it is, are
going to have to buy it. They do not have to buy
it, actually; but if they are going to buy it, it
has to be desirable.
There are several alternatives which face us.
One of them is to maintain the status quo. As
Dr. Good has said, I hope that nobody elects that,
because I think it would be better to vote Blue
Shield out of existence than to let it die a death
of attrition. I have heard it said that if we lose
one big group, the Dade County Teachers’ As-
sociation, Blue Shield is going to be out of busi-
ness, because they are a preferred risk group.
Their low utilization rate enables Blue Shield to
sell many other policies to older or less desirable
people at a lower rate, one which they can afford,
than would otherwise be possible. If it loses the
several hundred, possibly thousand, members in
that group, then with the preferred risk people
gone, Blue Shield cannot afford to underwrite the
indigents. So the status quo is not a solution, it is
a conclusion.
The second thing that we can do is offer an
indemnity contract, completely indemnity. I am
not going to say anything more about that, be-
cause I think that Dr. Good and others have said
enough about it. I am convinced that the service
principle is important for two reasons. One is
that it shows we are interested and we are in-
terested enough that we will give, and the second
thing is that it makes us unique. We as doctors
and we as members of Blue Shield have an in-
terest and, I might add, a stake in the health and
the medical problems of the entire community
rather than in the preferred risks only. The old,
the indigent, and the poor risk are going to re-
ceive medical attention somehow, either through
insurance which they can afford, from us for
nothing, or from the government. If we go into
the strictly indemnity type contract, we have
nothing to offer which the commercial company
does not have.
Constructive Measures
I had made up my mind to say a little bit
about the things that I think should be done.
After listening to the talks of the last hour or so,
I am not so sure that I know all the answers.
There are several things, however, which have be-
come self evident to me in the past year and what
I have heard here today increases the strength of
my convictions:
1. The service income limits of Blue Shield
must be raised to a level high enough to attract
a sufficient number of middle income subscribers
to enable Blue Shield to underwrite the medical
indigents, the elderly, and the other poor risks
at a price they can afford to pay. Just what this
level will be will be determined by what is ac-
ceptable to the doctors of Florida.
2. The scope of services covered by Blue Shield
must be broadened to the extent that it is truly
a medical and surgical contract.
3. The fee schedule must be completely revised
so that certain gross inequities in the present
schedule are eliminated and so that fees commen-
surate with increased service limits are paid.
4. Some system for permitting Blue Shield to
change its contracts to meet changing conditions
must be devised. At the present time, this has to
984
BLUE SHIELD
Volume XLIV
Number 9
be presented at the annual meeting of the House
of Delegates, which makes the whole setup so
rigid and cumbersome that it neither serves the
best interests of the doctor nor of the subscriber.
One solution might be to do as they do in Massa-
chusetts where the Board of Governors of the
State Medical Association is empowered to au-
thorize changes in the Blue Shield contract. An-
other possible solution would be to permit the
Committee of Seventeen to approve such changes,
although I think the Board of Governors would
be better. Whoever it is should have the respect
and confidence of the entire Association and
should be conversant and interested in the prob-
lems of both Blue Shield and the medical pro-
fession.
5. A continuing campaign for the dissemina-
tion of information about Blue Shield and Blue
Cross problems is another must. If the same ef-
fort expended in the past 18 months by the Com-
mittee of Seventeen had been spent six, seven, or
eight years ago, I firmly believe that many of the
problems and much of the misunderstanding
about Blue Shield in the past several years would
never have arisen.
I do hope that you gentlemen will understand
that our interest in this matter has been in doing
to the best of our abilities a job that was given
to us by the Florida Medical Association, by you.
some 18 months ago. It has been the hardest job
that I have had to do in medicine during the
period of my membership in this Association. It
has been a headache in many respects, and un-
less something comes of it. unless we can get back
to the members of the society itself the informa-
tion which we have been able to distil out of what
we have learned, our time has been wasted. I
sincerely hope that what you have learned from
what has been said here today, you will take
back, and that as a result of the information
which we have been able to accumulate, come
next spring, we will be able to come up with a
solution that will be acceptable to the members
of the Association, which will be salable to the
public, and with which Blue Shield can live.
Blue Shield Annual Meeting
The annual meeting of Blue Shield will be
held Monday, May 12, in the Bal Masque
Room of the Hotel Americana, Bal Harbour,
Miami Beach. The session begins at 4:00 p.m.
Blue Shield Yesterday, Today and
Tomorrow
Jay C. Ketchum
DETROIT
Executive Vice President, Michigan Medical Service.
The development of medical prepayment
plans, Blue Shield Plans, from the very beginning
was built around the idea of freedom of choice.
I was pleased to hear Judge Willis, a member of
your Blue Shield Board of Directors, use the
term '‘freedom of choice” because it leads right
down to almost all that I have to say. More im-
portant than the freedom of the patient to choose
his own physician, and the freedom of the phy-
sician to participate in your Blue Shield Plan
and to accept or reject a particular case or patient,
is the freedom of choice exercised by the pro-
fession to accept or reject prepayment by Blue
Shield as a principle or policy. You made this
choice in Florida in January 1946, when you
established Blue Shield of Florida, Inc. In any
attempt to evaluate medicine’s position in relation
to prepayment, and to determine its course of
action for the future, it is logical to think back
and to consider the past: how and why you are
where you are and the choices you made which
brought you to this situation.
Dr. David B. Allman, the present president
of the American Medical Association, in an article
published in the Journal of the American Medi-
cal Association. Xov. 23, 1957. expressed this
point: that medicine did have, and had exercised
a choice in regard to Blue Shield. He wrote,
“Ideally, physicians believe in the provision of
medical service on a fee-for-service basis; a mar-
ket in which a multitude of individual purchasers
of medical care can choose freely and voluntarily
the physician they want. The free choice con-
cept is obviously not confined to medical care.
It is a basic concept of our American system.
Clarence Randall, in his book “The American
Way,” makes this explanation: ‘The outward
manifestation of the American system at work
is freedom of choice for the individual in every
activity of his life. The more that society can
contrive to leave him free to select the aims for
his life and the means of satisfying his own needs
as he conceives them to be needs, the more will-
ingly will he give of his best efforts in order that
those ends may be attained.’
“Under these circumstances,” Dr. Allman con-
tinued, “medicine operates in a competitive cli-
T. Florida M.A.
March, 1958
BLUE SHIELD
985
mate that fosters incentive, rewards ability, and
smothers mediocrity. But medicine has had to
yield, although its basic tenets remain. It yielded
to financing mechanisms that clearly restrict the
seller’s right to price his service, when it was
convinced that the only alternative was sub-
mission to less acceptable conditions. Physicians,
for example, in many areas developed and partici-
pated in Blue Shield Plans of the service type
. . . because they felt even less desirable third
party control would have ensued had the pro-
fession itself not sponsored prepayment service
type plans.
“From the beginning, the profession was split
on this question of sponsorship of service type
benefits. And today the controversy continues.
Many consider that physician-sponsored plans
must stress service or cease to exist, while others
condemn the approach as paving the way to con-
trol of medical practice by third parties. Even
among the service advocates intense controversy
exists in connection with the income level at
which the service benefits are to apply. Some
demand low income levels so as to assure a self-
contained, relatively limited, program, while
others maintain that the plan serves neither the
public nor the profession well unless the income
level is increased so that a reasonably large sec-
tion of the public can be covered. You are familiar
with most of these considerations. ... I mention
them only to emphasize the point that the phy-
sician has, by the pressure of events, come to
play a more important role in financing mech-
anisms than he ever conceived would have been
possible only a few years ago.”
Obviously, if Dr. Allman is right, and I think
he is, medicine, in sponsoring Blue Shield, chose
the lesser of two alternative evils. Also, obviously,
you are here to attend his meeting of your House
of Delegates tomorrow for the reason that you
now find yourselves, by the pressure of events,
again called upon to make a choice. While you
still have your freedom of choice, you are not
free from the necessity of making a choice, and
again, it may be only the best of poor alternatives.
Michigan’s Experience
The invitation to come here and speak to
you at this meeting was probably extended to me
because my state of Michigan has just gone
through and concluded what you are obviously
now starting: a re-examination, a whole fresh
look at your position in prepayment, particularly
your Blue Shield. There may be some consider-
able difference between my state of Michigan
and your state of Florida. I wish I could say
my state of Florida. I am sure that in this
matter of the economics of medicine and Blue
Shield, the differences are only of degree. The
nature of the problems and the pressures are
undoubtedly the same. In May 1956, I attended
the meeting of the Council of the Michigan State
Medical Society. I often attend these meetings to
report the progress and problems of Blue Shield
and to discuss such matters as our Home Town
Care Veterans Program and Medicare, which we
administer for the society in Michigan. Be-
cause of this close relationship, I feel almost as
though I were an employee of the state society, as
well as of our Blue Shield Plan. At any rate, at
this meeting in May, I expressed to the Council
considerable concern and doubt that I had been
feeling for some time in regard to the future
of the Michigan Medical Service, Blue Shield, as
well as Blue Shield Plans and Medicine’s atti-
tudes and positions throughout the country.
The Michigan society entered into Blue Shield
much as the rest of you did, as the lesser of two
evils. We got into it long before you did in Flor-
ida because the pressures were evident and were
felt much sooner and to a much greater degree
in Michigan. After some labor pains and some
digestive upsets during its early infancy, the
Plan began experiencing a surprising and, some-
times, terrifying growth. As far as size and en-
rolment, number of participating doctors, and
financial aspects are concerned, the Plan can be
considered successful.
It was this apparent success, however, which
gave me concern and some doubts. Our sub-
scriber contracts have always been limited as to
the scope of benefits. Although we provided, and
still do, medical, surgical and obstetric care for
almost all hospitalized illnesses, as well as cer-
tain specific procedures of surgery in the doctor’s
office, we have never gone into diagnostic services,
x-ray therapy, physiotherapy, the ancillaries nor
the auxiliaries of supplemental services, if 1 may
use those terms, to the basic medical services.
We enrolled nearly half the population of the
state of Michigan under these very limited con-
tracts. More and more as time passed, we be-
gan to hear requests. Unfortunately, in Michigan,
we often consider requests to be demands be-
cause of the nature of the organization of our
population in labor unions. These requests came
986
BLUE SHIELD
Volume XLIV
Number 9
from large labor organizations. They came from
industry itself; Ford, General Motors, Chrysler,
as well as numerous smaller concerns. The pro-
fession, too. had ideas about the expansion of
Blue Shield into areas which we had not previ-
ously covered — some difficult areas, from the ac-
tuaries. underwriters and managers point of view.
There were also, on the part of the profession,
particularly in different specialized groups, con-
stant complaints about the inequities in fees.
At any rate, the obvious success we had had in
a limited way seemed to indicate to our critics,
our public, and our profession that if we just
tried a little harder, cast aside some of our fears,
our doubts, and our inhibitions, we could prob-
ably do pretty well in covering this whole field
of medical service, and pay what they consider
more equitable, adequate fees.
Locally, labor, among others, was criticizing us
severely, and in about the way expressed by Dr.
Morris Brand, who is the Medical Advisor to the
UAW-CIO, and now to the combined AFL-CIO.
In the AFL-CIO News, in December 1956, Dr.
Brand stated that since the Congress has not
enacted legislation to set up a national health
insurance program, which most labor unions
favor, unions have had to find other sources of
health insurance coverage for their members,
mainly Blue Cross and Blue Shield and com-
mercial carriers. “Since home and office care
is rarely offered in these plans.” Dr. Brand con-
tinued. “some labor groups have established di-
rect service medical centers where services are
actually provided rather than indemnities to
cover part of the cost. The latter type of plan
has proven much more popular with members,
because there are no barriers to the service. Pre-
ventive services are usually included in the bene-
fits, and there are no hidden bills cropping up
after the services are rendered.” In general, he
thought, the extent to which commonly available
insurance programs meet the family’s health
needs is not too impressive to labor. He said
that idemnitv payments, a base upon which some
physicians too frequently add substantial charges,
are not a satisfactory method of paying for ser-
vices. Also, the emphasis on hospital and surgical
coverage, as in the case of most plans, without
substantial outpatient benefits, is frequently a
cause for unnecessary hospitalization. Further-
more, as a result of inadequate concern for op-
erating efficiency in hospitals and an unwilling-
ness to enforce legitimate controls, there are un-
justified premium increases.
According to Dr. Brand, these are labor’s
goals for better health plans: 1. Complete pre-
payment for medical care without co-insurance
and deductible features and hidden added costs.
2. Comprehensive benefits. Only if the range
of health services is complete, will the individual’s
health needs be effectively and economically met.
3. Rational organization of medical services on
the basis of group practice, and control of the
quality of medical services which must be built
into medical care plans. In April 1957, Walter
Reuther, the president of UAW, in his presidential
address to the convention, confirmed that as be-
ing labor’s position. In the meantime, Mr. Reuth-
er in Detroit had been proposing a laying of the
groundwork for the United Automobile Workers
Sponsored Program, Community Health Associa-
tion. This, as near as we have been able to de-
termine, and it is not off the ground yet, will
operate as a closed panel practice group, utilizing
salaried physicians, either full or part time, con-
tracting with hospitals for some facilities and
perhaps constructing some clinic facilities of their
own. While providing a comprehensive scope of
services, the diagnostic and preventive services
would be stressed.
The Council of the Michigan State Medical
Society, recognizing that prepayment was becom-
ing much more than had been contemplated in
1940. decided to engage in an all out effort to
educate its members to the facts of the situation
to help them reach a decision as to the future
of Blue Shield. This effort consisted of inform-
ing the profession of the problems and the al-
ternative possible actions, which might even in-
clude getting out of Blue Shield as you obviously
have considered in Florida. Beginning with the
special meeting of the House of Delegates in
April 1957, every practical means was utilized
to inform the profession. We used the Journal
of the Michigan State Medical Society every
month. The county society bulletins month after
month carried informative articles. Meetings were
held through county societies, councilor district
meetings were utilized, and the staffs of hospitals
were gathered together. Panels of society officials,
public relations people and Blue Shield personnel
traveled up and down the state to present in-
formation at these group meetings and to an-
swer questions. The delegates at this special meet-
ing of the Michigan House of Delegates in April
I. Florida M.A.
March, 195S
BLUE SHIELD
987
were asked to take no action at that time. They
were informed as completely as possible and be-
cause there was need for more information than
was then available, two surveys were authorized
at that meeting. The only real action that was
taken was an authorization to spend the money
to make a survey of the public's attitudes and
opinions toward prepayment in health insurance
and to survey the attitudes, opinions and desires
of the medical profession.
Surveys of Public and Professional Opinion
A report on the results of this survey is an
all day job in itself. The printed results from that
survey weigh A'/2 pounds in the original form,
in which they were produced by mimeograph. I
understand that in Philadelphia last week, bound
copies, in a reduced size, were distributed to all
the delegates of the American Medical Association
and other interested people at the meeting of its
House of Delegates. The only part that Blue
Shield had in that survey, on which the Michigan
State Medical Society spent $20,500, was paying
for the binding and printing of this reduced size
copy which was distributed at Philadelphia. This
was the Michigan society’s survey, including
60,000 responses from the public and 1,200
scientifically selected personal interviews.
A total of 60,000 responses were received
from questionnaires printed in two of the largest
leading newspapers in Michigan. The society also
received about 20,000 responses to questionnaires
mailed, on some sort of a scientifically selected
basis, to people throughout the state, with the
numbers in each area being selected in proportion
to the population. The survey of the profession
resulted in a 35 per cent response from the indi-
viduals, physicians, county societies, and specialty
groups. During this time, however, the House of
Delegates had appointed a special study com-
mittee, and we went you one better; it had 18
rather than 17 members. The council also ap-
pointed a special study committee; as I recall,
there were nine members appointed by the chair-
man of the Council. The two committees were
to do exactly the same job independently of each
other, coming back to the regular meeting of the
House of Delegates, which was held in September
at Grand Rapids, to make a report of their find-
ings and recommendations to the House of Dele-
gates. Results of the public opinion and doctors
survey were related to the findings and recommen-
dations of both committees, and it was startling
to see the similarity in the findings of these two
independent committees. The program of rec-
ommendations, drawn up by these two committees,
one in rather general terms and one in rather
detailed specific terms, was supported right down
the line by the findings of the surveys. As a
consequence, after hearings by a reference com-
mittee of the House of Delegates, which in total
lasted something like 18 hours, and went on two
nights until after 2 a.m., with all having a
chance to express themselves, the House of Dele-
gates on the third day, unanimously, without
one dissenting vote, approved a whole new pro-
gram for Michigan Medical Service.
New Michigan Program
That program gave approval, for the pur-
pose of establishing fee schedules by Blue Shield,
for the use of the California Relative Value
Scale of surgical, medical and related procedures,
with the Michigan State Medical Society setting
the dollar factors to be used in connection with
that Relative Value Scale for the purposes of our
subscriber contracts. I could spend some time, I
think, expressing my idea of the value of the
Relative Value Scale to be developed by state
societies in this area of prepayment, as well as in
the area of Medicare and other programs with
which you are ultimately going to be forced to
cooperate in the provision of medical services for
the people.
Perhaps the most advanced step, after adopt-
ing this program which includes service benefits
for people earning up to $7,500 annually, was the
basing of income limits upon the base wage or
salary rate of the subscriber. This $7,500 is not
family but individual income; and he may earn
or receive twice as much income, or 10 times as
much income from investments, from other mem-
bers of his family, and from other sources. What-
ever his base wage rate is, not including over-
time or bonuses, will determine his income status
for the purposes of Blue Shield contracts. There
will be three income levels, one $2,500 income,
one $5,000, and one $7,500. One at $10,000 was
almost adopted because the doctors in Michigan,
after studying this problem for months, have de-
cided that even the $30,000 a year executive,
these days, if he is stricken with severe illness
or injury, is only three months away from bank-
ruptcy. This may be hard for doctors to under-
stand. The $30,000 a year executives would have
to sell their yachts to pay doctors’ and hospital
988
BLUE SHIELD
Volume XUV
Number 9
bills, and 1 mean that literally. We live it up
just as fast as the little guy who earns only
$4,000 or $5,000, and we would be in just as
tight a pickle if we were stricken as he would
be — primarily because Uncle Sam takes most of
it before we get it.
The Michigan State Medical Society made a
great advance in the establishment first of a
State Society Health Insurance Committee, and
under that committee, in councilor districts, health
insurance committees to operate at the local com-
munity level for the purpose of arriving at, pro-
mulgating, enforcing and administering rules and
regulations for the conduct of prepayment health
insurance— not just Blue Shield, but commercial
as well. These were not advisory committees
that they were talking about; they used the
term, policing committees, to see that the plan
worked as it was intended to work for the pub-
lic and for the doctors. Unfortunately, the time
1 have been alloted here could all be spent on
talking about the necessity for such committees
if these programs are going to work as the public
has a right to expect them to work. I am not
implying that doctors are dishonest, or at least
any more so than any other group of citizens,
but policing is necessary whether we have the
substance or not so that we can satisfy our op-
ponents in this field of health care that every-
thing is being done that needs to be done to as-
sure proper operation.
Years ago, I was the Chief Examiner for the
Insurance Department of Michigan, where we
employed young men, just out of college. These
young men, other than their college experience,
had traveled little; at least they had not traveled
on expense accounts as they were then. They were
not generous expense accounts, but there was
enough so that if a fellow were inclined in the eve-
ning, he could go out on the town and have a
pretty good time. We had to impress on these
young men that in this position as public servants,
particularly dealing with financial institutions,
some of them of doubtful character, we, as exam-
iners, could not afford to be seen out on the town.
They used to express it this way for these young
men, ‘you not only have to be honest, you have to
look honest!’ That is what I mean by the sub-
stance of these regulatory committees as well as
the form.
The medical profession throughout the whole
country is more or less going through this same
process that Michigan went through, and that
you are now going through in Florida. The need
for consideration and action is evidenced by
many, many groups of our public, and you must
consider these public attitudes. This Community
Health Association proposal in Michigan which
will amount to a closed panel practice scheme,
is not just our problem in Michigan. We have
UAW labor groups in every one of the 48 states
in the Union. I do not know how many sub-
scribers Blue Shield of Florida and Blue Cross of
Florida cover for General Motors, Ford and
Chrysler, but I would gamble that there are
groups covered by your local Plans for at least
two of these corporations, and probably number-
ing in the hundreds. Mr. Reuther is not going
to be satisfied to organize and operate this Com-
munity Health Association just in the state of
Michigan. If he were satisfied, he could not get
away with it anyway, because what he does for
his labor people in Michigan, he is going to have
to do for all of them, wherever they are.
Mr. Reuther is not foolish; he is one of the
smartest persons I know. He knows that he is
not going to have a plan operating covering six
or seven million people across the nation by
tomorrow. He is going to operate this proposal as
a pilot study for some time, and find out what the
problems are, and how susceptible the profession
is to working on salaries for unions. We do not
expect Community Health Association to amount
to anything for five or six or seven years, even in
Michigan, as far as size and volume are concern-
ed. Nevertheless, it is a threat that you must
consider when you make your decisions because
after he makes his pilot study and finds out what
his problems are, then you can look for expansion
and not just by Reuther, but almost all of labor,
if it works. Whether it works will depend upon
Medicine and hospitals.
Care of the Aged
Some of these unfilled needs in Blue Shield
which are expressed to us have to do with special
categories of people. One of the great and one of
the most immediate problems that medicine and
prepayment must deal with is the care of the
aged or elder citizens, the retirees. Unfortunately,
in our economic climate, this is a growing prob-
lem. It is a growing problem, also, in that the
expectancy of these people has been extended.
Their lifetime has been extended by you gentle-
men and by hospitals. Two years ago, there were
14 million of these people who were over 65 in
J. Florida M.A.
March, 1958
BLUE SHIELD
989
this country. Today there are around 16^2 mil-
lion. Two years from now, no one knows what
the number will be.
These people so far have been unable to obtain
for themselves health insurance coverage from the
Blue Cross and Blue Shield Plans, to any great
extent, and definitely not from the commercial
insurance companies, or any other source. They
are becoming a vocal, highly organized group of
voters. We hold conferences on the aged two or
three times a year in our universities in Michi-
gan, and such conferences are going on all over
the country. These elderly citizens are finding
spokesmen, and they are employing spokesmen.
They are paying lobbyists, and they are going to
have health insurance coverage, one way or the
other. There are in the Congress now, pending
hearings, the Forancl Bill and the Roberts Bill.
The Roberts Bill provides hospitalization cover-
age for beneficiaries under OASI. The P'orand
Bill provides hospitalization and surgical care
for the beneficiaries- under the OASI. So, with
our Social Security taxes, we will be paying, if
such legislation should come about, for the care
of these older people. This is what you term
socialized medicine if it comes about, and it will
come about, unless something more than a posi-
tion of opposition is taken by Medicine and pre-
payment insurance.
I happen to be on the Government Relations
Committee of the Blue Shield Commission. There
are only three of us that deal with legislation in
Washington on a national level as a committee.
I am also on the American Medical Association
Study Committee on Prepayment Medical Care
Plans, one of the two laymen who got caught in
that one. As a member of these groups, I have
to study these bills, and on many matters such
as Medicare, I have had to testify at hearings in
Washington. Although the American Medical
i\ssociation and Blue Shield Executive Committee
in Philadelphia, last week, came up with a state-
ment opposing the Forand Bill, I would hate to
be the fellow who has to go to Washington and
try to convince the legislative hearing committee
that this is not needed, that the answer is avail-
able through voluntary means. We could have
an answer to it if we were able to control prepay-
ment as some of us think we should be able to,
and probably would be able to do if the medical
profession understood the problem that is involved
here.
Until recently, not much has been done about
these people who are not employed in groups:
the individuals, the farmers, the self-employed.
We in Michigan Blue Shield have been doing
something; we have been feeling our way in it.
Much more is going to have to be done, because
some of these people are organized in groups,
speak with a loud voice, and hire lobbyists.
In a few words, we are convinced that every-
one must have the opportunity to obtain good
health insurance coverage at reasonable cost, if
we are to retain the freedoms in medical care
which are now left to us. The medical profession,
having created Blue Shield and having encouraged
the public to depend upon the voluntary insurance
mechanism as the answer to the problems of
financing health care, is now held responsible for
the conduct and the results of prepayment on
a voluntary basis. This is understandable and
is logical, but having taken this position and
held it out as your idea and your alternative,
you are now held responsible for making it work.
Repeating part of Dr. Brand’s statement, ‘‘also
as a result of inadequate concern for operating
efficiency in hospitals and an unwillingness to en-
force legitimate control there are unjustified
premium increases.” Not only representatives of
labor, industry and government, but medicine
itself is becoming concerned.
The Wisconsin Physicians Service, Blue Shield
in Wisconsin, which is actually the state society
itself in Wisconsin, and not a separate corpora-
tion, recently in its own state journal said this:
“For while most people will have implicit confi-
dence in a health insurance program approved by
the medical profession, there is also, always the
possibility that some may think that the doctor’s
plan is designed primarily to benefit the doctor,
rather than the subscriber. Subscribers to Blue
Shield and the insured of insurance companies
expect to pay reasonable rates for the benefits
supported by their policies, but if they are also
to be called upon to pay for unnecessary hospital-
ization, unnecessary procedures and inefficiency,
they will consider the rates unreasonable. And if
because they have followed the advice of the
medical profession and simply because they have
insurance, a physician’s charges are increased,
they will consider the whole proposition unfair.”
This is especially true when the Blue Shield
subscriber of a service plan is charged fees over
and above those established by the physicians
themselves.
990
BLUE SHIELD
Volume XLIV
Number 9
There are men among you, as there are among
every group of this type before which I am asked
to speak, who take for granted the benefits of
Blue Shield and insurance, who regard it as a
collection agency for them, and who do nothing
to further its cause, who quarrel about its limita-
tions, and even question the need for its existence.
These men have a perfect right to their opinions,
and their attitudes. In our society, thank the
Lord, an individual citizen has a perfect right
to be dead wrong. Dr. Elmer Hess, the immediate
past president of the American Medical Associa-
tion, at Seattle last November a year ago, said.
“Today's professional freedom to be a private
practitioner of medicine instead of a slave of
government is due solely to Blue Shield, the
physician’s answer to socialized medicine." I)r.
Hess continued, “Since we have accepted the in-
surance principle, many patients who previously
would be non-paying patients have had their bills
at least partially paid. I am rather intolerant of
the physician who is not a participating physician
in Blue Shield, who in the defense of his attitude,
says with a loud voice, ‘nobody is going to tell me
what to charge.’ ”
Indemnity Insurance
In addition to Blue Shield and Blue Cross,
the profession has endorsed and relied upon in-
demnity insurance as at least a part of its answer
in financing health care. There are as many, if
not more, of our people in the country who have
purchased indemnity health insurance as have
purchased Blue Cross and Blue Shield. There
are no overwhelming reasons why indemnity
insurance could not adequately serve the medi-
cal profession as part of its answer in this field.
The unfortunate fact is that in the main, it does
not serve medicine, and unless some drastic re-
visions in viewpoints and practices are brought
about, it probably never will. Practices in under-
writing indemnity insurance could become one of
your greatest problems, and this is so for two ob-
vious reasons. (I wish to make it clear that I am
not criticizing the insurance industry. These prac-
tices are inherent in the business of insurance and
could be modified only by a complete understand-
ing and a co-operation between medicine and in-
surance. I am only talking about what exists and
1 do not contend that insurance is dishonorable or
conducts itself improperly.)
First, the profit motive, which is the primary
reason for investors or members of insurance
companies, tends in health insurance, as in all
other lines of insurance, to eliminate the poor or
substandard risks from acceptance by the carrier.
In competing among themselves, as well as with
Blue Cross and Blue Shield Plans, the insurance
companies have employed a standard practice of
insurance underwriting, what is termed experience
rating or merit rating, by which rates of members
of a particular group are based on that group’s
own utilization of benefits, its own experience.
There is considerable doubt that there is really
any distinction between individuals as health
risks, regardless of in what group they may be
employed. There may be some differentials, jus-
tified for expense factors, having to do with bill-
ing and collecting, accounting, and so on. There
are a number of different applications of the
experience rating or merit rating principle, but
the results over-all are identical. Reduction in
rates, the cost of insurance, which gives advan-
tage to the preferred or so-called “cream risk” can
have had only the effect of increasing the cost
compared to the total average to the poorer class
of risks. The ultimate end of this practice can be
rates for insurance that are priced so high that
most people will not carry insurance. When the
price of insurance is too high for some people and
we have many people not carrying it, they will
clamor for relief, and the only place they clamor
is to their legislators. There is still a Wagner-
Murray-Dingell Bill in the Congress.
Second, the failure of insurance to answer
socioeconomic problems involving most of our
population has been demonstrated in other lines
of insurance. An example, and not the only one,
is Workmen’s Compensation Insurance, where the
unwillingness of insurance carriers to expose their
funds to substandard or high risk classifications
has brought about in many states the establish-
ment of monopolistic compensation funds oper-
ated by the state. Other examples are assigned
risk pools, which, by law, require the participation
of unwilling insurance carriers to provide cover-
age for poor risks, the state regulation of rates,
and even in many states regulations of charges by
physicians for services in compensation injury
cases.
In no other field of insurance are so many of
our individual citizens affected as in health in-
surance. Every citizen is concerned with the cost
of health. Even Harlow C. Curtice, the president
of General Motors, complained that when his
wife was stricken with an abdominal difficulty, he
was charged $900 for a rather serious and difficult
operation. One man, H. C. Curtice, can affect
J. Florida M.A.
Si arch, 1958
BLUE SHIELD
991
medicine’s public relations in the same way as
Walter Reuther or George Meaney or other labor
leaders. Probably no one man controls as many
dollars of Blue Cross and Blue Shield subscriber
dues as does Harlow C. Curtice. If he wants to
speak in opposition to Blue Cross and Blue Shield
in favor of some other method of providing health
care for the employees of General Motors and
their families, which add up to almost a million
people, we may lose General Motors next year in
the bargaining between General Motors and the
union. If so, we will also lose Ford, Chrysler and
700 other corporations in the state of Michigan
that are now enrolled in Blue Cross and Blue
Shield.
As General Motors, Ford or Chrysler goes,
so goes United Automobile workers. We will lose
them not only in Michigan, where they comprise
about 3 million of our population in the state and
about one half of the 3.6 million people who are
enrolled in the Blue Cross and Blue Shield in
Michigan, we will also lose them in Florida, Cali-
fornia and Washington, and every other state in
the Union. A pattern will be set, and that pat-
tern will spill over into the other industries, steel,
coal and the rest of them. Blue Shield in Michi-
gan will probably shortly thereafter, and I do not
mean a couple of months, be out of business if we
lose those groups. And we will lose them because
we have failed to do what the public thinks must
be done in this field, or because the commercial
insurance companies will cut the rates for these
cream risks, which up until now, we have been
able to sell on the principle of community rating.
- — the same rate for everyone for the same
contract.
We have attempted to find answers for the
aged people. In Michigan. Blue Shield is carry-
ing all the retirees in all of the groups which have
formal retirement programs. On the average,
these people cost us about four and one-half
times more in benefits or utilization than the peo-
ple in the lower ages. To make up this four and
one-half times, we have to charge the younger
people in these groups enough to carry the old
people in the over-all average. If commercial in-
surance companies are going to fail to cover these
older people, and are going to give lower rates
to our groups because they do not cover them,
we are going to have to quit because we will then
have failed to do the job which we set out to do
and that was to make good health insurance avail-
able to all of the people who want to buy it. The
service benefit principle in Blue Shield has often
and still does decide the buyer in favor of Blue
Shield in competition with indemnity insurance.
Other Threats to Blue Shield and Blue Cross
In the last few years, in order to find some
means of competing with Blue Shield and Blue
Cross, the commercial companies have developed
a completely new idea, which they call Major
Medical Insurance Coverage. It has considerable
appeal and has considerable merit as it was orig-
inally intended as a supplement to good basic
health insurance, such as Blue Cross and Blue
Shield — particularly for those people who might
be called upon, as was Harlow Curtice, to pay
bills that are considerably above the average.
In order to defeat the competitive advantage of
service benefits, however, these commercial in-
surance companies have now reduced the deduc-
tibles and co-insurance features which were of
considerable amount in their original package.
They are down to such low amounts, that they are
now practically providing basic coverage. Today,
we are seeing Major Medical Insurance, with as
low as $25 deductibles, sold in aggregate cover-
age amounts of up to $25,000. It has a terrific
appeal and it is going to cut into Blue Cross and
Blue Shield, unless we can broaden the scope
of our benefits to provide for the very expensive
and unusual and the long stay cases in hospitals.
The big danger in Major Medical, because of
its unlimited allocation of large aggregate sums
for medical and hospital services, is in the lack
of control over charges made by the physicians
and the hospitals to these assureds. It is not
that the physicians are going to make exorbitant
charges, although there is considerable documen-
tation of some of that. It is easy to spot the
exorbitant charge and deal with it, such as the
$3,500 that was charged the $5,000 a year em-
ployee of Ford, in Los Angeles, for a gallbladder
operation. The Aetna Insurance Company, which
carries that risk, went to the local county media-
tion committee and got an adjustment on it.
It is not that that bothers us. It is the very
gradual, almost unconscious increase in all phases
which does nothing but increase the cost of medi-
cal care out of proportion to other increases so
that eventually the cost of health care becomes
such that only a few people can afford it, and
the others will call upon the government to pro-
vide what they think they need. I am not going
into detail about the many other threats — we
992
BLUE SHIELD
Volume XLIV
N UMBER 9
consider them threats — such as the closed panel
practice groups, Health Insurance Plan of New
York, Kaiser Permanente and Ross Loos type
of coverage. These are almost all closed panel
practice groups and some of them on the prepay-
ment principle, such as Health Insurance Plan of
New York City and Permanente in California.
They all have varying arrangements on paying
physicians on a salary or per capitation basis and
they limit the choice of physician. Some of these
are showing healthy growth and a degree of
acceptance by members of the profession which
is alarming, in that these physicians seem to
prefer the security of salaries to the competitive
practice of medicine.
There are plenty of examples of government
intervention into the field of paying for the health
care of citizens, and the most recent example, of
course, as you can understand without detailed
description of it, is Medicare. While we are on
this question of Medicare, because it is a con-
troversial one in Medicine, I do not think that
there is over one physician in a thousand in this
country who knows how you got where you are
in Medicare. It is easy to sit back and criticize
the fact that this is a service program in which
you are obliged to accept the fees if you treat
these people, these assumed wards of government.
I would like to state I was one of the three people
representing organized medicine in the conferences
and discussions and battles in Washington on the
Medicare Bill. This came about, not as a result
of the introduction of a bill in the last session of
the Congress; it came about as a result of six
years of hard work by many doctors of the Ameri-
can Medical Association. It was not a question
of whether we were going to build more govern-
ment hospitals and draft more doctors into the
armed services to take care of these dependents,
because they were going to be taken care of. We
did not get everything we wanted in the Medi-
care Bill. We got the best possible compromise,
however, and Medicine right now. by ill-consider-
ed action, can wreck the best deal that you could
possibly have gotten as regards the dependents
of these service men, by denying them service
benefits under Medicare. The only possible alter-
native to that will be the government back in the
construction of hospitals and the drafting of
doctors. It did not happen overnight; it took six
years to get to this point. I am convinced that
only about one doctor in a thousand knew that
you just made the best deal you could make and
that the alternative was much worse.
Medicine’s Weaknesses
Perhaps the greatest help I could be to the
Florida Medical Association would be to point
out what I consider your greatest weakness in
this field of health economics. The first point in
this description of vour weakness would be the
complacency with which most doctors view the
situation — the expressed “go away and leave
me alone” attitude. I believe that Medicine is just
not equipped, up to this point, to deal adequately
with its problems in the financing, or the eco-
nomics, of health care. Most doctors, because of
complacency or lack of time to devote to the
economic side of medicine, do not possess the
knowledge necessary to evaluate the case. Medi-
cine has not the means of communication neces-
sary to provide the necessary intelligence to its
membership, and if it had, it still does not have
the discipline or the cohesion within its ranks to
present a united front or to take the united ac-
tion necessary if its policies are to prevail. Medi-
cine individually and collectively must acquire
the knowledge and the intelligence in this vital
area, consider its position, make decisions and
act. This is a large order, time-consuming and
often frustrating. If the job is to be done, Medi-
cine must be prepared to delegate to its able and
available members not only the responsibility, but
as well, the authority, and it must have discipline
within itself.
If the voluntary method is to be your answer,
as you contend it is, you have the responsibility
•to see that it works, and if Blue Shield is not
yours, you must see that it is made so. If it is
not what you want it to be. you must change it.
If you are convinced that Medicine needs Blue
Shield, support it. If you are convinced it does
not need it, kill it now because any further
promise to the public on which you fail to de-
liver will cost you more than no promise at all.
It is impossible for any plan to satisfy all the
varied and sometimes opposed views and interests
of all the specialties and the branch societies in
Medicine. There is only one banner about which
all doctors can rally. It must consider all the
varied interests, evaluate all the special prob-
lems, compromise, agree and decide, direct and
support united action on behalf of all the profes-
sion. Dr. Austin Smith, editor of the Journal of the
American Medical Association, in Lansing, Mich.,
just a few months ago pleaded with the doctors
to join hands in a united effort, a united front
to prevent the catastrophy that has overwhelmed
J. Florida M.A.
March, 1958
993
EFFECTIVE, DEPENDABLE THERAPY FOR VAGINITIS
Floraquin® eliminates
trichomonal and mycotic infection;
restores normal vaginal acidity
Leukorrhea is by far the most frequent symp-
tom of vaginitis; trichomonads and monilia are
the most common causes. Many authors have
reported2 trichomonal protozoa in the vagina
of 25 per cent of obstetric and gynecologic
patients. Increased use of broad spectrum
antibiotics has resulted in a sharp rise in the
incidence of monilial infections.
Floraquin effectively eradicates both tricho-
monal and monilial vaginal infections through
the action of its Diodoquin® content. Floraquin
also furnishes boric acid and sugar to restore
the normal vaginal acidity which inhibits patho-
gens and favors the growth of protective Doder-
lein bacilli.
Pitt1 recommends vaginal insufflation of
Floraquin powder daily for three to five days,
followed by acid douches and the daily inser-
tion of Floraquin vaginal tablets throughout one
or two menstrual cycles. G. D. Searle & Co.,
Chicago 80, Illinois. Research in the Service of
Medicine.
1. Pitt, M. B.: Leukorrhea. Causes and Management, J. M.
A. Alabama 25: 182 (Feb.) 1956.
2. Parker, R. T.; Jones, C. P., and Thomas, W. L.: Pruritus
Vulvae, North Carolina M. J. 16: 570 (Dec.) 1955.
s
994
Volume XL1V
Number 9
the profession in almost every other country in
the world. I mentioned earlier that Blue Shield
was built around the principles of freedom of
choice and I do not mean by that that I believe
your choice is unrestricted. I believe the choice
in this case does not include the privilege of
ignoring the pressures upon you. You will decide
between just two alternatives: (1) Let others ad-
vance and impose upon you their proposals,
which will probably be abhorrent to you, or (2)
make Blue Shield an adequate, functioning, reli-
able program, providing for the cost of health
care under your sponsorship and control, where
I am certain control must be.
INSTRUMENT REPAIR
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Microscopes, pHmeters, balances,
colorimeters, microtomes, etc.
Factory authorized repairs for
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OPPORTUNITY
The Daniel Rehabilitation Institute of Florida
has a fully developed Physical Therapy Service and
Department that needs the services of an M.D.
interested in this type of work; also for prescription
of surgical supplies, orthopedic shoes, artificial limbs
and braces that the Institute sells and produces.
A fully equipped Physical Therapy Dept.; Doc-
tor’s office and examining room are available for
lease. Equipment on rental or rental purchase plan.
Therapist, a member of American Physical Therapists
Assn, and Florida Chapter, would continue to work
for M.D. if desired.
Write, phone or call in person for further partic-
ulars.
Daniel Rehabilitation Institute of Florida
2120 W. Broward Blvd.
Fort Lauderdale, Fla. Phone Jackson 3-1686
STATE NEWS ITEMS
The Florida Society of Dermatology has
scheduled its annual meeting for April 19-20 in
the Balmoral Hotel, Bal Harbour on Miami
Beach, according to announcement by Dr. Ken-
neth J. Weiler, of St. Petersburg, secretary of the
Society. The Southeastern Dermatological As-
sociation is also meeting in the Balmoral Hotel
at the same time. The Florida Society of Derma-
tology was formerly the Florida Society of Der-
matology and Syphilology.
The annual meeting of the Gulf Coast Clinical
Society will be held in Pensacola, Thursday and
Friday, October 23-24, 1958. Dr. Lee Sharp, of
Pensacola, is president, and Dr. John J. Baehr
Jr., also of Pensacola is secretary-treasurer.
Dr. Peter F. Ragan III has been appointed
Chairman of the Department of Psychiatry at
the College of Medicine of the University of
Florida in Gainesville. Dr. Ragan formerly
served as Assistant Professor of Psychiatry at
Cornell University Medical College and Assistant
Attending Psychiatrist at New York Hospital.
Dr. Louis M. Orr of Orlando, who is serving
as vice speaker of the House of Delegates of the
American Medical Association, will be featured
speaker at the fourth annual Senior Day Program
on April 21 in Louisville, Ky. The event is spon-
sored by the University of Louisville School of
Medicine, the Kentucky State Medical Associa-
tion and the Jefferson County Medical Society.
The Tenth Annual Scientific Assembly of the
American Academy of General Practice is being
held March 24-27 in the Memorial Auditorium
at Dallas, Texas. The program features 35
prominent physicians as speakers, 90 scientific
and 300 technical exhibits.
Dr. DeWitt C. Daughtry of Miami, president
of the Florida Tuberculosis and Health Associa-
tion, has announced the availability of a limited
number of grants for medical research in tuber-
culosis and related fields. Grants are open to
personnel attached to an approved hospital, medi-
cal center or university. Applications should be
submitted to the Chairman, Medical and Social
Research Committee, Florida Tuberculosis and
Health Association, P. O. Box 4785, Jacksonville.
I. Florida M.A.
IMarch, 1958
995
Drs. Henry J. Babers Jr. and J. Maxey Dell
Jr. of Gainesville participated in the symposium
which was part of a Cancer Institute sponsored
recently for nurses at the J. Hillis Miller Health
Center in Gainesville.
A review course in Surgical Pathology princi-
pally designed for physicians preparing for ex-
amination by the American Board of Surgery
will be offered at the Baptist Memorial Hospital
in Jacksonville beginning April 2. The course
will be conducted by Drs. Alvan G. Foraker and
Curtis M. Phillips of Jacksonville. Interested phy-
sicians are requested to contact Dr. Foraker,
Baptist Memorial Hospital, Jacksonville, for in-
formation.
Dr. Henry G. Morton of Sarasota has been
named Doctor of the Year by the Sarasota Coun-
ty Medical Society. He is president of the Florida
Chapter of the American Academy of Pediatrics
and has been practicing in Sarasota for about 15
years.
Dr. Thomas H. Lipscomb of Jacksonville has
been appointed chairman of the State Air Pol-
lution Control Commission.
The Third International Congress of Allergy
is being held in Paris, France, October 19-26,
1958. It is sponsored by the International Associ-
ation of Allergollogy and the French Allergy As-
sociation. For information regarding the program,
physicians are requested to contact Dr. Samuel
M. Feinberg, 303 East Chicago Ave., Chicago, 111.
The Fourth Annual Surgery, Radiology, Path-
ology Symposium sponsored by the Division of
Postgraduate Medicine of the University of Okla-
homa Medical Center has been scheduled for
March 14-15. Information is available from the
Division of Postgraduate Education, University
of Oklahoma School of Medicine, Oklahoma City,
Okla.
Dr. James C. Rinaman of St. Cloud was prin-
cipal speaker at a recent meeting of the Parent-
Teachers’ Association there. His topic was “School
and Health Examinations.”
The Fourteenth Congress of the American
College of Allergists and the Graduate Instruc-
tional Course in Allergy will be held in Atlantic
City, N. J., April 20-25. The headquarters hotel
is the Shelburne.
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996
Dr. Purdue L. Gould of Lakeland discussed
“Diagnosis and Care of Brain Tumors” at the
January meeting of members of District No. 12,
Florida Nurses Association, held at Morrell Mem-
orial Hospital in Lakeland.
Dr. Millard B. White of Sarasota was prin-
cipal speaker at a recent meeting of the Venice-
Nokomis Rotary Club.
Dr. John J. Farrell of Miami served as a mem-
ber of the panel which discussed the complications
of abdominal surgery at the recent sectional meet-
ing of the American College of Surgeons held at
Jackson, Miss.
Dr. George W. Karelas of Newberry discussed
“Some Problems Pertaining to Older People” at a
recent meeting of the Division of Books at the
Twentieth Century Club held in Gainesville.
The Sixth Annual Interim Scientific Meeting
of Phi Lambda Kappa medical fraternity will be
held at the Deauville Hotel, Miami Beach. April
13-20. The program, arranged primarily for the
general practitioner, features papers and symposia
Volume XLIV
Number 9
by specialists in their fields. Advance registration
is being handled by Dr. Samuel L. Lemel, 1030
Euclid Ave., Cleveland IS, Ohio.
The Thirty-Sixth Annual Scientific and Clini-
cal Session of the American Congress of Physical
Medicine and Rehabilitation will be held August
24-29 at the Bellevue Stratford Hotel, Philadel-
phia. Information may be obtained from Miss
Dorothea C. Augustin, executive secretary of the
Congress, 30 North Michigan Ave., Chicago 2,
111.
Dr. Leonard G. Rowntree of Miami Beach
has been awarded the honorary degree of Doctor
of Letters by the University of Miami for his
“great contributions to the progress of medicine
and his significant role in the founding of the
University of Miami School of Medicine.”
Dr. William C. Roberts of Panama City,
President of the Florida Medical Association, was
among the group of citizens of that city honored
recently by the First Friday Club of the Cham-
ber of Commerce.
150,000
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HYFRECATOR
A HYFRECATOR in every offioe • Many physicians now have
hyfrecators in every examining and treatment room to save time
and inconvenience for their patients. This time-proven method for the
removal of moles, warts and other growths is used so frequently in the
average practice, it’s impractical not to have several hyfrecators !
Dermatology • General Practice
Gynecology • Urology • Proctology
Ophthalmology • E.E.N.T.
Physicians in virtually every
field find the HYFRECATOR
an invaluable instrument.
FREE 32-PAGE BOOKLET SYMPOSIUM
ON ELECTRO-DESICCATION AND BI-
active COAGULATION and full color
booklet with color progress pho-
tographs of technics and results
sent on request without obligation.
THE
BIRTCHER
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THE BIRTCHER CORPORATION
Dept. FM 358
4371 Valley Blvd., Los Angeles 32, Calif.
Send me the 2 booklets on hyfrecation
Dr —
Address
City Zone State
J. Florida M.A.
March, 1958
997
TRIC &fuRO N
VAGINAL SUPPOSITORIES AND POWDER
85% CLINICAL CURES*
In 219 patients with either trichomonal
vaginitis, monilial vaginitis or both,
clinical cures were secured in 187.
71% CULTURAL CURES*
157 patients showed negative culture
tests at 3 months follow-up examinations.
Patients reported rapid relief of burning
and itching, often within 24 hours.
STEP 1 Office administration of
Tricofuron Vaginal Powder improved
at least once weekly.
STEP 2 Home use of
Tricofuron Vaginal Suppositories improved J
by the patient, 1 or 2 daily, including
the important menstrual days.
*Combined results of 12 independent clinical
investigators. Data available on request.
suppositories:
0.375% Micofur, 0.25% Furoxone.
powder ;
0.5% Micofur, 0.1% Furoxone.
EATON LABORATORIES, NORWICH, NEW YORK
a new era
in sulfa therapy
■ ULFAMETHOXYPYRIDAZINE ( 3-S U LFANIL AMIDO-8 M ETHOX YPY RIDAZIN E ) LEOERLE
New authoritative studies prove that Kynex dosage can be reduced even
further than that recommended earlier.1 Now, clinical evidence has established
that a single (0.5 Gm.) tablet maintains therapeutic blood levels extending
beyond 24 hours. Still more proof that Kynex stands alone in sulfa per-
formance—
• Lowest Oral Dose In Sulfa History— 0.5 Gm. (1 tablet) daily in the usual
patient for maintenance of therapeutic blood levels
• Higher Solubility— effective blood concentrations within an hour or two
• Effective Antibacterial Range— exceptional effectiveness in urinary tract
infections
• Convenience— the low dose of 0.5 Gm. (1 tablet) per day offers optimum
convenience and acceptance to patients
hew dosage. The recommended adult dose is 1 Gm. (2 tablets or 4 teaspoon-
fuls of syrup) the first day, followed by 0.5 Gm. ( 1 tablet or 2 teaspoonfuls of
syrup) every day thereafter, or 1 Gm. every other day for mild to moderate
infections. In severe infections where prompt, high blood levels are indicated,
the initial dose should be 2 Gm. followed by 0.5 Gm. every 24 hours. Dosage
in children, according to weight; i.e., a 40 lb. child should receive 14 of the
adult dosage. It is recommended that these dosages not be exceeded.
tablets: Each tablet contains 0.5 Gm. (714 grains) of sulfamethoxypyri-
dazine. Bottles of 24 and 100 tablets.
syrup: Each teaspoonful (5 cc.) of caramel-flavored syrup contains 250 mg.
of sulfamethoxypyridazine. Bottle of 4 fl. oz.
1. Nichols, R. L. and Finland, M.: J_. Clin. Med. 49:410, 1957.
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK
•Reg. U. S. Pat. Off.
1000
Volume XL IV
Number 9
COMPONENT SOCIETY NOTES
Bay
Dr. Sidney E. Baffin has been elected presi-
dent of the Bay County Medical Society. Dr.
James D. Nixon has been chosen vice president,
and Dr. Henry C. Smallwood secretary. All the
officers are from Panama City.
Brevard
Dr. William H. Eyster, of Indialantic, pre-
sented a comprehensive and interesting discussion
of the “Office Management of Common Skin
Diseases” at the January meeting of the Brevard
County Medical Society. The meeting was held
in the Rockledge Clinic at Rockledge.
Collier
Dr. David R. Millard Jr., of Miami, was prin-
cipal speaker on the program for the January
meeting of the Collier County Medical Society
held at the Naples Community Hospital.
DeSoto-Hardee-Highlands-GIades
Newly elected officers of the DeSoto-Hardee-
Highlands-Glades County Medical Society are
Dr. Charles H. Kirkpatrick, president; Dr. Harold
S. Agnew, vice president, and Dr. Cordon H.
McSwain, secretary-treasurer. All are from
Arcadia.
Duval
Dr. Edward R. Woodward, of Gainesville,
Professor of Surgery and head of the Department
of Surgery at the College of Medicine, University
of Florida, discussed “Recent Studies on the
Antrum of the Stomach” at the February meet-
ing of the Duval County Medical Society.
Indian River
Dr. Enoch J. Vann who served the Indian
River County Medical Society as secretary last
year has been elected president for 1958. Chosen
to serve with Dr. Vann are Dr. B. Bowman
Guerin as vice president, and Dr. Charles F. Rat-
tray Jr. as secretary. The officers are from Vero
Beach.
Lake
Dr. William Chew, of Orlando, presented an
excellent address on “Diagnostic Procedures in
Chest Pathology” at the December meeting of the
Lake County Medical Society. The meeting was
held at Howey-in-the-Hills.
and inflammation
with BUFFERIN®
IN ARTHRITIS
salicylate benefits with
minimal salicylate drawbacks
Rapid and prolonged relief — with less intoler-
ance. The analgesic and specific anti-
inflammatory action of Bufferin helps re-
duce pain and joint edema— comfortably.
Bufferin caused no gastric distress in 70
per cent of hospitalized arthritics with
proved intolerance to aspirin. (Arthritics
are at least 3 to 10 times as intolerant to
straight aspirin as the general population.1)
No sodium accumulation. Because Bufferin is
sodium free, massive dosage for prolonged
periods will not cause sodium accumula-
tion or edema, even in cardiovascular cases.
Each sodium-free Bufferin tablet contains acetyl-
salicylic acid, 5 grains, and the antacids magnesium
Carbonate and aluminum glycinate.
Reference: 1. J.A.M.A. 158:386 (June 4) 1955.
Bristol-Myers Company
19 West 50 St., New York 20, N. Y
J. Florida M.A.
March. 1958
1001
minor
chemical
changes
can mean
major
therapeutic
improvements
1949 cortisone
HO, M
1951 Indrocortis
A
1955 lirednisoloni:
Now
CH3 Medrol
The most
efficient of all
anti-inflammatory
steroids
• Lower dosage
(K lower dosage
than
prednisolone)
• Better tolerated
(less sodium
retention, less
gastric irritation)
♦TRADEMARK for methyippednisolone, UPJOHN
For
complete information, consult
your Upjohn representative ,
or write the Medical Department,
The Upjohn Company ,
Kalamazoo, Michigan.
Upjohn
HOCH CH— N CH,
H,C CM — CHCM = CH,
■2MCl*2M,0
- 400 to
■rtor.ee — !
SUPPLIED:
ARALEN
J. Florida M.A.
March, 195S
1003
For the January meeting, Dr. James L. Camp-
bell Jr., of Orlando, discussed the problem and
indications for radical perineal prostatectomy.
He presented a film to illustrate his address.
Lee-Charlotte-Hendry
Dr. Gustave F. Bieber has been elected presi-
dent of the Lee-Charlotte-Hendry County Medical
Society. Dr. James L. Bradley has been chosen
vice president, and Dr. William M. Taylor secre-
tary-treasurer. All are from Ft. Myers.
Leon-Gadsden-Liberty- Wakulla- Jefferson
The regular quarterly meeting of the Leon-
Gadsden-Liberty-Wakulla-Jefferson County Medi-
cal Society was held the middle of January in
the W. T. Edwards Hospital at Tallahassee. Dr.
George S. Palmer, president of the Society,
presided. Speakers included Dr. Thomas J.
Brooks, Assistant Dean of Medicine at the Uni-
versity of Mississippi Medical Center in Jackson,
and Dr. Robert G. Ellison, Assistant Professor of
Surgery at the Medical College of Georgia at
Augusta.
Madison
Dr. Wilmer J. Coggins, of Madison, has be-
gun serving as president of the Madison County
Medical Society. Dr. Julian M. DuRant, also of
Madison, is serving with Dr. Coggins as secre-
tary-treasurer.
Marion
The Marion County Medical Society held its
annual seafood supper January 14 at the Mag-
nolia Lodge in Crystal River. Dr. Beverly Doug-
las, of Nashville, Tenn., was a guest.
Pinellas
Dr. H. Phillip Hampton, of Tampa, was prin-
cipal speaker at the January meeting of the
Pinellas County Medical Society. His topic was
“Remarks on Welfareism.” Dr. John M. Thomp-
son, of St. Petersburg, discussed “Recent Ad-
vances in Neurological Surgery” at the Society’s
February meeting.
Putnam
Dr. Bennie J. Massey has been elected presi-
dent of the Putnam County Medical Society.
Drs. Lawrence G. Hebei and Fairfax E. Montague
are to serve with Dr. Massey, Dr. Hebei as chair-
man of the Society, and Dr. Montague as secre-
tary-treasurer. All are from Palatka.
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
m
CALL THE MEDICAL SUPPLY MAN!
HOSPITAL , PHYSICIANS and LABORATORY SUPPLIES A EQUIPMENT
EDICAL SUPPLY COMPANY
JacksonvUle
42# W. Monroe St.
Telephone EL 4-6661
ot Jacksonville
Orlando
329 N. Orange Ave.
Telephone 5-3537
1004
Volume XLlV
Number 9
St. Johns
Dr. Thomas L. Glennon, of Green Cove
Springs, has been elected president of the St.
Johns County Medical Society. Dr. William J.
Gibson, of St. Augustine, who served as secretary
of the Society last year, has been chosen vice
president, Dr. Walter Weigel, of St. Augustine,
secretary, and Dr. S. Raymond Cafaro, also of
St. Augustine, treasurer.
St. Lucie-Okeechobee-Martin
Dr. Howard C. McDermid has begun serv-
ing as president of the St. Lucie-Okeechobee-
Martin County Medical Society. Dr. McDermid
was vice president last year. Drs. Robert F.
Meeko and Maltby F. Watkins are serving with
Dr. McDermid, Dr. Meeko as president-elect, and
Dr. Watkins as secretary-treasurer. All are from
Fort Pierce.
Taylor
Dr. John A. Dyal Jr. has been elected presi-
dent of the Taylor County Medical Society. Dr.
John H. Parker Jr. has been chosen vice presi-
dent, and Dr. Charles R. Wiley secretary.
Volusia
Dr. William C. Roberts of Panama City,
President of the Florida Medical Association,
was principal speaker on the program of the
February meeting of the Volusia County Medical
Society.
Walton-Okaloosa-Santa Rosa
Dr. Howard A. Parker, of Valparaiso, former-
ly secretary-treasurer of the Walton-Okaloosa-
Santa Rosa County Medical Society, has been
elected president. Dr. Frederic E. Caldwell, of
Fort Walton Beach, has been chosen vice presi-
dent, and Dr. Eric F. Geiger, of Milton, has been
elected secretary-treasurer to succeed Dr. Parker.
MARRIAGES AND DEATHS
Marriage
Dr. Donald M. Bryan, of St. Petersburg, and Dr.
Laurette Adelaide Martin, of Miami, were married Janu-
ary 5, 1958, at Coral Gables.
Deaths — Members
Buford, Coleman, G., West Palm Beach Dec. 23, 1957
Conklin, Raymond C., Mount Dora Nov. 19, 1957
Johnston, Walter B., Winter Park Nov. 19, 1957
Moore, John T., Tampa Jan. 11, 1958
Deaths — Other Doctors
Burns, Joseph P., Lake City Oct. 28, 1957
Krans, DeHart, Tallahassee Oct. 13, 1957
Martinson, Martin M., Orlando Oct. 3, 1957
TO SERVE YOU BEST
TAKES EXPERIENCE
☆
KNOW WHAT— KNOW HOW
Our seven sales representatives
have a combined total of 65 years experience -
plus a large stock and repair department.
1050 W. Adams St.
T. B. SLADE, JR.
P. O. Box 2580
Jacksonville. Fla.
j. BEATTY WILLIAMS
J. Florida M.A.
March, 1-958
1005
overgrowth
factor
Combines Achromycin V with Nystatin
SUPPLIED a
CAPSULES contain 250 mg. tetracycline HC1
equivalent (phosphate-buffered) and 250,000
units Nystatin. ORAL SUSPENSION (cherry-
mint flavored) Each 5 cc. teaspoonful contains
125 mg. tetracycline HCI equivalent (phos-
phate-buffered) and 125,000 units Nystatin.
DOSAGE :
Basic oral dosage (6-7 mg. per lb. body weight
per day) in the average adult is 4 capsules or
8 tsp. of Achrostatin V per day, equivalent
to 1 Gm. of Achromycin V.
LEDERLE LABORATORIES DIVISION. AMER
♦■Trademark tReg. U. S. Pat. Off.
Achrostatin V combines Achromycin! V
...the new rapid-acting oral form of Achromycin f
Tetracycline. . .noted for its outstanding
effectiveness against more than 50 different infections
. . . and Nystatin . . . the antifungal specific.
Achrostatin V provides particularly effective
therapy for those patients prone
to monilial overgrowth during a protracted course
of antibiotic treatment.
ICAN CYANAMID COMPANY, PEARL RIVER, N. Y. (j
H
1006
Volume XLIV
Number 9
m
EDEMA
Start therapy with one or two 500 mg.
tablets of 'DiURiu once or twice a day .
BENEFITS:
The only orally effective nonmercurial agent
with diuretic activity equivalent to that of the
parenteral mercurials.
Excellent for initiating diuresis and maintaining
the edema-free state for prolonged periods.
Promotes balanced excretion of sodium and
chloride— without acidosis.
Any indication for diuresis is an in-
dication for 'DIURIU:
Congestive heart failure of all degrees of severity;
premenstrual syndrome (edema) ; edema and toxe-
mia of pregnancy; renal edema — nephrosis; ne-
phritis; cirrhosis with ascites; drug-induced edema.
May be of value to relieve fluid retention compli-
cating obesity.
SUPPLIED: 250 mg. and 500 mg. scored tablets 'DIURIL*
(chlorothiazide); bottles of 100 and 1,000.
'DIUBIL' and 'invebsine' are trade-marks of Merck & Co., Inc.
MERCK SHARP & DOHME
Division of MERCK & CO., Inc., Philadelphia 1, Pa.
J. Florida M.A.
March, 1958
1007
as simple
as l~ 2 ~3
in
HYPERTENSION
INITIATE DIURIL' THERAPY
'DIURIL' is given in a dosage range of from 250
mg. twice a day to 500 mg. three times a day.
ADJUST DOSAGE OF OTHER AGENTS
The dosage of other antihypertensive medication
(reserpine, hydralazine, etc.) is adjusted as indi-
cated by patient response. If the patient is estab-
lished on a ganglionic blocking agent (e.g., 'IN-
VERSINE') this should be continued, but the total
daily dose should be immediately reduced by 25
to 50 per cent. This will reduce the serious side
effects often observed with ganglionic blockade.
ADJUST DOSAGE OF ALL MEDICATION
The patient must be frequently observed and care-
ful adjustment of all agents should be made to
determine optimal maintenance dosage.
BENEFITS:
.improves and simplifies the management of hypertension
• markedly enhances the effects of antihypertensive agents
• reduces dosage requirements for other antihypertensive
agents— often below the level of distressing side effects
• smooths out blood pressure fluctuations
INDICATIONS: management of hypertension
Smooth , more trouble-free manage-
ment of hypertension with ' DIURIL '
K
CORRECTS IRON DEFICIENCY
AS IT STIMULATES APPETITE
Offers appetite stimulating Vitamins B1( B6, B12 and protein
upgrading I -Lysine, fortified with a readily absorbed, well
tolerated form of iron.
Delicious cherry base designed to appeal to all patients.
PARTICULARLY FOR CHILDREN
Helps young appetites keep pace with the increased nutritiona
demands of childhood while supplying adequate amounts o
essential iron.
Average dosage is one teaspoonful daily. Available in bottles of 4 fl. oz.
P
Provides the following percentages of Minimum Daily Requirements per teaspoonful:
SYRUP
FORMULA
EACH TEASPOONFUL (5 cc.) CONTAINS
l-Lysine HCI 300 mg.
Ferric Pyrophosphate (Soluble) 250 mg.
Iron (as Ferric Pyrophosphate) 30 mg.
Vitamin B12 Crystalline 25 mcgm.
Thiamine Mononitrate (Bj) 10 mg.
Pyridoxine HCI (B6) 5 mg.
Alcohol 0.75%
Child under 6
Child over 6
Adult
B,
2000%
1333%
1000%
Iron
400%
300%
300%
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. NEW YORK If
Results with rc . . . antacid therapy ivith DAA are essentially the same as . . . with
potent anticholinergic drugs.”
Dihydroxy aluminum aminoacetate, N.N.R.
In recent years, a number of new synthetic anticholiner-
gic drugs with numerous and varying side effects have
been investigated for treatment of peptic ulcer. However,
a double-blind study conducted recently by Cayer et al
suggests that the use of such anticholinergic drugs is
seldom necessary. The authors concluded that "The
percentage of 'good to excellent’ results obtained in
patients on continuous long-term antacid therapy with
DAA (71%) is essentially the same as that previously
noted in ulcer patients treated under similar conditions
with potent anticholinergic drugs alone.”
The authors’ choice of dihydroxy aluminum amino-
acetate (DAA) was based on the fact that "the tablet
form of DAA (is) more active than a variety of straight
aluminum hydroxide magmas.” They further commented
that "Because of the convenience of tablet medication
as compared with the liquid gel — a convenience which
in the use of other tablets is gained at the expense of
therapeutic effectiveness — dihydroxy aluminum amino-
acetate was used exclusively.”
Alclyn (dihydroxy aluminum aminoacetate) Tablets
are supplied in bottles of 100 tablets (0.5 Gin. per tablet).
BRAYTEN PHARMACEUTICAL COMPANY • Chattanooga 9, Tennessee
I. Florida M.A.
March, 1958
ion
A NEW, CORTICOSTEROID MOLECULE WITH GREATER ANTIALLERGIC,
ANTIRHEUMATIC AND ANTI-INFLAMMATORY ACTIVITY
■ far less gastrointestinal
distress ,
■ safe to use in asthma with
associated cardiac disease;
no sodium and water retention
■ does not produce secondary
hypertension— low salt diet
not necessary
■ no unnatural psychic
stimulation
■ often works when other
glucocorticoids have failed
■ and on a lower daily dosage
range
Initial dosage; 8 to 20 mg. daily. After 2 to 7 days
gradually reduce to maintenance levels.
See package insert for specific dosages and precautions.
1 mg. tablets, bottles of 50 and 500.
4 mg. tablets, bottles of 30 and 100.
0 Squibb
Squibb Quality— the Priceless Ingredient
»co«r
1012
Volume XLIV
Number 9
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
HOSPITAL FOR SALE: 30 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner qualified to do
surgery or surgeon willing to do general practice in
small town with excellent hospital. Salary or percent-
age to start; partnership after six months. Write
69-254, P.O. Box 2411, Jacksonville, Fla.
BRAND NEW AIR CONDITIONED AND
HEATED MEDICAL BUILDING in fast growing
North Miami has three openings. Prefer Board-certi-
fied (or eligible) internist, ophthalmologist, otolaryn-
gologist, dermatologist, or laboratory to complement
present occupants: pediatrician, surgeon, orthopedist,
obstetrician. All independent. See it at 1545 N.E.
123rd Street and phone PL 4-2744.
WANTED: Physician with Florida license to sub-
stitute for one to two months in General Practice.
Future association possible. Write 69-257, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner or Pediatrician
to share fully equipped office with M.D. in N.W.
Miami; part or full time. Florida license necessary.
Excellent opportunity. Write 69-258, P.O. Box 2411,
Jacksonville, Fla.
POSITION WANTED: General Surgeon, Board
eligible, desires location or position in small Florida
city. Write 69-259, P.O. Box 2411, Jacksonville, Fla.
WANTED: White male under the age of 40
interested in General Practice. Minimum of one year
in rotating internship. Must have Florida license.
Net salary, $10,000 per year. Write 69-260, P. O. Box
2411, Jacksonville, Fla.
SUITE AVAILABLE: St. Nicholas Medical Cen-
ter, 3127 Atlantic Blvd., Jacksonville. 700 square
feet, conveniently located to all Jacksonville by pub-
lic and private transportation, in a balanced clinic.
Janitor and maid service. Air conditioned. All utili-
ties furnished except telephone. W. G. Allen Jr.,
Mgr., Colonial Properties, Inc., 3116 Atlantic Blvd.
Phone EX 8-5500.
PEDIATRICIAN: Completing training in July
1958. University trained. Board eligible in Pediatrics.
Florida license. Desires group practice or association
with one or more pediatricians. Write 69-261, P.O.
Bex 2411, Jacksonville, Fla.
POSITION WANTED: In Ophthalmology or
EENT by Georgian. Florida license. Board eligible
in Ophthalmology. 3 years in EENT practice. Write
69-262, P.O. Box 2411, Jacksonville, Fla.
POSITION WANTED: Board eligible Internist.
Completing residency in June 1958. Will consider
some General Practice to begin. Write 69-263, P.O.
Box 2411, Jacksonville, Fla.
WANTED: Need for full time Doctor. New
medical building in Longwood, Florida. Rent free.
Doctor to pay utilities. Contact H. S. Lew Arnold,
Box 43, Longwood.
T. Florida M.A.
March. 1958
1013
1 . Recurrent joint pain followed by-
long- periods of complete remis-
sion. (Percentages refer to inci-
dence.)
this case involving the olecranon
bursa.
SERUM URIC ACID
CONCENTRATION
3. Elevated serum uric acid levels.
4. Colchicine test: full dose (0.5
mg.) every 1 to 2 hours until pain
is relieved or nausea, vomiting or
diarrhea occur. The test requires
usually 8 to 16 doses. Pain relief
is highly indicative of gout.
FROM THESE FINDINGS... SUSPECT GOUT:
^BENEMID
PROBENECID
A SPECIFIC FOR GOUT
Once findings point to gout, long-term management can be started
with Benemid. This effective uricosuric agent has these unique
benefits:
• Urinary excretion of uric acid is approximately doubled.
• Serum uric acid levels are reduced.
• Uric acid deposits (tophi) in tissues are mobilized.
• Formation of new tophi can often be prevented.
• Fewer attacks and severity is reduced.
RECOMMENDED DOSAGE: 0.25 Gm. ( V2 tablet) twice daily for
one week followed by 1 Gm. (2 tablets) daily in divided doses.
Benemid is a trade-mark of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc.. PHILADELPHIA 1, PA.
1014
Voi.ume XLIV
Number 9
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Ballard, William C., St. Petersburg
Bunch. Rob R., St. Petersburg
Clayton, Malcolm D. Jr., Tampa
Gould, Purdue L., Lakeland
Hamilton, John M., St. Petersburg
Hartman, Howard E., Sarasota
Johnson, Walter H., Largo
Kaszuba, Alexander, St. Petersburg
Levy, Sidney W., Quincy
Magill, John C., St. Petersburg
Miller, Helen K., Tampa
Montague, Fairfax E., Palatka
Myerson, Samuel, St. Petersburg
Orr, Alva D., Fort Pierce
Penick, Richard Q., Jensen Beach
Rattray, Charles F. Jr., Vero Beach
Sherman, Arthur G., St. Petersburg
Siek, H. Gerard Jr., Clearwater
Smallwood, Henry C., Panama City
Tagliarini, Frank P., Tampa
Tanner, Terry F., St. Petersburg
vanBoven, John III, Palm Beach
Weigel, Walter W., St. Augustine
OBITUARIES
John Singer McEwan
Ur. John Singer McEwan of Orlando died on
Sept. 26, 1957, at Orange Memorial Hospital
where for many years he was chief of the surgical
service. He had been hospitalized there for nearly
two years with a heart ailment. He was 80 years
of age.
Dr. McFlwan was born in Cooperstown, N.Y.,
on Sept. 4, 1877. His early professional train-
ing was in pharmacy and for a time he had a
drugstore in Carlsbad, N. Mex. He then at-
tended Northwestern University Medical School
in Chicago, where he was awarded the degree of
Doctor of Medicine in 1905. His medical fra-
ternity was Phi Beta Pi. After graduation, he
served an internship in New York at the New
York City Hospital.
In 1906 Dr. McEwan entered the private
practice of medicine in Orlando in association
with Dr. R. L. Harris, but soon opened his own
office, specializing in surgery. For half a cen-
(Continued on page 1018 )
NEW “flavor -timed” dual-action
CORONARY VASODILATOR
TRADEMARK
ORAL (tablet swallowed whole)
for dependable prophylaxis
SUBUNGUAL-ORAL
for immediate and
4 sustained relief
of ANGINA PECTORIS
NITROGLYCERIN -
0.4 mg. (1/150 grain) — acts quickly
CITRUS "FLAVOR-TIMER" —
signals patient when to swallow
PENTAERYTHRITOL TETRANITRATE -
15 mg. (1/4 grain) — prolongs action
For continuing prophylaxis patient swallows
the entire Dilcoron tablet.
Average prophylactic dose:
1 tablet four times daily.
Therapeutic dose:
1 tablet held under the tongue until citrus
flavor disappears, then swallowed.
Bottles of 100.
A8O0ATO0ICS Nfw YORK II. ■
a new high in
anti-inflammatory effects
with lower dosage
(averages 1 less than
prednisone)
The
Achievements
of
Triamcinolone LEDERLE
in the collateral
hormonal effects associated
with all previous corticosteroids
0 No sodium or water retention.
# No potassium loss
• No interference with psychic equilibrium
0 Low incidence of peptic ulcer and osteoporosis
Aristocort is available in 2 mg. scored tablets (pink), bottles of 30; and 4 mg. scored tablets (white), bottles of 30 and 100.
The Achievement in Skin Diseases: In a study of 26 patients with severe
dermatoses, aristocort was proved to have potent anti-inflammatory and antipruritic properties,
even at a dosage only 2/i that of prednisone.1 11. . . Striking affinity lor skin and tremendous potency in
controlling skin disease, including 50 cases of psoriasis, of which over 60% were reported as
markedly improved2. . . absence of serious side effects specifically noted. 1,2,3
The Achievement in Rheumatoid Arthritis impressive therapeutic effect
in most cases of a group of 89 patients4. . .6 mg. of aristocort corresponded in effect to 10 mg. of
prednisone daily (in addition, gastric ulcer which developed during prednisone therapy in 2 cases
disappeared during aristocort therapy).5
TO
b
c~
r h
1. Rein, C. R., Fleischmajer, R., and Rosenthal, A. L.: J. A. M. A.
165:1821, (Dec. 7) 1957.
2. Shelley, W. B., and Pillsbury, D. M.: Personal Communication.
3. Sherwood, A., and Cooke, R. A.: Personal Communication.
4. Freyberg, R. H., Berntsen, C. A., and Heilman, L.: Paper
presented at International Congress on Rheumatic Diseases, Toronto,
June 25, 1957.
5. Hartung, E. F.: Personal Communication.
6. Schwartz, E.: Personal Communication.
7. Sherwood, A., and Cooke, R. A.: J. Allergy 28:97, 1957.
8. Heilman, L., Zumoff, B., Kretshmer, N., and Kramer, B.: Paper
presented at Nephrosis Conference, Bethesda, Md., Oct. 26, 1957.
9. Ibid.: Personal Communication.
10. Barach, A. L.: Personal Communication.
1 1. Segal, M. S.: Personal Communication.
12. Cooke, R. A.: Personal Communication.
13. Dubois, E. L.: Personal Communication.
The Achievement in Respiratory Allergies: “Good to excellent” results
in 29 of 30 patients with chronic intractable bronchial asthma at an average daily dosage of only
7 mg.6. . . Average dosage of 6 mg. daily to control asthma and 2 to 6 mg. to control allergic rhinitis
in a’ group of 42 patients, with an actual reduction of blood pressure in 12 of these.7
The Achievement in Other Conditions: Two failures, 4 partial remissions
and 8 cases with complete disappearance of abnormal chemical findings lead to characterization
of aristocort as possibly the most desirable steroid to date in treatment of the nephrotic syn-
drome.8,9. . . Prompt decrease in the cyanosis and dyspnea of pulmonary emphysema and fibrosis,
with marked improvement in patients refractory to prednisone.10,11,12. .. Favorable response
reported for 25 of 28 cases of disseminated lupus erythematosus.13
—OH
Depending on the acuteness and severity of the disease under therapy, the initial
dosage of aristocort is usually from 8 to 20 mg. daily. When acute
manifestations have subsided, maintenance dosage is arrived at gradually,
usually by reducing the total daily dosage 2 mg. every 3 days until the smallest
dosage has been reached which will suppress symptoms.
Comparative studies of patients changed to aristocort from prednisone
indicate a dosage of aristocort lower by about Vi in rheumatoid arthritis,
by Vi in allergic rhinitis and bronchial asthma, and by Vi to Vi in inflammatory
and allergic skin diseases. With aristocort, no precautions are necessary
in regard to dietary restriction of sodium or supplementation with potassium.
aristocort is available in 2 mg. scored tablets (pink), bottles of 30;
and 4 mg. scored tablets (white), bottles of 30 and 100.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER NEW YORK
1018
Volume XLIV
Number 9
(Continued from page 1014)
tury thereafter he was prominently identified
with the professional, civic and social life of the
city. He was the local surgeon for the Atlantic
Coast Line Railroad for many years, and he
served on the Florida Crippled Children’s Com-
mission under five governors starting with Gov.
Spessard Holland in 1940. He was a charter
member of the Orlando Rotary Club and was a
Mason with affiliations in Orlando Lodge No. 69,
F&AM, Eureka chapter No. 7, RAM, Orlando
Council No. 5, R&SM, Olivet Commandery No.
4, and Morocco Shrine Temple. He was a mem-
ber of the Cathedral Church of St. Luke. Also,
he held membership in the Orlando Country Club
and the Orlando University Club. For many
years he served on the Orlando Utilities Com-
mission, for a time as president, and was also a
director in the Gulf Life Insurance Company.
Prior to the entry of the United States into
World War I, Dr. McEwan volunteered for the
American Ambulance Corps and went to France.
He was chief surgeon of a hospital at Juilly,
France, behind the front lines at Verdun and
was given the rank of major in the French army.
Soon after engaging in the practice of surgery
in Orlando, Dr. McEwan recognized the need of
a county medical society closer than the one
in Tampa, which he attended. He therefore was
most active in the formation of the Orange Coun-
ty Medical Society in 1908 and served as its
first secretary.
A distinguished member of the Florida Medi-
cal Association through the years, Dr. McEwan
served as its president in 1925. He held life mem-
bership with honorary status at the time of his
death and was completing his fiftieth year of
membership in the Association.
One of the original diplomates of the American
Hoard of Surgery, this pioneer Florida surgeon
was a fellow of the American College of Surgeons
and a member of the Southern Surgical Society.
In addition, he held membership in the American
Medical Association and the Southern Medical
Association.
In 1907, Dr. McEwan was married to Roberta
Dunn of Sanford, who survives him. Also surviv-
ing are three sons, John A. McEwan, O. Beverly
McEwan and Robert H. McEwan, all of Orlando,
and seven grandchildren. Other survivors include
TAKE A LOOK AT
NEW DIMETANE
THE UNEXCELLED
ANTIHISTAMINE
J. Florida M.A.
March, 1958
1019
a brother, Arthur McEwan, of Oneonta, N.Y.,
and a nephew, Dr. Duncan T. McEwan, of Or-
lando, who took over his practice when he re-
tired.
Alfred Eugene Cronkite
Dr. Alfred Eugene Cronkite of Fort Lauder-
dale died of a heart attack while at work at his
office on Sept. 27, 1957. He was 45 years of age.
A native of Los Angeles, Dr. Cronkite was
born on Sept. 9, 1912. He had his early school-
ing in the public schools of Los Angeles. He re-
ceived his Bachelor of Arts degree at Stanford
University and was awarded the degree of Doc-
tor of Medicine by the Stanford University
School of Medicine in San Francisco in 1938.
His medical fraternity was Alpha Kappa. After
graduation he served as an instructor and as an
Assistant in Anatomy at his alma mater for a
year and spent the following year there as a re-
search fellow in the Department of Public Health
and Preventive Medicine. After completing an in-
ternship in Oakland, Calif., he held successive
fellowships in Surgery and Pathology at the Mayo
Clinic in Rochester, Minn., for five years. During
World War II he served three years aboard a de-
stroyer in the Pacific.
In January 1949, Dr. Cronkite came to Flori-
da to become Broward County’s first full time
pathologist, serving at the North Broward Gen-
eral Hospital in that capacity until 1956. In De-
cember 1951, he became the first Medical Exami-
ner for Broward County, retiring in 1956 because
of illness. He established the first blood bank in
that county and helped organize the Florida
Blood Bank Clearing House; he was a strong
supporter of the American Association of Blood
Banks. He was also the first to establish a De-
partment of Forensic Pathology in Florida.
Locally, Dr. Cronkite was a Rotarian, a di-
rector of the Broward County Chapter of the
American Red Cross, a Boy Scout leader, and
Director of the Broward County Tumor Clinic.
He was particularly interested in the work of the
American Cancer Society and was influential in
establishing a medical library at North Broward
General Hospital. He was affiliated with the
Church-by-the-Sea.
(Continued on page 1026)
JRPASSED THERAPEUTIC
EX AND RELATIVE SAFETY. MINIMUM
ROWSINESS AND OTHER SIDE EFFECTS.
H. ROBINS CO., INC., RICHMOND, VIR-
INIA. ETHICAL PHARMACEU-
IPA T C AtrDTT 1Q7Q
(PARABROMDYLAMINE MALEATE)
A NEW SKELETAL
MUSCLE RELAXANT
Robaxin — synthesized in the Robins Research Laboratories, and
intensively studied for five years -introduces to the physician an
entirely new agent for effective and well-tolerated skeletal muscle
relaxation. Robaxin is an entirely new chemical formulation, with
outstanding clinical properties:
• Highly potent and long acting.5,8
• Relatively free of adverse side effects.1,2,3,4,6,7
• Does not reduce normal muscle strength or reflex activity
in ordinary dosage.7
• Beneficial in 94.4% of cases with acute back pain
due to muscle spasm.1,3,4,6,7
CLINICAL. RE
DISEASE ENTITY
Acute back pain du
(d) Muscle spasm se
to discegenic dis
and postoperath
orthopedic proce
Miscellaneous (bursi
torticollis, etc.)
TOT
(b) Muscle spasm du
trauma
(c) Muscle spasm du
nerve irritation
(a) Muscle spasm se
to sprain
(Methocarbamol Robins, U.S. Pat. No. 2770649)
Highly specific action
Robaxin is highly specific in its action on the
internuncial neurons of the spinal cord — with
inherently sustained repression of multisyn-
aptic reflexes, but with no demonstrable effect
on monosynaptic reflexes. It thus is useful in
the control of skeletal muscle spasm, tremor and
other manifestations of hyperactivity, as well
as the pain incident to spasm, without impair-
ing strength or normal neuromuscular function.
Beneficial in 94.4 % of cases tested
When tested in 72 patients with acute back
pain involving muscle spasm, Robaxin in-
duced marked relief in 59, moderate relief in
6, and slight relief in 3 - or an over-all bene-
ficial effect in 94.4%.1,3-4-6*7 No side effects
occurred in 64 of the patients, and only slight
side effects in 8. In studies of 129 patients,
moderate or negligible side effects occurred
in only S^.1-2-3’4’6'7
H ROBAXIN IN ACUTE BACK PAIN’ ’
DURATION
OF
TREATMENT
DOSE PER DAY (divided)
RESPONSE
marked mod. slight
neg.
SIDE EFFECTS
2-42 days
3-6 Gm.
17
1
0
0
None, 16
Dizziness, 1
Slight nausea, 1
1 -42 days
2-6 Gm.
8
1
3
1
None, 12
Nervousness, 1
4-240 days
2.25-6 Gm.
4
1
0
0
None, 5
2-28 days
1.5-9 Gm.
24
3
0
3
None, 25
Dizziness, 1
Lightheaded-
ness, 2
Nausea, 2 *
3-60 days
4-8 Gm.
6
0
0
0
None, 6
59
6
3
4
* Relieved on
reduction
of dose
References : 1. Carpenter, E. B.: Publication pending. 2. Carter,
C. H.: Personal communication. 3. Forsyth, H. F.: Publication
pending. 4. Freund, J.: Personal communication. 5. Morgan,
A. M., Truitt, E. B., Jr., and Little, J. M.: American Pharm. Assn.
46:374, 1957. 6. Nachman, H. M.: Personal communication.
7. O’Dohertv. D Publication nendimr 5J. Truitt IT. R .lr nnrl
Indications — Acute back pain associ-
ated with: (a) muscle spasm secondary to
sprain; (b) muscle spasm due to trauma;
(c) muscle spasm due to nerve irritation;
(d) muscle spasm secondary to discogenic
disease and postoperative orthopedic
procedures; and miscellaneous conditions,
such as bursitis, fibrositis, torticollis, etc.
Dosage — Adults: Two tablets 4 times
daily to 3 tablets every 4 hours. Total daily
dosage: 4 to 9 Gm. in divided doses.
Precautions — There are no specific con-
traindications to Robaxin and untoward
reactions are not to be anticipated. Minor
side effects such as lightheadedness, dizzi-
ness, nausea may occur rarely in patients
with unusual sensitivity to drugs, but dis-
appear on reduction of dosage. When ther-
apy is prolonged routine white blood cell
counts should be made since some decrease
was noted in 3 patients out of a group of
72 who had received the drug for periods
of 30 days or longer.
Supply - Robaxin Tablets, 0.5 Gm., in
bottles of 50.
A H RflRINS nn INn Richmond 711 Vo
1022
Volume XUV
Number 9
J. Florida M.A.
March, 1958
Gastric distress accompanying "predni-steroid”
therapy is a definite clinical problem — well
documented in a growing body of literature.
lew of the beneficial re-
observed when antacids
d diets were used concom-
itli prednisone and prcdni-
re feel that these measures
»e employed prophylacti-
offset any gastrointestinal
:ts.” — Dordick, J. R. et al.:
te J. Med. 57:2049 (June
r.
*“It is our growing convic-
tion that all patients receiving
oral steroids should take each
dose after food or with ade-
quate buffering with aluminum
dr magnesium hydroxide prep-
arations.”— Sigler, J. W . and
Ensign, D. J. Kentucky
State M.A. 54:771 (Sept.) 1956.
*“The apparent high inci-
dence of this serious (gastric]
side effect in patients receiving
prednisone or prednisolone
suggests the advisability of
routine co-administration of an
aluminum hydroxide gel.” —
Bullet. A. J. and Bunim, J. J.:
J. A. M. A. 158:459 (June 11)
1955.
One way to make sure that patients receive
full benefits of "predni-steroid” therapy plus
positive protection against gastric distress is
by prescribing CO-DELTRA or CO-HYDEITRA.
oDeltra
PREDNISONE BUFFERED
pie compressed tablets
provide all the benefits
of “Predni-steroid” therapy-,
plus positive antacid protection
against gastric distress
2.5 mg. or 5.0 mg. of prednisone
or prednisolone, plus 300 mg. of
dried aluminum hydroxide gel
and 50 mg. magnesium trisili-
cate, in bottles of 30, 100, 500.
1023
MERCK SHARP & D0HME Division of MERCK & CO.. INC.. Philadelphia I. Pa. flsg
1024
Volume XLIV
N UMBER 9
The Best Tasting Aspirin you can prescribe.
The Flavor Remains Stable down to the last tablet.
25^ Bottle of 48 tablets (IK grs. each).
Childrens Size
We will be pleased to send samples on request.
THE BAYER COMPANY DIVISION of Sterling Drug Inc. 1450 Broadway. New York 18, N. Y.
J. Florida M.A.
March, 1958
1025
See anybody here you know, Doctor?
I’m just too much
IflllAMPLUS
for sound obesity management
dextro-amphetamine plus vitamins
and minerals
I’m too little
STIMAVITE
stimulates appetite and growth
vitamins Bi, Bfi, B]2, C and L-lysine
I’m simply two
OBRON
a nutritional buildup for the OB patient
OBRON*
HEMATINIC
when anemia complicates pregnancy
And I’m getting brittle
NEOBON
5-factor geriatric formula
hormonal, hematinic and
nutritional support
With my anemia,
I’ll never make it up
ROETINIC
one capsule a day, for all treatable anemias
HEPTUNA® PLUS
when more than a hematinic is indicated
solve their problems with a nutrition product from
( Prescription information on request)
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
1026
VOLUMK XLIV
Number 9
(Continued from page 1019)
Dr. Cronkite was active in the Broward
County Medical Association and was also a
member of the Florida Medical Association and
the American Medical Association. He was a
member of the Florida Society of Pathologists
and served as its president in 1953. Active in
numerous other organizations of his specialty, he
was a fellow of the American College of Path-
ology, a member of the Mayo Foundation for
Medical Research, a fellow of the American
Society of Clinical Pathology and an associate
member of the American College of Physicians.
Survivors include the widow, Mrs. Margaret
Cronkite, and three children, Margaret Anita,
Robert Eugene and Ruth Collins, all of Fort
Lauderdale; and his parents, of Los Angeles.
Walter Clayton Page
Dr. Walter Clayton Page of Cocoa died in the
local hospital on Oct. 23, 1957, after a long ill-
ness. He was 71 years of age.
Dr. Page was born at Wrightsville, Ga., in
1885 and was educated in his native state. He
received his medical training at the Atlanta Medi-
cal College, now Emory University School of
Medicine, in Atlanta, and was awarded the degree
of Doctor of Medicine in 1910. He entered the
general practice of medicine in Live Oak soon
after graduation. In 1917 he moved to Cocoa,
where he had continued to practice until ill health
forced his retirement.
The dean of the local medical profession, Dr.
Page had been active in the civic and social life
of the community for four decades. He was a
Past Master of the local Masonic Lodge.
Dr. Page was active through the years in the
Brevard County Medical Society and in 1926 and
1927 served as its president, e was a life mem-
ber of the Florida Medical Association, holding
honorary status at the time of his death. He had
been a member of the Association for 44 years
and had served as Councilor in his district.
Surviving are two brothers, E. M. Page, of
Miami, and C. D. Page, of Vienna, Ga.; three
sisters, Miss Cora Page, Miss Evelyn Page, and
Mrs. Esther P. Smith, all of Miami; and one
niece, Mrs. W. A. Bailey, of Miami. Mrs. Page,
the former Florence Bache of Live Oak, died
several years ago.
NEO -T11C0MTIN1™.,
Hydrocortisone 0.5%, Neomycin 0.35% (as Sulfate) and Special
Coal Tar Extract 5% (TARBONIS) in an ointment base.
JERMATITt® • ECZEMAS • SEBORRHEA • ANOGENITAL PRURITUS * DERMATITIS VENENATA • PSORIASIS
PERFORMANCE WITH
GREATER PERMANENCE
IN THE MANAGEMENT
OF DERMATOSES...
(Regardless of Previous Refractoriness)
Confirmed by
an impressive and
growing body of published
clinical investigations
Hydrocortisone 0.5% and Special Coal Tar Extract 5%
(TARBONIS®) in a greaseless, stainless vanishing cream base.
*
J.A.M.A. t66 :158,1951s; Welsh, A.L. and Ede.M.
'. . . prompt remissions of ... acute phases.”
with TARCORTIN
REED A CARNRICK / Jersey City 6. New Jersey
*
1. Clyman, S. G. : Postgrad. Med. 21: 309, 1957.
2. Bleiberg, J.: J. M. Soc. New Jersey 53: 37, 1956. 1
3. Abrams, B. P., and Shaw, C. : Clin. Med. J:839, 1956.
4. Welsh. A. L.. and Ede, M. : Ohio State M. J. 50:837, 1954.
5. Bleiberg. J.: Am. Practitioner S:1404, 1957.
NOW- FROM ABBOTT LABORATORIES
AN ANTIBIOTIC TRIAD
-FOR THE CONTROL OF
ALL COCCAL INFECTIONS
Indications
against staph-,
strep- and
pneumococci
erythrocin is indicated in treat-
ing infections caused by staphy-
lococci, streptococci (including
enterococci), and pneumococci.
Indicated also, in treating infec-
tions that have become resistant
to other antibiotics. May be used
for patients who are allergic to
penicillin or other antibacterials.
Dosage
Usually administered in a total
daily dose of 1 to 2 Gm., depending
on severity of infection. Suggested
dose is 250 mg. every six hours;
for severe infections, usual dose is
500 mg. every six hours.
Supplied
In bottles of 25 and 100 Filmtabs
( 100 and 250 mg. ) . Also, in tasty,
cinnamon-flavored oral suspen-
sion, in 75-cc. bottles. Each 5-cc.
teaspoonful represents 100 mg. of
erythrocin activity.
®Filmtab — Film -sealed tablets, Abbott; pat. applied for.
J Florida M.A.
March. 1958
1027
REMARKABLE EFFECTIVENESS PLUS A SAFETY RECORD
UNMATCHED IN SYSTEMIC ANTIBIOTIC THERAPY TODAY
Actually, after almost six years of extensive use, there has not been a single report
of a serious reaction to erythrocin. And, after all this time, the incidence of
resistance to erythrocin has remained exceptionally low.
You’ll find ERYTHROCIN is highly effective against the majority of coccal infec-
tions and may also be used to counteract complications from n n
severe viral attacks. It comes in Filmtabs and in Oral Suspension. v^IaJuTMX
1028
Volume XLIV
Number 9
Compocillin-V
for those
penicillin-sensitive
organisms
Indications
Against all penicillin-sensitive
organisms. For prophylaxis and
treatment of complications in
viral conditions. And as a prophy-
laxis in rheumatic fever and in
rheumatic heart disease.
Dosage
Depending on the severity of the
infection, 125 to 250 mg. (200,000
to 400,000 units) every four to six
hours. For children, dosage is de-
termined by age and weight.
Supplied
Filmtabs compocillin-v (Potas-
sium Penicillin V, Abbott) come in
125 mg. (200,000 units), bottles of
50; and in 250 mg. (400,000 units),
bottles of 25. Oral Suspension
compocillin-v (Hydrabamine
Penicillin V, Abbott), contains 180
mg. per 5-cc. teaspoonful, in 40-cc.
and 80-cc. bottles.
9020/1
J. Fi.orifw M.A.
March, 1958
1029
THE HIGHER BLOOD LEVELS OF COMPOCILLIN-V
-IN EASY-TO-SWALLOW FILMTABS AND TASTY, ORAL SUSPENSION
units/cc. 16
Hours
Now, with Filmtab compocillin-v, patients get (and within minutes) fast, high peni-
cillin concentrations. Note the blood level chart.
compocillin-v is indicated whenever penicillin therapy is desired. It comes in
two highly-acceptable forms. Filmtab compocillin-v offers two therapeutic dosages
(125 and 250 mg.). Patients find Filmtabs tasteless, odorless and easy-to-swallow.
For children, compocillin-v comes in a tasty, banana-flavored
suspension. It’s ready-mixed — stays stable for at least 18 months.
ClBIrott
1030
Volume XLIV
Number 9
Indications
and when
coccal infections
hospitalize
the patient
spontin is indicated for treating gram-
positive bacterial infections. Clinical
reports have indicated its effectiveness
against a wide range of staphylococcal,
streptococcal and pneumococcal infec-
tions. It can be considered a drug of
choice for the immediate treatment of
serious infections caused by organisms
resistant to other antibiotics.
Dosage
Recommended dosage depends on the
sensitivity of the microorganism and on
the severity of the disease under treat-
ment. For pneumococcal and streptococ-
cal infections, a dosage of 25 mg./Kg.
per day will usually be adequate. Major-
ity of staphylococcal infections will be
controlled by 25 to 50 mg./Kg. per day.
However, in endocarditis due to rela-
tively resistant strains or where vege-
tations or abscesses occur, dosages as
high as 75 mg./Kg. per day may be used.
It is recommended that the daily dosages
be divided into two or three equal parts
at eight- or twelve-hour intervals.
Supplied
spontin is supplied as a sterile, lyophi-
lized powder, in vials representing 500
mg. of ristocetin activity.
•o?o?o
J. Florida M.A.
March, 1958
1031
A LIFESAVING ANTIBIOTIC AFTER OTHER ANTIBIOTICS HAD FAILED
SPONTIN comes to the medical profession with a clinical history of dramatic results
— cases where the patients were given little chance of survival.
During these careful, clinical investigations, lives were saved after weeks (and
sometimes months) of antibiotic failures. These were the cases where the infecting
organisms had become resistant to present-day therapy. And, just as important,
were the good results found against a wide range of gram-positive coccal infections.
Essentially, SPONTIN is a drug for hospital use, for patients with potentially
dangerous infections. In its present form, spontin is administered intravenously
using the drip technique. Dosage may be dissolved in 5% dextrose in water or in
any isotonic or hypotonic saline solution. Some of the important therapeutic points
of spontin include:
1 successful short-term therapy for acute or subacute endocarditis
new antimicrobial activity — no natural resistance to spontin was found in
tests involving hundreds of coccal strains
antimicrobial action against which resistance is rare — and extremely diffi-
cult to induce
4 bactericidal action at effective therapeutic dosages.
spontin is truly a lifesaving antibiotic. It could save the life
of one of your patients — does your hospital have it stocked?
CKMWtt
SALCOLAN
e
• TESTED • APPROVED . ACCEPTED
SAFE
|°/t
•BURNS -SCALDS -ABRASIONS
★ "Initial rapid pain relief, early tissue
regrowth, control of secondary
infection.”
★ "A marked reduction in total healing
time.”
rflCH COMPANY,
3518 Polk Avenue
★ Clinical reports, samples, and descrip-
tive brochure may be had upon
request. Please write us on your
letterhead.
INCORPORATED
Houston, Texas
TASTY,
FAST-ACTING
ORAL FORM
OF CITRATE-BUFFERED
ACHROMYCIN V
TETRACYCLINE BUFFERED WITH SODIUM CITRATE
• accelerated absorption in the gastro-
intestinal tract
• early, high peaks of concentration in body
tissue and fluid
• quick control of a wide variety of infections
• unsurpassed, true broad-spectrum action
• minimal side effects
• well-tolerated by patients of all ages
ACHROMYCIN V SYRUP:
Orange Flavor. Each teaspoonful (5 cc.)
contains 125 mg. of tetracycline, HCI equivalent,
citrate-buffered. Bottles of 2 and 16 fl. oz.
DOSAGE:
6-7 mg. per lb. of body weight per day.
•Reg. U.S. Pot. Off.
LEDERLE LABORATORIES DIVISION
AMERICAN CYANAMID COMPANY
PEARL RIVER. NEW YORK
aqueous
ready-to-use
freely miscible
1034
Volume XLIV
Number 9
1. TRAPPED — This highly mo-
tile, viable sperm becomes non-repro-
ductive the instant it contacts
IMMOLIN Cream-Jel.
2. WEAKENED — Devitalized,
and no longer motile, the sperm
swerves from line of travel and is
pulled aside by spreading matrix.
3. KILLED — Motion, whiplash
stop as sperm succumbs to matrix.
“freezes,” weakens and kills
even the most viable sperm
The unique sperm-trapping matrix formed with explo-
sive speed when semen meets IMMOLIN11 Vaginal
Cream-Jel accounts for the outstanding effectiveness
of this new contraceptive for use without diaphragm.
These unusual pictures, taken at high speed and mag-
nification, show the IMMOLIN matrix in action — how
a single sperm “freezes,” weakens and dies — within the
distance it normally travels in one-quarter of a second.
DEPENDABLE WITHOUT DIAPH RAG M— With this
new contraceptive technique, a pregnancy rate of 2.01
per 100 woman-years of exposure is reported.* “This
extremely low pregnancy rate indicates that IMMOLIN
Cream-Jel used without an occlusive device is an effi-
cient and dependable contraceptive.”
*Goldstein. L. Z.: Obst. & Gynec. 70:133 (Aug.) 1957.
JULIUS SCHMID, INC.
423 West 55th Street, New York 19, N. Y.
IMMOLIN is a registered trade-mark of Julius Schmid. Inc.
4-. BURIED The dead sperm is trapped
deep in the impenetrable IMMOLIN matrix.
MY DAP- he
AND THE PAIN
WENT AWAY FAST
HURT m BACK REAL "BAP
"He told
Mom his
shoulder
felt like
it was on
fire"
"He couldn’t
swing a bat
without
hurting"
"But Doctor
gave him
some nice
pills — and
the pain
went away
fast"
"Dad said
we’d play
ball again
tomorrow
when he
comes home"
"It happened
at work
while he
was putting
oil in
something"
■>U.S. Pat. 2,628,185
Percodan
\ • • N E W
FOR PAIN
LASTS LONGER . . .
usually for 6 hours or more
MORETHOROUGH RELIEF...
permits uninterrupted sleep through the night
RARELY CONSTIPATES . . .
excellent for chronic or bedridden patients
VERSATILE
New “demi” strength permits dosage flexibility to meet
each patient’s specific needs. PERCODAN DEMI provides
the Percodan formula with one-half the amount of salts
of dihydrohydroxycodeinone and homatropine.
AVERAGE ADULT DOSE: 1 tablet every 6 hours. May
be habit-forming. Available through all pharmacies.
Each Percodan'* Tablet contains 4.50 mg. dihydrohydroxyco-
deinone hydrochloride, 0.38 mg. dihydrohydroxycodeinone
terephthalate, 0.38 mg. homatropine terephthalate, 224 mg.
acetylsalicylic acid, 160 mg. phenacetin, and 32 mg. caffeine.
(Saits of Dihydrohydroxycodeinone
and Homatropine, plus APC)
TABLETS
ACTS FASTER...
usually within 5-15 minutes
ENDO LABORATORIES
Richmond Hill 18, New York
Percodan-
Demi
1038
Volume XLIV
Number 9
WOMAN’S AUXILIARY
TO THE
FLORIDA MEDICAL ASSOCIATION
OFFICERS
Mrs. Perry D. Melvin, President Miami
Mrs. Lee Rogers Jr., President-Elect Rockledge
Mrs. William D. Rogers. 1st Vice Pres. .. .Chattahoochee
Mrs. Leffie M Carlton Jr., 2nd Vice Pres Tampa
Mrs. Edward W. Ludwig, 3rd Vice Pres Jacksonville
Mrs. James M. Weaver, 4th Vice Pres.. .Fort Lauderdale
Mrs. Wendell J. Newcomb, Recording Sec’y ... .Pensacola
Mrs. Willard L. Fitzcerald, Treasurer Miami
Satisfaction Guaranteed
While visiting the various County Auxiliaries,
the subjects I am most often asked to discuss are
the need for an Auxiliary and the advantages of
belonging to an Auxiliary. To those of us who
have had the privilege of belonging to an active,
friendly, working auxiliary, these seem like super-
fluous questions since to us the answers are self
apparent but, with the influx of new doctors and
their wives into nearly every county in Florida,
these subjects become increasingly important.
Why an Auxiliary? According our Charter,
we exist primarily to cultivate friendly relations
and to promote mutual understanding among the
families of medical doctors; secondly, to carry
out projects and programs under the advice of
an advisory committee to the end that philan-
thropic and educational programs may be con-
ducted to assist in the betterment of health and
health needs of the people of Florida. All of
this sounds like a large order but with 2000, or
more, women doing their share, wonders can be
accomplished.
More valuable than the actual hours worked
in community projects, are the hours of pleasant
association spent with other women whose lives
and problems are similar to our own and with
whom we have mutual interests. Women from
all over the United States and foreign countries
too, whose lives would never touch ours if it
were not for the Auxiliary, become our friends.
New friends to be made for the small effort of
being friendly ourselves to the stranger in our
midst. Soon they are no longer strangers but our
dependable friends on whom we can call for help
and council in meeting the problems that are
faced in any organization.
One auxiliary in this state has adopted a “big
sister” program where every new member is
sponsored by an older member for the first six
meeting after she joins, and in another auxiliary
the president calls on every new doctor’s wife
as soon as her husband applies to the county
medical society. These women, who are made
For undue emotional stress
in the menopause
WRITE SIMPLY. . .
<
Also available as
PMB-400 (0.4 mg. "Premarin," 400 mg. meprobamate
in each tablet).
Supply:
No. 880, PMB-200
bottles of 60 and 500.
No. 881, PMB-400
bottles of 60 and 500.
PMB-200
"Premarin" with Meprobamate new potency
Each tablet contains 0.4 mg. "Premarin," 200 mg. meprobamate
AYERST LABORATORIES
New York 16, New York
Montreal, Canada
%
6830
"Premorin®" conjugated estrogens (equine)
Meprobamate licensed under U.S. Pat. No. 2,724,720
J. Florida M.A.
March, 1958
1039
*
A versatile, well-balanced formula offering in one tablet the
drugs often prescribed separately for treating upper respira-
tory infections.
Traditional and nonspecific nasopharyngeal symptoms
of malaise and chilly sensations are rapidly relieved, and
headache, muscular pain, and pharyngeal and nasal dis-
charges are reduced or eliminated.
Early effective therapy is provided against such bacterial
complications as sinusitis, otitis, bronchitis and pneumonitis
to which the patient may be highly vulnerable at this time.
Adult dosage for Achrocidin Tablets and new, caffeine-
free Achrocidin Syrup is two tablets or teaspoonfuls of
syrup three or four times daily. Dosage for children reduced
according to weight and age.
Available on prescription only.
checks
TABLETS (Sugar-coated)
Each tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Bottles of 24 and 100
SYRUP (Lemon-lime flavored)
Each teaspoonful (5 cc.) contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyrilamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
Bottle of 4 oz.
1040
Volume XLIV
Number 9
so welcome, cannot help but have the kindliest
feelings toward the other members of these auxi-
liaries and her feelings will be reflected by her
husband. Doctor’s Day is another effort on the
part of the Auxiliary to promote better relations
among doctors and their families.
As for the programs and projects we carry
out, the list goes on and on, and regardless of
any woman’s taste or talent there will be some-
thing she can do that will interest her and further
the aims and requests of the local medical so-
ciety. On the state level, we have eleven project
committees starting with the American Medical
Education Foundation and going on down through
the alphabet to Today’s Health, all of which in
some way are either educational or philanthropic
and conducive to the betterment of health. Our
larger auxiliaries can follow the state pattern but
in the smaller auxiliaries, we urge that they do
only what suits the needs of their community
to the limit of their womanpower.
Our members man the medical and health ex-
hibits at state and district fairs. At the annual
meeting of the Florida Medical Association, we
will aid in the project of giving physical exami-
nations to the members. We are providing prizes
for the two teachers whose pupils produce the
best health exhibits in the Senior and Junior Di-
vision at the State Science Fair. We sponsor the
66 Future Nurse Clubs and expect to have over
300 of these girls at their convention this spring.
I could go on and on but nothing I say can
add to the sense of real satisfaction that comes
to the women in the Auxiliary when they look
back on the worthwhile work done to further their
husband’s chosen profession and the pleasant and
lasting friendships that have come from this work.
Judith F. Melvin
BOOKS RECEIVED
Practical Gynecology. By Walter J. Reich, M.D.,
F.A.C.S., F.I.C.S., and Mitchell J. Nechtow, M.D.,
F.A.C.S., F.I.C.S. Ed. 2. Pp. 648. Illus. 284. Price,
$12.50. Philadelphia, J. B. Lippincott Company, 1957.
This is a book designed principally for use by the
general practitioner in the office practice of gynecology.
It places the diagnosis and treatment of female disorders
within the framework of medicine as a whole. Every
effort is made to practicalize and simplify, basing dis-
cussion solidly on the best in modern practice. At the
same time, through its concisely informative presentation,
the book manages to provide a complete coverage of the
entire field. A common sense evaluation of the emotion-
al implications for the patient of the various conditions
considered is a widely praised feature of the text.
Throughout the book there is full consideration of the
newer concepts and current practices in gynecology as
(Continued on page 1046)
couCfk/ Mf/u/p-
ANTITUSSIVE • DECONGESTANT • ANTIHISTAMINIC
CowbiuM :
pHuA
W LABORATORIES
NEW YORK 18, N Y,
Ejuk~tmpcm^il (4tt.) cm. tarn ■.
EXEMPT NARCOTIC
J. Florida M.A
March. 1958
1041
when you encounter
• respiratory infections
• gastrointestinal
infections
• genitourinary
infections
• miscellaneous
infections
for all
tetracycline-amenable
infections,
'prescribe superior
SUMYCIN
Squibb Tetracycline Phosphate Complex
Squibb
©
Squibb Quality—
the Priceless Ingredient
In your patients, sumycin produces:
1. Superior initial tetracycline blood levels-faster and higher
than ever before-assuring fast transport of adequate tetra-
cycline to the site of the infection.
2. High degree of freedom from annoying or therapy-inter-
rupting side effects.
Tetracycline phosphate
complex equiv. to
Supply: tetracycline HCl (mg.) Packaging :
Sumycin Capsules (per Capsule) 250 Bottles of 16 and 100
Sumycin Suspension (per 5 cc.) 125 2 oz. bottles
Sumycin Pediatric Drops 100 10 cc. dropper bottles
(per cc.— 20 drops)
•lUMYCtN’ 19
1042
Volume XLIV
Number 9
"hector"
Give Us Your Transportation Worries
OUR BENEFITS
TO YOU ARE
COMPLETE
RELEASE OF CAPITAL
New Automobiles
Any Make
No Worries Over
Taxes . . . Fees
Service Cost
Insurance
Repairs
License Fees
Towing Cost
Anti-Freeze
Battery Replacements
Tire Replacements
Inspection Registration
Fees
Piedwxt
Plan
FOR THE
MEDICAL
PROFESSION
EXCLUSIVELY
For Most of You, All This
is 100% Tax Deductible
WE COVER
YOU WITH—
LIABILITY INSURANCE
of, 100,000/300,000
Bodily injury and
50,000 for Property
Damage
You Are Protected
With 100% Coverage
On Collision, Fire
and Theft Insurance
and $2,000 Medical
Payment
If Your Car
Is Out of Service, You
Are Provided With a
Replacement
All Repairs, Tire &
Battery Replacement
Are Purchased In
Your Home Town
We are as near as your Telephone!
If You Would Like to Have Our Doctor's Leasing Plan Explained to You In Detail,
Please Call or Write. We will Manage to Have One of Our Representatives Call
On You at Your Convenience.
Piedmont
Auto and Truck Rental, Inc.
P. O. BOX 427 212 MORGAN STREET
DURHAM, NORTH CAROLINA PHONE 2-8151
G. B. Griffith, President
Relieve moderate or severe pain
Reduce fever
Alleviate the general malaise of
upper respiratory infections
TABLOID
3pbols
OF
PROVEN
PAIN
RELIEF
j
®
EMPIRIN
COMPOUND
CODEINE
PHOSPHATE
maximum codeine analgesia/optimum antipyretic action
*
‘Subject to Federal Narcotic Regulations
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
gr. 1
gr. %
gr. 'A
gr. %
...from pain of muscle and joint origin, simple headache, neuralgia,
and the symptoms of the common cold.
‘TABLOID’
EMPIRIN COMPOUND
Acetophenetidin gr. 2*4
f Aspirin ( Acetylsalicylic Acid) gr. 3}4
£P|m Caffeine gr. V2
L Am
...from mild pain complicated by tension and restlessness.
®
Phenobarbital gr. %
Acetophenetidin gr. 2V2
Aspirin (Acetylsalicylic Acid) gr. 3*/4
‘Subject to Federal Narcotic Regulations
J. Florida M.A.
March. 195b
1043
— and a glass
of beer, at
your discretion,
for a
morale-booster
indeed and
A few suggestions on how to give your patient a diet he can “stick to” —
The Low
Calorie Diet
A diet that calls for lamb chops when they
aren’t on the restaurant menu is an invitation
to “slip off.” But a diet outline that lets
your patient fill in the details provides incen-
tive to stick to his diet.
He must remember that a candy bar equals
a hamburger in calories only. An alternative
must be equivalent in nutrition, too.
Fresh fruits or vegetables such as celery
and radishes make good low-calorie nibbles.
Spices and herbs, lemon and vinegar add
zest with few or no calories.
Have your patient keep a calorie count.
Then with a glass of beer* to brighten meals, he
is more likely to follow a balanced diet later.
*104 Calories/8 oz. glass (Average of American Beers)
%
United States Brewers Foundation
Beer — America’s Beverage of Moderation
If you'd like reprints of 12 special diets, please write United States Brewers Foundation, 535 Fifth Avenue, New York 17, N. Y,
1044
Volume XI. fV
Number 9
FOR SERVICE -THE GUILD OPTICIAN
Good service is another extra that the ophthalmologist
knows he can take for granted when his patients have their
glasses made by their guild optician. Years of experience
have taught him that quick repairs and careful
adjustments are an integral part of pleasing the public
and helping them to better vision.
Guild of Prescription Opticians of Florida
f Florida M.A.
March, 1958
1045
To cut daytime lethargy
(and keep rauwolfia potency)
in treatment of hypertension:
Mounting clinical evidence
confirms the view that
Harmonyl produces much less
lethargy while reducing blood
pressure effectively. In the most
recent study1, Harmonyl was
evaluated in comparison with
reserpine and other rauwolfia
alkaloids. Harmonyl was the
only alkaloid which produced a
hypotensive response closely
matching that of reserpine,
coupled with a greatly reduced
rate of lethargy. Only one
Harmonyl patient in 20
showed lethargy, while an
average of 11 out of 20 showed
lethargy with reserpine, and 10
out of 20 with the ^
alseroxylon fraction. LUMjott
Ha tony!
(deserpidine, Abbott)
want
Rome up
by quitting
time...
for your hypertensives who must stay on the job
while the drug works effectively . .
. so does the patient
1. Comparative Effects of Various
Rauwolfia Alkaloids in Hypertension;
Diseases of the Chest, in press.
Volume XL1 V
Number 8
NO WAITING
in anxiety and hypertension
NEW fast-acting
Harmonyl-N*
(Harmonyl* and Nembutal ? )
Calmer days, more restful nights starting first day
• of treatment, through synergistic action of
Harmonyl ( Deserpidine, Abbott) and Nembutal
( Pentobarbital, Abbott). Lower therapeutic
doses, lower incidence of side effects. Each
Harmonyl-N Filmtab contains 30 mg. Nembutal
Calcium and 0.25 mg. Harmonyl. Each
Harmonyl-N Half-Strength Filmtab combines
15 mg. Nembutal Calcium and
0.1 mg. Harmonyl. (1 Mmtt
Filmtab Fn -„ealed tablets, Abbott, pat. applied for
eoio6o ^Trademark
(Continued, from page 1040)
well as authoritative description of basic and time-tested
methods and procedures. Nine entirely new chapters
have been added to this second edition: Cytology in
Gynecology, Acute Gynecologic Abdomen, Fibroids of
the Uterus, Tumors of the Ovary, Radiation Therapy in
Gynecology, Pediatric Gynecology, Geriatrics, The Role
of the Male in Gynecology, and Pitfalls in Gynecologic
Diagnosis. A section has been added on the diagnosis
of early pregnancy, and considerable new material has
been incorporated in the chapter on the examination of
the breast. Sixty-eight subjects are in color, and many
new and original photographs have been added. The
book lives up to its title.
Chronic Illness in the United States. Volume
I. Prevention of Chronic Illness. Commission on
Chronic Illness. Pp. 338. Price, $6.00. Published for
The Commonwealth Fund by Harvard University Press,
Cambridge, Massachusetts, 1957.
Prevention is the subject of this, the first volume of the
four volume report. Chronic Illness in the United States.
How can the concept of prevention be instilled in stu-
dents of medicine, nursing and social work, in health
education, and in related disciplines? What organiza-
tional patterns will be most effective for the administra-
tion of preventive programs? How can the public be
moved to adopt and support preventive measures? It is
these questions that this book is designed to explore.
Part I of this volume presents 21 conclusions and
recommendations concerning prevention which were
adopted by the Commission on Chronic Illness in Febru-
ary 1956. Part II is a series of summaries on the pre-
ventive aspects of most of the major chronic diseases and
impairments and on several of the most important factors
contributing to them. These summary statements, pre-
pared originally for the National Conference on the Pre-
ventive Aspects of Chronic Disease, were revised in 1956
by the persons or organizations originally responsible for
their preparation. Many of the summaries are followed
by bibliographies.
Physicians and medical social workers ; health and
welfare workers; and the research, teaching, practicing,
and nursing staffs of hospitals across the country will all
find that this book presents a valuable compendium of
information and of leads to further research. This is
another important Commonwealth Fund book.
Your Wonderful Body. By Peter Pineo Chase,
M.D. Pp. 391. Illus. 70. Price, $5.95. Englewood
Cliffs, N. J., Prentice-Hall, Inc., 1957.
Dr. Chase, distinguished physician, author and for
many years editor of the Rhode Island Medical Journal,
is at his best in this fascinating, factual and yet easy-to-
read account of the miraculous complexity of the human
body and how to keep it healthy. His cheerful, pithy
explanations help one understand how the body functions
in part and as a whole, the interconnection and inter-
dependence of all its elements, the change it undergoes
and its awe-inspiring power to renew itself. There is
sound medical advice on a variety of such vital subjects
as: the origin and development of the body; childbirth;
child-rearing; the skin, bones, and muscles; circulation
and blood; digestion, respiration and excretion; the
nervous system and sense organs; vitamins and hormones;
reproduction and heredity; rest and pain, inflammation,
immunity, repair; emotions; drugs; allergies; and a final
section on Dr. Chase’s inimitable medical philosophy.
Here, in this introduction for laymen to the fascinating
complexities of the human body, the reader finds an
admirable expression of the author’s personality and ex-
perience, his wit and humor, and his cheerful, optimistic
approach to good health and a long and happy life.
new for angina
links
freedom from
anginal attacks
with a shelter of
tranquility
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
In pain. Anxious. Fearful. On the road to cardiac
invalidism. These are the pathways of
angina patients. For fear and pain are inexorably
linked in the angina syndrome.
For angina patients — perhaps the next one who
enters your office— won’t you consider new
cartrax? This doubly effective therapy combines
petn (pentaerythritol tetranitrate) for lasting
vasodilation and atarax for peace of mind.
Thus cartrax relieves not only the anginal pain
but reduces the concomitant anxiety.
Dosage and supplied: begin with 1 to 2 yellow cartrax
“10” tablets (10 mg. petn plus 10 mg. atarax) 3 to 4 times
daily. When indicated, this may be increased for more
optimal effect by switching to pink cartrax “20” tablets
(20 mg. petn plus 10 mg. atarax.) For convenience, write
“cartrax 10” or “cartrax 20.” In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on
a continuous dosage schedule. Use petn preparations
with caution in glaucoma.
“ Cardiac patients who show significant manifestations of
anxiety should receive ataractic treatment as part of the
therapeutic approach to the cardiac problem.”1
I. Waldman, S., and Pelner, I..: Am. Pract. & Digest Treat. S:1075 (Inly) 1957.
•trademark
there’s pain and
inflammation here.,
it could be mild
or severe, acute
or chronic, primary
or secondary
fibrositis— or even
early rheumatoid
arthritis
more potent and
comprehensive
treatment than
salicylate alone
. . . assured anti-inflammatory
effect of low-dosage
corticosteroid'
. . . additive antirheumatic
action of corticosteroid
plus salicylate1"5 brings
rapid pain relief; aids
restoration of function.
. . . wide range of applicati
including the entire
fibrositis syndrome
as well as early or mild
rheumatoid arthritis
more manageable
corticosteroid dosag
. . . much less likelihood
of treatment-interrupti
side effects''6
. . . simple, flexible
dosage schedule
i conditions: Two or three
s four times daily. After
:d response is obtained,
tally reduce daily dosage
hen discontinue.
:ute or chronic conditions:
lly as above. When satisfactory
ol is obtained, gradually reduce
3 i ly dosage to minimum
ive maintenance level. For best
:s administer after meals and
dtime.
tutions: Because sigmagen
ins prednisone, the
precautions and
aindications observed
this steroid apply also
e use of SIGMAGEN.
in any case
it calls for
rcorticoid saticytate compound t3t)l6tS
Composition
Meticorten® (prednisone) 0.75 mg.
Acetylsalicylic acid 325 mg.
Aluminum hydroxide 75 mg.
Ascorbic acid 20 mg.
Packaging: Sigmagen Tablets, bottles of 100 and 1000.
References: 1. Spies, T, D., et al.: J.A.M.A. 159:645,
1955. 2. Spies, T. D,, et al.: Postgrad. Med. 17:1, 1955.
3. Gelli, G., and Della Santa, L.: Minerva Pediat.
7:1456, 1955. 4. Guerra, F.: Fed. Proc. 12:326, 1953.
5. Busse, E. A.: Clin. Med. 2:1105, 1955. 6. Sticker,
R. B.: Panel Discussion, Ohio State M. J. 52:1037, 1956.
SCHERING CORPORATION • BLOOMFIELD, N. J.
<~yc/cet//r,
Three advantages of
tf V ■ :r
glucosamine- potentiated
tetracycline:
in new
well -tolerated
COSA-TETRACYN
T. Florida M.A.
March, 1958
1051
How to provide unsaturated fatty acids
without dieting
'With type as well as amount of fat in the human
diet now assuming such importance, the new
role of com oil as a source of unsaturated fatty
acids has prompted these questions:
What is the role of unsaturated fats in
the daily diet?
There is now ample clinical evidence
that unsaturated fats tend to lower
the serum cholesterol level of human
subjects, whereas saturated fats have
the opposite effect.
How much of the important unsaturated
fatty acids does corn oil provide?
MAZOLA Corn Oil yields an average
of 85 per cent unsaturated fatty acids.
100 grams of MAZOLA will yield: 53
grams of linoleic acid and 28 grams of
oleic acid; it also provides 1.5 grams
of sitosterols, and only 12 grams of
saturated fatty acids.
What is the best way to provide unsatu-
rated fatty acids?
By balancing the types of fat in the
daily diet. Many doctors now agree
that from one third to one half of the
total fat intake should be in the form
of a vegetable oil such as corn oil
(MAZOLA).
1
^answer:
answer:
[ answer :
4 How is corn oil most easily taken in the
usual daily diet?
^ answer : There is no need to disturb the daily
routine of meals or to have separate
diets for individual members of the
family. MAZOLA Com Oil can be
used instead of solid fats in preparing
and cooking foods, it is also ideal for.
salad dressings.
5
How can
*~1
obtain further information on ,
the value of corn oil as a source of un-
saturated fatty acids?
answer: The subject is reviewed in the book
“Vegetable Oils in Nutrition.” Also
available is a recipe book for distribu-
tion to your patients. It tells how to
use corn oil in everyday meals. Both
books will be sent free of charge to
physicians, on request.
*
1052
Volume XLIV
Number 9
Therapeutic Nutrition in Chronic Disease
and Protein Nutrition
in Vascular Disease
\AAiether the eventual solution of the problem of
atherogenesis will come out of the field of dietetics, bio-
physics, or pharmacology, one fact remains undeniable:
Adequate protein nutrition is considered of impor-
tance for the age group most commonly affected by
disease of the vascular system, so that the demands of
good nutritional health might be met.
Meat is outstanding among protein foods. It supplies
all the essential amino acids, and closely approaches the
quantitative proportions needed for biosynthesis of
human tissue.
In addition, it is an excellent source of B vitamins,
including B« and B,2, as well as iron, phosphorus, potas-
sium, and magnesium.
When curtailment of fat intake is deemed indicated,
meat need not always be denied the patient. Visible fat
obviously should not be eaten. But the contained per-
centage of invisible (interstitial) fat is well within the
limits of reasonable fat allowance.
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nutri-
tion of the American Medical Association and found
consistent with current authoritative medical opinion.
American Meat Institute
Main Office, Chicago.-.Members Throughout the United States
J Florida M.A.
March, 1958
1053
when anxiety and tension "erupts” in the G. I. tract...
IN DUODENAL ULCER
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate (400 mg.) (he most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of duodenal ulcer — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON (25 mg.) (he anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ® Registered Trademark for Tridihexefhyl Iodide Lederle
LEDERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St., New York 3.
1054
Volume XLIV
Number 9
Gnderson Surgical Supply Go.
Established 191b
A COOD REPUTATION
It takes years to build, but can be
quickly destroyed.
It must be carefully guarded.
“A good name is rather to be chosen
than great riches.”
Distributors of Known Brands of Proven Quality
TELEPHONE 2-8504
MORGAN AT PLATT TELEPHONE 5-4362
P. O. BOX 1228 9th ST. & 6th AVE.. SO.
TAMPA 1, FLORIDA ST. PETERSBURG, FLORIDA
MEMBEli
when anxiety and tension "erupts” in the G. I. tract...
IN ILEITIS
PATHIBAMATE
Meprobamate with PATHILON® Lederle
*
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer . . . helps control
the “emotional overlay” of ileitis — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON (25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t. i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
^Trademark ® Registered Trademark for Tridihexethyl Iodide Lederle
LEOERLE LABORATORIES DIVISION, AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
The psychological needs of the elderly confront physicians with one of their most
perplexing problems. Perhaps no other patient group suffers so much from emo-
tional distress. Yet, precisely because of their age, geriatric patients often seem
beyond the reach of tranquilizing treatment.
When tranquilization seems risky . . .
They are too much beset by complicating chronic ailments, too susceptible to
serious side effects. Ataraxia is clearly indicated, yet the doctor cannot risk side
reactions on liver, blood or nervous system.
Is there an answer to this dilemma?
We feel there is. In four recent papers investigators have reported good results with
atarax in patients up to 90 years of age.* In one study, improvement was “pro-
nounced” in 76%, “good” in an additional 18.5%.* atarax has been successfully
used in such cases as senile anxiety, agitation, hyperemotivity and persecution
complex.* On atarax, patients became “. . . quieter and more manageable. They
slept better and demonstrated improved relations with other patients and hospital
personnel. Even their personal hygiene improved, and they required less super-
visory management.”*
. . . ATARAX is safe
ATARAX
n any
lyperemotive
state
or childhood behavior disorders
10 mg. tab!ets-3-6 years, one tab-
let t.i.d.; over 6 years, two tablets
t.I.d. Syrup — 3-6 years, one tsp.
t.i.d.; over 6 years, two tsp. t.i.d.
or adult tension and anxiety
25 mg. tablets — one tablet q.i.d.
Syrup-one tbsp. q.i.d.
or severe ematirmal disturbances
100 mg. tablets— one tablet t.i.d.
:or adult psychiatric and emotional
smergencies
Parenteral Solution-25-50 mg.
(1-2 cc.) intramuscularly, 3-4
times dally, at 4-hour intervals.
Dosage for children under 12 not
established.
Supplied: Tablets, bottles of 100. Syrup,
alnt bottles. Parenteral Solution, 10 cc.
multiple-dose vials.
Yet even in the aged, ATARAX has given "no evidence of toxicity. . . . Complete liver
function tests and blood studies were made on all patients after two months of
therapy. . . . There were no significant abnormalities.”* With still other elderly
patients “tolerance to the drug was excellent, even in cases where the patients
were given relatively high doses.”* Similarly, no parkinsonian effects have been ob-
served on ATARAX therapy.
Nor does ATARAX make your patients want to sleep all day. Instead, they can better
take care of themselves, because atarax leaves them both calm and alert. In sum,
ATARAX . . does not impair psychic function and has a minimum of side effects.
. . . It appears that atarax is a safe drug. . . .”*
These, undoubtedly, are the results you want when emotional problems beset your
geriatric patients. For the next four weeks, won't you prescribe tiny atarax tablets
or pleasant-tasting atarax syrup - both so readily acceptable to the elderly.
♦Documentation on request
ATARAX
(BRAND OF HYDROXYZINE)
Medical Director
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
1056
Volume XLIV
Number 9
YOUR OFFICE, DOCTOR, is the “cancer detection center” which we urge all adults
to visit once a year, and where early diagnosis of cancer can help save many thou-
sands of lives. It is upon you that we largely rely for the carrying out of many
aspects of our education, reseai'ch and service programs. As members of our Boards
of Directors — on the National, Division and Unit levels — it is your thinking and
your guidance which are such vital factors in creating and executing our policies
and programs.
You, of course, are concerned with all the ills affecting the human body. The
American Cancer Society deals specifically with cancer. But our mutual concern —
the tie that binds us inextricably— is the saving of human lives. Through your efforts,
we may soon say— “one out of every two cancer patients is being saved.” Indeed,
with your help, cancer will one day no longer be a major threat.
AMERICAN CANCER SOCIETY
AMERICAN CANCER SOCIETY, FLORIDA DIVISION, INC.
416 TAMPA STREET, TAMPA 2, FLORIDA
J. Florida M.A.
March, 1958
1057
’TffcUfcnactice Pra yfiAxflaxid.
I COVERAGE THAT SUFFICES,
NOT THAT WHICH ENTICES
Sfcetialijed Service
ou'i doctor <KZ^en.
THE I
MEDICAXPROTEGTIVEt CjOMPANj^
FpBT. Wayne, Inpiama-,
Professional Protection Exclusively
since 1899
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores , k
Tel. PLAZA 4-2703
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
RADIUM
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician.Radiologist)
HAROLD SWANBERG, 6.S., M.D., Director
W. C. U. Bldg. Quincy, Illinois
when anxiety and tension "erupts” in the G. I. tract...
in spastic
and irritable colon
PATH I BAM ATE
Meprobamate with PATHILON® Lederle
Combines Meprobamate ( 400 mg.) the most widely prescribed tranquilizer. . . helps control the
“emotional overlay” of spastic and irritable colon — without fear of barbiturate loginess, hangover or
habituation . . . with PATHILON {25 mg.) the anticholinergic noted for its extremely low toxicity
and high effectiveness in the treatment of many G.I. disorders.
Dosage: 1 tablet t.i.d. at mealtime. 2 tablets at bedtime. Supplied: Bottles of 100, 1,000.
‘Trademark ®
LEDERLE LABORATORIES DIVISION,
Registered Trademark (or Tridihexethyl Iodide Lederle
AMERICAN CYANAMID COMPANY, PEARL RIVER, NEW YORK
1058
Volume XLIV
Number 9
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dk. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
Westbrooks Sanatorium
RICHMOND • • • Established lQU • • - VIRGINIA
A. private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff t*AUL V. ANDERSON, M.D., President
REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request - P. O. Box 1514 - Phone 5-3245
J. Florida M.A.
March, 1958
1059
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5228 Nichol Si DON SAVAGE P. O. Box 10368
Telephone 61-4191 Owner and Manager Tampa 9. Florida
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1151
1060
Volume XLIV
Number 9
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
ASHEVILLE
APPALACHIAN HALL
Established 1916 NORTH CAROLINA
J. Florida M.A.
March, 1958
INDEX TO ADVERTISERS
1061
• Abbott Laboratories 1026a, 1027, 1028, 1029, 1030,
1031, 104S, 1046
• Allen’s Invalid Home 1062
• American Meat 1052
• Ames Co,, Inc. Third Cover
• Anclote Manor 1061
• Anderson Surgical Supply Co. 1054
• Appalachian Hall 1060
• Ayerst Laboratories 1038
• Ballast Point Manor 1059
• Bayer Co 1024
• Birtcher Corp 996
• Brawner’s Sanitarium 1062
• Brayten Pharmaceutical Co. 1010
• Bristol Laboratories 1036, 1037
• Bristol - Myers Co 1000
• Burroughs Wellcome & Co. 938, 942, 1042a
• Carlton Corp 1053
• Convention Press 1062
• Corn Products Refining Co. 944, 1051
• Daniel Rehabilitation Institute 994
• Davies, Rose & Co 1012
• Drug Specialties, Inc 946
• Duvall Home 1057
• Eaton Laboratories 997
• Endo Laboratories 1035
• Guild of Prescription Opticians 1044
• Highland Hospital, Inc 1060
• Hill Crest Sanitarium 1059
• Lakeside Laboratories 933
• Lederle Laboratories 995, 998, 999, 1005, 1008,
1009, 1015, 1016, 1017, 1033, 1039,
1053, 1054, 1057
Eli Lilly & Co 948
Medical Protective Co. 1057
Medical Supply Co. 1003
Merck Sharp & Dohme 940, 941, 945, 1006, 1007,
1013, 1022, 1023
Miami Medical Center 1063
Parke-Davis & Co. 2nd Cover, 931
Piedmont Auto & Truck Rental, Inc. 1042
Pfizer Laboratories 1050
Picker X-Ray Corp 936
Precision Instruments 994
Quincy X-Ray 1057
Reed & Carnrick 1026
Rich Company, Inc. 1032
A. H. Robins & Co. 1018, 1019, 1020, 1021
Roerig & Co 943, 1025, 1047, 1055
Schering Corp 947, 1048, 1049
Julius Schmid 1034
G. D. Searle Company 935, 993
Smith - Dorsey 937
Smith, Kline & French Labs. Back Cover
E. R. Squibb & Sons 934, 1011, 1041
Surgical Supply Co 1004
Tucker Hospital, Inc. ..... 1058
Upjohn Co. 1001, 1034a
U. S. Brewers Foundation 1043
Wallace Laboratories 938a, 939
Westbrook Sanatorium 1058
Winthrop Laboratories, Inc 1002, 1014, 1040
Information
Brochure
Rates
Available to Doctors
and Institutions
# Modern Treatment Facilities
# Psychotherapy Emphasized
9 Large Trained Staff
9 Individual Attention
# Capacity Limited
• Occupational and Hobby Therapy
9 Healthful Outdoor Recreation
O Supervised Sports
9 Religious Services
9 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
SAMUEL G. WARSON, M.D.
TARPON SPRINGS •
Consultants in Psychiatry
ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
• ON THE GULF OF MEXICO • PH. VICTOR 2-1811
FLORIDA
1062
Volume XLIV
Number 9
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY BOOK MINTING
PUBLICATIONS ■& BROCHURES
Convention
PRESS -
2 18 West Church St.
Jacksonville, Florida
i Allen’s Invalid Home I
i i
MILLEDGEVILLE, GA. 1
Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
5 Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
* ■ — +
BRAWNER’S SANITARIUM
Jas. N. Brawner, Jr., M.D
Medical Director
Albert F. Brawner, M.D.
Associate Director
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Member
Georgia Hospital Association, American Hospital Association
National Association of Private Psychiatric Hospitals
P.O. Box 218
HEmlock 5-4486
ESTABLISHED 1910
RIDA M.A.
i, 1958
SCHEDULE OF MEETINGS
1063
ORGANIZATION
ia Medical Association
ia Medical Districts
Northwest
Mortheast
Southwest
Southeast
ia Specialty Societies
emy of General Practice
;v Society
:hesiologists, Soc. of
Phys., Am. Coll., Fla. Chap.
latology, Soc. of
h Officers’ Society
strial and Railway Surgeons
nal Medicine
md Gynec. Society
hal. & Otol., Soc. of
ipedic Society
ilogists, Society of
trie Society
ic & Reconstructive Surgery
ologic Society
liatric Society
^logical Society
:ons, Am. Coll., Fla. Chapter
igical Society
da—
sic Science Exam. Board
)od Banks, Association
ae Cross of Florida, Inc
le Shield of Florida, Inc
ncer Council
abetes Assn
ntal Society, State
art Association
spital Association
?dical Examining Board
?dical Postgraduate Course
irse Anesthetists, Fla. Assn.
irses Association, State
armaceutical Assoc., State
blic Health Association
udeau Society
berculosis & Health Assn
man's Auxiliary
rican Medical Association
VI. A. Clinical Session
hern Medical Association
ama Medical Association
gia, Medical Assn, of
. Hospital Conference
heastern Allergy Assn
heastern, Am. Urological Assn,
heastern Surgical Congress ...
Coast Clinical Society
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Donald F. Marion, Miami
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax.
Howard M. Du Bose, Lakeland
DeWitt C. Daughtry, Miami
Mrs. Perry D. Melvin, Miami
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City ....
John A. Martin, Montgomery .
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
J. O. Morgan, Gadsden, Ala.
Lee Sharp, Pensacola
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax.
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola . .
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers ....
Nathan J. Schneider, Jax
Frank Cline Jr., Tampa
Mrs. R. H. McIntosh, Port St. Joe
Mrs. Wendell J. Newcomb, Pensa.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss...
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
J. J. Baehr Jr., Pensacola
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Miami Beach, May 1958
11 ft if if
if a it a
tf a a if
Miami Beach, April 19-20, ’58
Miami Beach, May 1958
if it a a
if a it a
fi if if fi
ff if ft if
a it n a
a it ft tf
ft ft ft a
a it a ii
if ii ii ii
if it it ii
it if ii ii
ii ii it it
Miami Beach, May 11, ’58
Miami, June 7, 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
If If ft ft
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
June 29, 1958
Jacksonville, May 18-21, ’58
Clearwater, April 25-26, ’58
Miami Beach, May 10-14, ’58
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Montgomery, Apr. 17-19, ’58
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Pensacola, Oct. 23-24, ’58
MIAMI MEDICAL CENTER f
P. L. Dodge, M.D. <|
Medical Director and President x
1861 N.W. South River Drive X
Phones 2-0243 — 9-1448 |
A private institution for the treatment of ner- <s>
vous and mental disorders and the problems of $
drug addiction and alcoholic habituation. Modern $
diagnostic and treatment procedures — Psycho- y
therapy. Insulin, Electroshock, Hydrotherapy, y
Diathermy and Physiotherapy when indicated, y
Adequate facilities for recreation and out-door y
activities. Cruising and fishing trips on hospital y
yacht. <>
Information on request X
.Member American Hospital Association X
1064
Volume XLIV
Number 9
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
WILLIAM C. ROBERTS, M.D., President . .Panama City
JERE W. ANNIS, M.D., Pres.-EIect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . Jacksonville
SHALER RICHARDSON, M.D., Editor. Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR., M.D. ..AL-58 Ocala
GEORGE S. PALMER, M.D... A-58 Tallahassee
CLYDE O. ANDERSON, M.D... C-59 St. Petersburg
REUBEN B. CHRISM AN JR., M.D. D-60. .Coral Gables
MEREDITH MALLORY, M.D. B-61 Orlando
JOHN D. MILTON, M.D. PP-58 Miami
FRANCIS H. LANGLEY, M.D.. . PP-59. . . St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio Jacksonville
EDWARD JELKS, M.D. (Public Relations) . .Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
t. Veterans Care
FREDERICK H. BOWEN, M.D. Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory).- Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
S. CARNES HARVARD, M.D., Chm AD58 Brooksville
First— ALPHEUS T. KENNEDY, M.D 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D 3-58 Jacksonville
Fourth— DON C. ROBERTSON, M.D 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D. 5-59 Sarasota
Sixth— GORDON H. McSWAIN, M.D—.6-58 Arcadia
Seventh— RALPH M. OVERSTREET JR., M.D
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D...... 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
TOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm Orlando
THOMAS H. BATES, M.D. “A” Lake City
FRANK L. FORT, M.D. ‘'B" Jacksonville
ALVIN I.. MILLS, M.D. “C” St. Petersburg
JOHN D. MILTON, M.D “D” Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm C-61 Tampa
EEC) E. REILLY, M.D. AL-58 Panama City
ROBERT B. McIVER, M.D B-58 Jacksonville
GUI TCI 1 1 .\ V SOU I RES. M.D. A 59 .... Pensacola
DON /ID W. SMITH, M.D D-60 - Miami
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A-58 Tallahassee
JOHN J. CHELEDEN, M.D. B-58 Daytona Beach
JOHN M. BUTCHER, M.D. C 58 Sarasota
PAUL G. SHELL, M.D. D-58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
HENRY L. HARRELL, M.D. B-59 Ocala
JAMES R. BOULWARE JR., M.D C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 W. Palm Beach
MERRITT R. CLEMENTS, M.D A-60 Tallahassee
ROBERT E. ZELLNER, M.D. B-60.._ Orlando
WHITMAN C. McCONNELL, M.D. C-60 St. Petersburg
RALPH S. SAPPENFIELD, M.D. D 60 Miami
HAROLD E. WAGER, M.D. A 61 Panama City
CHARLES F. McCRORY, M.D. B-61 Jacksonville
JOHN S. STEWART, M.D. C-61 Fort Myers
DONALD F. MARION, M.D. D 61 Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 .... Miami
BARCLEY D. RHEA, M.D A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm D 58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D. AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D. A 60 Tallahassee
J. K. DAVID JR., M.D. B-61 Jacksonville
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm AL-58 Orlando
WILLIAM W. TRICE JR., M.D C-58 Tampa
JOHN V. HANDWERKER JR., M.D D-59 JWiami
WALTER C. PAYNE JR., M.D A-60 Pensacola
W. DEAN STEWARD, M.D B-61 Orlando
CONSERVATION OF VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orlando
HUGH E. PARSONS, M.D. C-58 Tampa
CHARLES C. GRACE, M.D B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D D-61 W. Palm Beach
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D ..._ St. Petersburg
JOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D _ Orlando
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 W. Palm Beach
GEORGE H. GARMANY, M.D A-61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
MATERNAL WELFARE
E. FRANK McCALL, M.D., Chm B-60 Jacksonville
WILLIAM C. FONTAINE, M.D AL-58 Panama City
J. LLOYD MASSEY M.D A-58 Quincy
RICHARD F. STOVER, M.D D-59 Miami
S. L. WATSON, M.D C-61 - Lakeland
J. Florida M.A.
March, 1958
1065
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm AL.58 Orlando
DEWITT C. DAUGHTRY, M.D. D 58 Miami
S. CARNES HARVARD, M.D C-59 Brooksville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm. B-60 Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D 58 Miami
RICHARD REESER JR., M.D C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D 58 Coral Cables
PAUL J. COUGHLIN, M.D. AL 58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. B 60 Gainesville
RAYMOND B. SQUIRES, M.D. A 61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL 58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D. B 58 Gainesville
JAMES N. PATTERSON, M.D. C-61 Tampa
EDWARD W. CUI.I.IPHF.R, M.D 1) 59 Miami
HOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MI)., Chm. A-60
NF.I.SON II. KRAF.FT, M.D. AI. 58
WILLIAM L. MUSSER, M.D. I! 58
whitman ii. McConnell, m.d. c 59
DONALD W. SMITH, M.D. 1) 61
Chattahoochee
Tallahassee
Winter Park
St. Petersburg
Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. ......B-61 Jacksonville
HENRY I. LANGSTON, M.D AL-58 Apalachicola
JOHN G. CHESNEY, M.D D-58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D A 60 Wewahitchha
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm. B 59 Jacksonville
LEO M. WACHTEL, M.D AI.-58 Jacksonville
C. FRANK CHUNN, M.D. C-58 Tampa
WILLIAM D. CAWTHON, M.D. A-60 DeFuniak Springs
V. MARKLIN JOHNSON, M.D. D 61 W. Palm Beach
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D AL-58 Pensacola
J. LLOYD MASSEY, M.D A-58..: Quincy
W. TRACY HAVERFIELD, M.D D 59 Miami
MASON TRUPP, M.D C-60 Tampa
NECROLOGY
J. BASIL HALL, M.D., Chm AL-58 Tavares
WALTER W. SACKETT JR., M.D D 58 Miami
LEO M. WACHTEL, M.D B-59 Jacksonville
ALVIN L. STEBBINS, M.D A-60 Pensacola
RAYMOND H. CENTER, M.D C-61 Clearwater
NURSING
THOMAS C. KENASTON, M.D., Chm B-59 Cocoa
CARL M. HERBERT, M.D AL-58 Gainesville
HERBERT L. BRYANS, M.D A-58 Pensacola
NORVAL M. MARR SR., M.D C-60 St. Petersburg
JAMES R. SORY. M.D D-61 „....W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B-59 Jacksonville
JOHN J. BENTON, M.D. AL-58 Panama City
GEORGE S. PALMER, M.D. A-58 Tallahassee
EDWARD W. CULLIPHER, M.D D-60 Miami
FRANK H. LINDEMAN JR., M.D. C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
PASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
WILLIAM J. HUTCHISON, M.D AL 58 Tallahassee
CHAS. L. FARRINGTON, M.D C-58 St. Petersburg
THOMAS N. RYON, M.D. I) 59 Miami
RAYMOND R. KILLINGER, M.D. 15 61 Jacksonville
Special Assignment
1. Industrial Health
C. W. SHACKELFORD, M.D., Chm. A-61 Panama City
FRANK V. CHAPPELL, M.D. AI.-58 Tampa
A. BUIST LITTERER, M.D. D-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
LORENZO L. PARKS, M.D. B 60 Jacksonville
WOMAN’S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
JOHN H. TERRY, M.D AL-58 Jacksonville
WILEY M. SAMS, M.D. D-58 Miami
G. DEKLE TAYLOR, M.D B-59 Jacksonville
CHARLES McC. GRAY, M.D C-61 Tampa
A. M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 — Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D, 1934 Miami
HERBERT L. BRYANS, M.l)., 1935 Pensacola
ORION O. FEASTE1J, M.D., 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. 1 HOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART. M l).. 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Attgustitie
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. McJVER. M.l) . 1952 Jacksonville
FREDERICK K. HERPEL, M.D, 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
l()ll\ 1). Mil TON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
1066
Volume XLIV
Number 9
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O
AN AMES CLINIQUICK
CLINICAL BRIEFS FOR MODERN PRACTICE
what are the 7 “dont’s”
of office psychotherapy?
(1) Don't argue — let patient “talk out” his troubles. (2) Don’t counsel — help
him solve his own problems. (3) Don’t be hostile — allow patient to express
hostility without reciprocating. (4) Don’t be unsure — stress significance of
normal or abnormal physical findings in relation to symptoms. (5) Don’t be
too reassuring — overoptimism may suggest you take the symptoms too
lightly. (6) Don’t approve or censure. (7) Don’t be too credulous— patients’
words mayconceal hidden meanings.
Source — Hyman, M.: Some Aspects of Psychiatry in General Practice, GP 76:83
(Oct.) 1957.
calmative NOSTYN®
Ectylurea, Ames
(2-ethyl-ciT-crotonylurea)
for tranquil— not “tranquilized” patients
“Anxiety and nervous tension states appeared to be most benefited The patients
experienced and expressed a feeling of greater inward security, serenity Mental
depression, one of the undesirable side actions in many other sedatives, did not
develop in any of the patients ”*
*Bauer, H. G.; Seegers, W.; KrawzofT, M., and McGavack, T. H.: A Clinical Evaluation
of Ectylurea (Nostyn®), in press.
dosage: Children— 150 mg. (Vi tablet) three or four times daily. Adults— 150-300
mg. QA to 1 tablet) three or four times daily.
supplied: 300 mg. scored tablets; bottles of 48 and 500.
AMES COMPANY, INC • ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto 442s8
2
:;£* YORK
^VG DlCI N
2 C J 0 3RD
NCW YORK
ACADtVY OF
t
N V 29 j C-E
Smith Kline & French Laboratories , Philadelphia
if
in G.l. disorders
‘Compazine’ controls tension
—often brings complete relief
In such conditions as gastritis, pylor-
ospasm, peptic ulcer and spastic
colitis, ‘Compazine’ not only re-
lieves anxiety and tension, but also
controls the nausea and vomiting
which often complicate these
disorders.
Physicians who have used ‘Com-
pazine’ in gastrointestinal disorders
— often in chronic, unresponsive
cases — have had gratifying results
(87% favorable).
Compazine
the tranquilizer and antiemetic
remarkable for its freedom from
drowsiness and depressing effect
Available: Tablets, Ampuls, Multi-
ple dose vials, Spansule" sustained
release capsules, Syrup and Sup-
positories.
*T.M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
APRIL, 1958 ^
Vol. XLIV
FLORI DA ME DICAL association
OFFICIAL PUBLICATION OF THE
FLORIDA MEDICAL ASSOCIATION
ORAL
progestational agent
with
unexcelled potency
and
unsurpassed efficac ;
in functional uterine bleeding
•unctional uterine-bleeding is usually due
0 failure of ovulation with sustained estrogenic
timulation of the endometrium in the absence
>f progesterone. The most effective type
>f hormone in arresting a bout of functional uterine
deeding is a progestational agent.1 Administered
>rally, NORLUTIN produces presecretory to secretory
tnd marked progestational endometrium in
1 to 14 days.1-3 The return of normal menstruation
requently can be induced by continued cyclic
herapy with NORLUTIN during successive months.
case summary
A 44-year-old woman had spotting and bleeding
for 10 days. She was treated with NORLUTIN,
10 mg. twice daily for 4 days. Bleeding stopped
during medication and 24 to 72 hours after
cessation of therapy normal withdrawal
bleeding occurred.
References: (I) Greenblatt, R. B., & Clark, S. L.:
M. Clin. North America, Philadelphia,
W. B. Saunders Company (Mar.) 1957, p. 587.
(2) Greenblatt, R. B.: /. Clin ■ Endocrinol.
16: 869, 1956. (3) Hertz, R.; Waite, J. H.,
& Thomas, L. B.: Proc. Soc. Exper. Biol, i? Med.
91: 418, 1956.
T.M.
( norethindrone, Parke-Davis )
indications for norlutin: conditions involving deficiency
of progesterone such as primary and secondary amenorrhea,
menstrual irregularity, functional uterine bleeding,
endocrine infertility, habitual abortion, threatened abortion,
premenstrual tension, and dysmenorrhea.
packaging: 5-mg. scored tablets (C. T. No. 882), bottles of 30.
PARKE, DAVIS & COMPANY • DETROIT 32, MICHIGAN
4*058
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
volume xliv, No. io ♦ April. 1958
CONTENT S
Scientific Articles
New Technics in the Study of Carcinoma of the Uterine
Cervix, Sam W. Denham, M.D., and Alvan G. Foraker, M.D. 1089
Abdominal Aortic Aneurysm, Harold C. Spear, M.D., DeWitt
C. Daughtry, M.D., and John G. Chesney, M.D. 1091
Gastroschisis, Report of a Case, Forrest Hinton, M.D. 1097
Choledochal Cyst, Frederick H. Bowen, M.D. 1099
Benign Myalgic Encephalomyelitis, Irvin M. Greene. M.D. 1105
Abstracts
Drs. Arthur R. Nelson and Maurice Rich 1106
Eighty-Fourth Annual Convention
General Information 1108
Meetings of Specialty Societies 1109
First Meeting House of Delegates 1113
General Session 1114
Scientific Assemblies 1115
Second Meeting House of Delegates 1116
Technical Exhibits 1117
Scientific Exhibits 1117
Woman’s Auxiliary, Thirty-First Annual Meeting 1118
Editorials and Commentaries
Association’s Annual Convention, Bal Harbour, May 10-14, 1958 1125
Is It Martyrdom To Serve? 1127
The County Medical Society Lay Executive Secretary 1128
First Permanent Disability Guide Published 1129
A. M. A. Administrative Changes 1130
Florida Medical Foundation Progress Report 1131
Southern Railway Surgeons Meet in Jacksonville, April 14-15, 1958 1132
1957-1958 Fair Exhibits Attract Large Crowds 1133
Fifth Biennial Cardiovascular Seminar, Miami, April 23-26, 1958 1136
General Features
Blue Shield
Blue Shield — The Doctors’ Plan 1137
Panel 1 141
Condensation of Questions, Answers and Discussion 1145
Others Are Saying 1147
State News Items 1148
Component Society Notes 1156
Medical Officers Returned 1160
New Members 1161
Classified 1166
Obituaries 1167
Books Received 1178
Schedule of Meetings 1195
Florida Medical Association Officers and Committees 1196
County Medical Societies of Florida .> 1198
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville. Florida. Price So. 00 a year: single numbers. 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411. 735 Riverside Ave.. Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail-
ing ai snecial rate of oostage provided for in Section 1103, Act of Congress of October 3, 1917; authorized October 16.
1918. Entered as second-class matter under Act of Congress of March 3, 1879, at the post office at Jacksonville.
Florida. October 23, 1924
f. Florida M.A.
April, 1958
1073
ANNOUNC I NG
EXHIBITS * ON -FILM
The Filmstrip Library
Of Scientific Exhibits
a unique new medical communications service — produced by the
Medical Education Department, Lakeside Laboratories, Inc.
Significant scientific exhibits at medical meetings throughout the nation
will be preserved on film... permanently available for study by the
thousands of physicians anxious to keep up with the newest develop-
ments in medicine and surgery.
These filmstrips, together with recorded commentaries, will be given
on request to Medical Schools, County, State and Sectional Medical
Societies, not as a loan but as a permanent contribution.
ready now for distribution
Six widely acclaimed scientific exhibits selected from those at the 106th Annual
Meeting, American Medical Association, New York, June 3-7, 1957.
FILMSTRIP 1 Part I The Present Indications for Cardiac Surgery •
Robert P Glover, Julio C. Davila and Robert G. Trout (Philadelphia) • Billings Gold
Medal for excellence in the correlation and presentation of facts • Part II Oral
Organomercurial Diuretics • Sim P Dimitroff and George C. Griffith (Los Angeles)
FILMSTRIP 2 Part I The Hands in Arthritis and Related Conditions •
Darrell C. Crain (Washington, D. C.) • Certificate of Merit • Part II Intra-
muscular Iron for the Treatment of Iron Deficiency Anemia in Infancy • Ralph O.
Wallerstein, and M. Silvija Hoag (San Francisco)
FILMSTRIP 3 Parti Bronchial Asthma • John W. Irwin, Irving H. Itkin,
Sandylee Weille and Nancy Little (Boston) • Honorable Mention Award • Part II
The Direct (Open) Surgical Repair of Congenital and Acquired Intracardiac Mal-
formations • C. W. Lillehei, H. E. Warden, R. A. DeWall, V L. Gott, R. D. Sellers,
M. Cohen, R. C. Read, R. L. Varco and O. H. Wangensteen (Minneapolis) • Hektoen
Gold Medal for originality and excellence of presentation in an exhibit of original
investigation
Officers of Medical Societies and Medical School libraries wishing to start their
library of Filmstrips of Scientific Exhibits now, should address their requests to:
EXHIBITS-ON-FILM, Medical Education Department, Lakeside Laboratories,
Inc., Milwaukee 1, Wisconsin
Individual physicians who wish to arrange showings such as at hospital staff meetings
should contact the secretary of their Medical Society or Medical School librarian.
"Rheumatoid arthritis is a constitutional disease with symptoms affecting chiefly joints and muscles.”1 "Pain
in the affected joint is accompanied by splinting of the adjacent muscles, with resultant ‘muscle spasm.' "2
T. Florida M.A.
April, 1958
1075
MEPR0L0NE is the only anti-
rheumatic-antiarthritic designed to
relieve simultaneously (a) muscle
spasm (b) joint-muscle inflammation
(c) physical distress ... and may
thereby help prevent deformity and
disability in more arthritic patients
to a greater degree than ever before.
SUPPLIED: Multiple Compressed
Tablets in two formulas:
MEPROLONE-2— 2.0 mg.
prednisolone, 200 mg. meprobamate
and 200 mg. dried aluminum
hydroxide gel (bottles of 100).
MEPROLONE-1— supplies 1.0 mg.
prednisolone in the same formula as
MEPROLONE-2 (bottles of 100).
1. Comroe's Arthritis: Hollander, J. L., p. 149 (Fifth
Edition. Lea & Febiger, Philadelphia, Pa. 1953).
2. Merck Manual: Lyght, C. E., p. 1102 (Ninth
Edition, Merck & Co., Inc.. Rahway, N. J. 1956).
THE FIRST MEPROBAMATE PREDNISOLONE THERAPY
meprobamate to relieve muscle spasm
prednisolone to suppress inflammation
relieves both
muscle spasm
and joint inflammation
MERCK SHARP & D0HME Philadelphia 1, Pa.
Division of MERCK & CO., Inc.
rheumatoid arthritis
involves both
joints and
muscles
only
1076
Volume X 1.1 V
Number 10
Q pETN + Q ATARAX^)
(PENTAERYTHRlTOL TETRAN ITRATe) (BRAND OF HYDROXYZINE)
Willi PETN ? F°r cardiac effect: PETN is . . the most effective drug:
•d ' currently available for prolonged prophylactic treatment
of angina pectoris.”1 Prevents about 80% of anginal attacks.
luhy ATARAX?
For ataractic effect: One of the most effective— and probably
the safest— of tranquilizers, ATARAX frees the angina patient
of his constant tension and anxiety. Ideal for the on-the-job
patient. And atarax has a unique advantage in cardiac
therapy: it is anti-arrhythmic and non-hypotensive.
why combine the two ?
For greater therapeutic success: In clinical trials, cartrax
was demonstrably superior to previous therapy, including
petn alone. Specifically, 87% of angina patients did better.
They were shown to suffer fewer attacks . . . require less
nitroglycerin . . . have increased tolerance to physical effort
. . . and be freed of cardiac fixation.
NEW YORK 17, NEW YORK
Division, Chas. Pfizer & Co., Ine.
1. Russek, H. I.: Postgrad. Med. 19: 562 (June) 1956.
Dosage and Supplied: Begin with 1 to 2 yellow cartrax "10”
tablets (10 mg. PETN plus 10 mg. atarax) 3 to 4 times daily.
When indicated this may be increased by switching to pink cartrax
■■20" tablets (20 mg. petn plus 10 mg. atarax.) For convenience,
write “CARTRAX 10” or "cartrax 20.” In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on a
continuous dosage schedule. Use petn preparations with caution
•Trademark in glaucoma.
T. Florida M.A.
April, 1958
1077
SYNTHETIC BILIARY ABSTERGENT
ZANCHOE
(brand of florantyrone)
Fills an Important Postcholecystectomy Need
The excellent results with Zanchol in pa-
tients whose gallbladders have been re-
moved have been most pronounced in two
phases of management:
1. Early— Zanchol in Postoperative Care.
T-tube studies have demonstrated that
Zanchol increases the volume and fluidity
of bile, at the same time changing its color
to a clear, brilliant green. The greatly im-
proved abstergent cleansing action of the
bile is noted in its ability to keep the T
tubes clean1 without rinsing in most cases.
2. Late— Zanchol in Postcholecystectomy
Syndrome. By improving the physico-
chemical properties of bile and increasing
its flow, Zanchol acts to eliminate biliary
stasis and sharply reduce or eliminate bil-
iary sediment. The drug may be employed
in both prophylaxis and therapy of the post-
cholecystectomy syndrome.
Medical Indication for Zanchol
This includes the treatment of patients
with chronic cholecystitis for which sur-
gery is not required or may be impossible
for any reason.
Dosage: one tablet three or four times
daily. Tablets of 250 mg. each.
G. D. Searle & Co., Chicago 80, Illinois.
Research in the Service of Medicine.
1. McGowan, J. M.: Clinical Significance of Changes in
Common Duct Bile Resulting from a New Synthetic
Choleretic, Surg., Gynec. & Obst. /Oi.163 (Aug.) 1956.
s
1078
Volume XLIV
Number 10
"hector "
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It You Would Like to Have Our Doctor's Leasing Plan Explained to You In Detail,
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DURHAM, NORTH CAROLINA PHONE 2-8151
G. B. Griffith, President
J. Florida M.A.
April, 1958
1079
SANBORN VISETTE
Miami Branch Office
1545 S. W. 8th St.
Franklin 3-5493 8c 3-5494
St. Petersburg Branch Office
1221 Arlington Ave. N.
St. Petersburg 7-3229
electrocardiograph
Everything you need for taking an accurate, permanent, directly-
recorded electrocardiogram is now available in a “package” the
size of a portable typewriter, and that weighs only 18 pounds!
This is the new Model 300 VISETTE — a completely modern,
transistorized ECG recently introduced by Sanborn Company.
The unique design has made possible for the first time a clinically
accurate instrument that is truly compact and fully portable.
By actual use — in your own examining room, in your patient’s
home, at a hospital — you can discover the Visette’s value and
portability. Convenience of use, greater ease of operation — and
even simpler, faster servicing, should the need arise — comprise
the design concept of this new Sanborn instrument.
A comprehensive folder describing the Model 300 VISETTE
electrocardiograph is available on request. Or call the Sanborn
Company Branch Office or Service Agency in your locality for a
demonstration in your office — to see for yourself the advantages
of owning the ECG that “brings ’cardiography to your patient.”
The established Sanborn Model 51 Viso-Cardiette is also
available for those who prefer a larger, heavier (34 lbs.)
instrument — $785.00, delivered. Many doctors use their
"51 Viso" in the office and the Visette on "cardiograph calls."
SANBORN COMPANY
MEDICAL DIVISION
175 Wyman Street, Waltham 54, Mass.
there’s pain and
inflammation here,
it could be mild
or severe, acute
or chronic, primary
or secondary
fibrositis— or even
early rheumatoid
arthritis
more potent and
comprehensive
treatment than
salicylate alone
. . . assured anti-inflammatory
effect of low-dosage
corticosteroid'
. . . additive antirheumatic
action of corticosteroid
plus salicylate2-5 brings
rapid pain relief; aids
restoration of function.
. . . wide range of applicatic
including the entire
fibrositis syndrome
as well as early or mild
rheumatoid arthritis
more manageable
corticosteroid dosage
. . . much less likelihood
of treatment-interruptir
side effects'-6
. . . simple, flexible
dosage schedule
e conditions: Two or three
its four times daily. After
ed response is obtained,
ually reduce daily dosage
then discontinue,
icute or chronic conditions:
ally as above. When satisfactory
rol is obtained, gradually reduce
Jaily dosage to minimum
.tive maintenance level. For best
Its administer after meals and
adtime.
autions: Because sigmagen
ains prednisone, the
e precautions and
raindications observed
this steroid apply also
ie use of SIGMAGEN.
SCHERING CORPORATION • BLOOMFIELD, N. J.
ea
m any case
it calls for
tablets
corttcoid-salicylate compound
Composition
Meticorten® (prednisone) 0.75 mg.
Acetylsalicylic acid 325 mg.
Aluminum hydroxide 75 mg.
Ascorbic acid 20 mg.
Packaging: Sigmagen Tablets, bottles of 100 and 1000.
References: 1. Spies, T. D., et at.: J.A.M.A. 159:645,
1955. 2. Spies, T. D„ et al.: Postgrad. Med. 17:1, 1955.
3. Gelli, G., and Della Santa, L.: Minerva Pediat.
7:1456, 1955. 4. Guerra, F.: Fed. Proc. 12:326, 1953.
5. Busse, E. A.: Clin. Med. 2:1105, 1955. 6. Sticker,
R. B.: Panel Discussion, Ohio State M. J. 52:1037, 1956.
1082
Volume XLIV
Number 10
respiratory infections
gastrointestinal infections
genitourinary infections
miscellaneous infections
immediate
therapeutic
response
use
intramuscular
with Xylocaine*
250 mg. per 1 dose vial
tlOO mg. per 1 dose vial
■ when oral therapy is contraindicated (vomiting, dysphagia,
intestinal obstruction, gastrointestinal disorders)
■ when the patient is comatose or in shock
■ postoperatively
1. fast peak blood and tissue concentrations
E — J 2. high cerebrospinal levels
3. for practical purposes, Sumycin is sodium-free
Each vial contains tetracycline phosphate complex equivalent
to 250 mg., or 100 mg., of tetracycline HCI. (Note: 250 mg.
dose may produce more local discomfort than the 100 mg.
dose.)
FLEXIBLE DOSAGE FORMS FOR CONTINUING ORAL THERAPY
Tetracycline phosphate
complex equiv.
tetracycline HCI (mg.) Packaging
Capsules (per capsule) 250 Bottles of
16 and 100
Half Strength Capsules
(per capsule)
Bottles of
16 and 100
Suspension
(per 5 cc. teaspoonful)
60 cc. bottles
Pediatric Drops
(per cc.— 20 drops)
10 cc. bottles
with dropper
Squibb
Squibb Quality— the Priceless Ingredient
J. Florida M.A.
April, 1958
1083
there is one tranquilizer clearly indicated ill peptic lllCGr...
*Tests in a series of 25 patients show that
there is “a definite and distinct lowering
[of both volume of secretions and of free
hydrochloric acid] in the majority of
patients. . . . No patients had shown any
increase in gastric secretions following ad-
ministration of the drug.”1
Now you have 4 advantages when
you calm ulcer patients with atarax:
1. atarax suppresses gastric secretions;
others commonly increase acidity.
2. atarax is “the safest of the mild tran-
quilizers.”2 (No parkinsonian effect
or blood dyscrasias ever reported.)
3. It is effective in 9 of every 10 tense
and anxious patients.
4. Five dosage forms give you maximum
flexibility.
supplied: 10, 25 and 100 mg. tablets, bottles of
100. Syrup, pint bottles. Parenteral Solution,
10 cc. multiple-dose vials.
references: 1. Strub, I. H. : Personal commu-
nication. 2. Ayd, F. J., Jr.: presented at Ohio
Assembly of General Practice, 7th Annual
Scientific Assembly, Columbus, September 18-
19, 1957.
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
1084
Volume XLIV
Number 10
NOW... A NEW TREATMENT
’Cardilate' tablets J? shaped for easy retention
in the buccal pouch
. . the degree of increase in exercise tolerance which sublingual ery-
throl tetranitrate permits, approximates that of nitroglycerin, amyl
nitrite and octyl nitrite more closely than does any other of the approxi-
mately 100 preparations tested to date in this laboratory.”
“Furthermore, the duration of this beneficial action is prolonged suffi-
ciently to make this method of treatment of practical clinical value.”
Riseman, J. E. F., Altman, G. E., and Koretsky, S.:
Nitroglycerin and Other Nitrites in the Treatment of
Angina Pectoris, Circulation (Jan.) 1958.
♦‘Cardilate’ brand Erythrol Tetranitrate SUBLINGUAL TABLETS, 15 mg. scored
BURROUGHS WELLCOME & CO. (U.S.A.) INC.. Tuckahoe, New York
J. Florida M.A.
April, 1958
1085
New. . .
meprobamate
prolonged
¥A AQOA
L uluaou
capsules
Evenly sustain relaxation of mind and muscle round the clock
TWO MEPROSPAN CAPSULES IN THE MORNING
RELIEVE ANXIETY. TENSION AND SKELETAL MUS-
CLE SPASM THROUGHOUT THE DAY.
TWO MEPROSPAN CAPSULES AT BEDTIME
PROVIDE UNINTERRUPTED SLEEP THROUGH-
OUT THE NIGHT.
Meprospan*
MEPROBAMATE IN PROLONGED RELEASE CAPSULES
• maintains constant level of relaxation
■ minimizes the possibility of side effects
■ simplifies patient’s dosage schedule
Dosage: Two Meprospan capsules q. 12 h.
Supplied : Bottles of 30 capsules.
Each capsule contains:
Meprobamate (Wallace) 200 mg.
2-methyl -2-n-propyl- 1,3-propanediol dicarbamate
Literature and samples on request.
WALLACE LABORATORIES, New Brunswick, N. J.
* TRADE -HAftR CME-6S98-48 W
1086
Volume XLIV
Number 10
DIABETES FOLLOWING TRANSIENT GLYCOSURIA*
AMES
CLINIQUICK
CLINICAL BRIEFS FOR MODERN PRACTICE
should a non-diabetic.
transient glycosuria ever be
considered unimportant?
Never. A patient showing even a mild transient glycosuria should
be observed for years as a diabetic suspect.*
Ultimate diagnosis on 126 patients with a previous transient mild
glycosuria. Twenty diabetics were discovered 5-10 years after a
recorded glycosuria— 10 diabetics after more than 10 years.*
*Murphy, R.: Connecticut M. J. 21: 306, 1957.
COLOR CALIBRATED CLINITESTr^, Tablets
BRAND
the STANDARDIZED urine-sugar test
for reliable quantitative estimations
. full color calibration, clear-cut color changes
. established “plus” system covers entire critical range
. standard blue-to-orange spectrum long familiar to diabetics
. unvarying, laboratory-controlled color scale
AMES COMPANY, INC • ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto .5457
for simultaneously combating
inflammation, allergy, infection
. :>b» tga ^-7/
(0.5% prednisolone acetate and 10% sulfacetamide sodium —
5 cc. dropper bottle)
(0.5% prednisolone acetate, 10% sulfacetamide sodium and
0.25% neomycin sulfate— Va oz. tube)
for ocular
allergies
suspension
(0.2% prednisolone
acetate and
3% Chlor-Trimetok®—
5 cc. dropper
bottle)
standard for ocular infections
(Sulfacetamide Sodium U.S.P. — 5 and 15 cc. dropper bottles)
i/V
(15 cc. dropper bottle)
(Va oz. tube)
SCHERING CORPORATION
M-J-128
1088
Volume XLIV
Number 10
QUALITY RESEARCH INTEGRITY
IN
At the last accounting,1 physicians throughout the coun-
try had administered at least one dose of poliomyelitis
vaccine to 64 million Americans — all three doses to an
estimated 34 million. Undoubtedly, these inoculations
have played a major part in the dramatic reduction of
paralytic poliomyelitis in this country.
APR. MAY JUNE JULY AUG. SEPT. OCT NOV. OEC
Incidence of polio in the United States, 1952-1957
(data compiled from U.S.P.H.S. reports)
vaccine is plentiful for the job remaining
There are still more than 45 million Americans under
forty who have received no vaccine at all and many
more who have taken only one o*^wokdoses.
As it was phrased in a pu£)Jfc statement\>y the Depart-
ment of Health,
“ It will
apathj^vaccme \
dea.tr,
Eh Lilly
your local me
still lack full p’
representative.
e of public
alysis or even
l to assist you and
i reach those individuals who
ton. For information see your Lilly
1. J. A. M. A., 165:21 (November 23) , 1957.
2. Department of Health , Education , and Welfare: News Release, October 10,
1957.
ELI LILLY AND COMPANY
649008
INDIANAPOLIS 6, INDIANA, U. S. A.
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, April, 1958 No. 10
•
New Technics in the Study of Carcinoma
Of the Uterine Cervix
Sam W. Denham, M.D.
AND
Alvan G. Foraker, M.D.
JACKSONVILLE
The growth patterns of the normal cervix have
become important in understanding the abnormal
growth behavior of malignant tissue. Histochem-
ical reactions are now known to be reliable indi-
cators of these growth processes. The natural
history and course of events in untreated cervical
cancer have been known for years. It soon be-
came apparent that little further was to be gained
in prognosis or treatment by studying the con-
ventional slide preparations in the laboratory. It
was evident that in order to evaluate and treat the
patient better something more must be known
about the intimate growth properties of the cervi-
cal cancer cells themselves.
In recent years, the characteristics of squa-
mous cells of the uterine cervix have received in-
tensive study. The clinical interest in this en-
deavor has been widespread, and many clinicians
have participated in combined clinical and labo-
ratory studies.1 This particular clinical interest
has greatly facilitated the development of the
field of exfoliative cytology.
From the clinical point of view, cervical
squamous cell carinoma is excellent for a com-
bined study between the research scientist and the
clinician. Cervical material in all its phases is
abundant and is obtained easily with either biopsy
or smear technics. Cervical carcinoma can be fol-
lowed through treatment and response with more
accuracy than ever before. The panoramic
changes of the cervix under the cyclic hormonal
stimulations lend further interest to the research
endeavor. Particularly in pregnancy, there is an
added opportunity to study the cervix as it under-
goes the proliferative reaction of this state.
From the Departments of Gynecology, Obstetrics and Path-
ology, Baptist Memorial Hospital, Jacksonville.
These investigations were aided by grants from the Na-
tional Cancer Institute, National Institutes of Health, Public
Health Service, including C-2719.
Read before the Florida Medical Association, Eighty-Third
Annual Meeting, Hollywood, May 7, 1957.
To understand the histochemical changes oc-
curring in the cells of squamous carcinoma of the
cervix, it is first necessary to appreciate the fol-
lowing: the histochemical patterns of the normal
cervix, the cervix with metaplastic epithelium, that
with hyperplastic atypical epithelium, the cervix
with intraepithelial carcinoma, and finally inva-
sive squamous cell carcinoma.
We, therefore, first investigated the histo-
chemical patterns of succinic dehydrogenase in
each of the types of cervical epithelia mentioned,
including pregnancy. Succinic dehydrogenase is a
vital respiratory cellular enzyme found in all tis-
sues. When neotetrazolium is incubated with
cervical tissue under controlled conditions, the
succinic dehydrogenase causes it to become a
hydrogen acceptor. A deeply colored granular
pigment called formazan is formed in the tissue
with the enzyme. There is a close correlation be-
tween the sites of dehydrogenase activity and the
proliferation and growth patterns of the cervi-
cal epithelium. The intensity of formazan depo-
sition closely follows the growth transition of
normal mucosa to metaplastic, to atypical epithe-
lium and finally to intraepithelial carcinoma and
frankly invasive cervical cancer. Since most of
this activity is a reflection of the growth potentials
of the basal layers of the cervical epithelium, the
next histochemical step was to study the matura-
tion factors in the upper layers of these various
cervical tissues.
The localization of glycogen and protein-bound
disulfide groups were the particular technics used.
Glycogen is found in maturing squamous cells
of the portio vaginalis; and disulfide groups are
associated with keratinization and epithelial pearl
formations. Glycogen has been reported to be
absent in squamous cell carcinoma of the cervix.2
1090
DENHAM AND FORAKER: CARCINOMA OF THE UTERINE CERVIX
Volume XLIV
Number 10
The specific histochemical reaction used to demon-
strate glycogen was the periodic acid-Schiff tech-
nic after malt diastase digestion. It was found
that the portio squamous epithelium has no
glycogen staining in the basal layer, but the
glycogen staining reaction increased with other
evidences of maturation toward the surface epi-
thelium. Less pronounced glycogen staining was
found in the metaplastic epithelium. Many of the
invasive squamous cell carcinomas studied showed
some glycogen in the tumor cells, particularly in
the areas of keratinization and epithelial pearl
formation. This was most evident in the sections
with well differentiated squamous carcinoma.
Concomitantly, pronounced disulfide reactions
were found in epithelial pearls and in regions of
intracellular keratinization. This is a strong blue
staining reaction.
In addition, parallel studies of phosphamidase
activity, alkaline phosphatase reactions, protein-
bound sulfhydryl groups, and lipid localization
were carried out along with the other histochem-
ical studies in cervical tissues.3 Histochemical
changes in the pregnant cervix were fascinating.4
The growth patterns were greatly accelerated, and
the dehydrogenase activity was particularly strik-
ing. Many of the sections resembled the malig-
nant cervical tissue from nonpregnant patients
in the amount and distribution of this respiratory
enzyme. Of particular interest was the decidual
reaction in the stroma and its intense dehydrogen-
ase staining.
It is evident from these studies that there is
no magic demarcation in cervical cells as they
pass from the normal portio vaginalis mucosa
through the varying phases to frankly invasive
carcinoma. Rather, the cervical cells manifest a
set of growth properties opposed to maturation
properties. The nucleocytoplasmic and stromal
changes are reflected by histochemical methods.
The specific histochemical changes and labo-
ratory methods are not germane to this paper. It
can be appreciated that the methods are time-con-
suming and a well trained technical staff is es-
sential for their production. These evaluations
of cervical tissue are obviously not now routinely
offered. Nevertheless, it is not in the realm of
the impossible that in the future they will give
much help to the clinician in the diagnosis and
treatment of cervical malignant disease.
Summary
In summary, these approaches to cervical
cancer are new and have never been studied be-
fore. Newer technics and methods will grow
from this understanding of the cervical epithelium
in its various situations relating to cancer. These
histochemical technics indicate that the chemical
properties of these cells parallel their microscopic
appearance and their growth potential: namely,
that there is a gradual transition from normal
mucosa to metaplastic epithelium, to a typical
hyperplastic epithelium, to intraepithelial carcino-
ma to invasive squamous cell carcinoma.
References
1. Nesbitt, R. E. Jr., and Brack, C. B. : Role of Cytology in
Detection of Carcinoma of Cervix, J. A. M. A. 161:183*188
(May) 1956.
2. McManus, J. F. A., and Findley, L. : Histochemical Studies
on Glycogen in Carcinoma in Situ of Cervix Uteri, Surg.
Gynec. & Obst. 89:616-620, (Nov.) 1949.
3. Foraker, A. G., and Denham, S. W. : Squamous Cell Car-
cinoma of Uterine Cervix: A Histochemical Review, Am.
J. Obst. & Gynec. In press.
4. Foraker, A. G., and Denham, S. W. : Succinic Dehydro-
genase as Indicator of Cellular Metabolism in Cervices of
Pregnant and Nonpregnant Women, Surg. Gynec. & Obst.
96:259-264 (March) 1953.
1022 Park Street (Dr. Denham).
800 Miami Road (Dr. Foraker).
Eighty-Fourth Annual Convention
Florida Medical Association
May 10-14, 1958
Bal Harbour
J. Florida M.A.
April, 1958
1091
Abdominal Aortic Aneurysm
Harold C. Spear, M.D.
DeWitt C. Daughtry, M.D.
AND
John G. Chesney, M.D.
MIAMI
With the decreased incidence of syphilis and
the increasing life span, arteriosclerosis has be-
come the commonest etiologic factor in the forma-
tion of aneurysms, and the abdominal aorta has
replaced the thoracic aorta as the vessel most
frequently involved. The purpose of the present
report is to outline the clinical features of ab-
dominal aortic aneurysms and to review the cur-
rent concepts of management of this problem.
Clinicopathologic Features
Arteriosclerotic aneurysmal dilatation of the
abdominal aorta is one of the degenerative cardio-
vascular diseases affecting the middle-aged and
elderly. Frequently, however, it is an isolated
problem unassociated with significant coronary
artery disease, hypertension, or extensive periph-
eral obliterative vascular disease. Its importance
lies in the fact that it is a progressive lesion lead-
ing to ultimate fatality from rupture and hemor-
rhage. The prognosis for the individual patient
with an abdominal aortic .aneurysm is impossible
to determine, but a careful survey of a large
number of patients with this condition revealed
that approximately one third died within one year
and two thirds within three and a half years of
the establishment of the diagnosis.1 Most of the
deaths were attributable to rupture of the aneu-
rysm.
Although rupture is generally unheralded by
any premonitory symptoms or signs, recent studies
have indicated that it is uncommon for an aneu-
rysm measuring less than 7 cm. in diameter to
rupture.2 Certainly, any aneurysm larger than
this should be regarded as a potentially fatal
lesion.
The common symptoms of abdominal aortic
aneurysm are pain, the presence of a pulsatile
mass, and general malaise. Pain, when present,
may be located in the lumbar area or abdomen,
or both. It may be intermittent or steady, sharp
or dull. Occasionally, radiation into the groin or
scrotal area is observed. A pulsatile mass is of
course most often noted by the thin person.
From the Daughtry-Chesney Clinic for Thoracic Surgery,
Miami.
The only noteworthy sign on physical exam-
ination is that of a pulsatile, rounded mass which
may be present in the midabdomen or to the left
or right of the midline. It may be clinically indis-
tinguishable from a pancreatic cyst or retroperi-
toneal neoplasm with transmission of aortic pul-
sations. A bruit may or may not be audible. The
femoral pulses are ordinarily normal.
With the occurrence of rupture, the patient ex-
periences an acute onset of excruciating pain com-
monly localized to the left lumbar and left flank
areas but occasionally radiating into the left in-
guinal or scrotal region to simulate ureteral colic.
The association, however, of a shocklike state with
the pain and the presence of a pulsatile mass serve
to clarify the diagnosis. Unlike dissecting aortic
meurysms, ruptured abdominal aneurysms are
not ordinarily productive of changes in the fem-
oral pulses.
Radiologic Examination
Generally the clinical diagnosis of abdominal
aneurysm can be confirmed by posteroanterior and
lateral roentgenograms of the abdomen which
show the rounded aneurysmal mass with its char-
acteristic ‘‘egg shell” calcification. On the lateral
roentgenogram, the abdominal contents are shown
to be displaced anteriorly by the aneurysm (fig.
1). Occasionally the configuration of the aneurys-
mal density or the “egg shell” calcification may
be atypical (fig. 2). In these instances, translum-
bar aortography may be helpful in confirming the
diagnosis (fig. 3).
Since the aneurysm arises below the renal ar-
teries in approximately 95 per cent of cases and
since this relationship can be most accurately
determined at operation, translumbar aortography
is not performed as a routine preoperative study.
We believe, however, that aortography should be
performed in the aged or poor risk patient to de-
linate the anatomic relationships of the aneurysm
prior to operation. Although De Bakey, Creech
and Morris3 have brilliantly demonstrated the
feasibility of resecting aneurysms which involve
the renal arteries, this is an operation of such mag-
nitude that it is generally inadvisable in the aged
1092
SPEAR ct al: ABDOMINAL AORTIC ANEURYSM
Volume XL IV
Number 10
Fig. 1.- — Lateral roentgenogram showing anterior
displacement of abdominal viscera by aneurysm.
or poor risk patient. Translumbar aortography
itself carries a low complication rate when prop-
erly applied.4
In the case of the ruptured abdominal aortic
aneurysm, posteroanterior and lateral roentgeno-
grams of the abdomen usually suffice to confirm
the diagnosis. The aneurysmal mass with its mural
calcification is observed to be surrounded and ob-
scured by a homogeneous density representing the
retroperitoneal hematoma, and the left psoas out-
line is partially or completely obliterated (fig. 4).
Occasionally, it may be helpful to perform an
emergency intravenous or retrograde pyelogram
to clarify the diagnosis or rapidly to appraise
renal function (fig. 5), but translumbar aortog-
raphy is contraindicated both because of the dif-
ficulties of performing it and because of the in-
creased hazard it incurs under these circum-
stances.
Treatment
During the past century, the surgical man-
agement of abdominal aortic aneurysms has pro-
gressed from proximal aortic ligation to internal
reinforcement of the aneurysmal wall by wiring
with or without concomitant electrocoagulation, to
external reinforcement with cellophane wrapping.
Although in many instances these measures have
forestalled the occurrence of rupture, each of these
procedures has been associated with its own inor-
Fig. 2. — Flat film of abdomen revealing aneurysm
without usual calcification (case 1).
dinate train of complications, and none has re-
sulted permanently in extripating the aneurysm.
In 1952, Dubost, Allary and Oeconomos,3
applying the principles of aortic grafting which
had been developed by Gross0 in the surgical
treatment of coarctation, first successfully resected
Fig. 3. — Aortogram showing irregular tortuous
channel through aneurysm, which begins about 2 cm.
below renal arteries (case 1).
J. Florida M.A.
April, 1958
SPEAR et al: ABDOMINAL AORTIC ANEURYSM
1093
an abdominal aortic aneurysm and re-established
continuity by means of a homograft. De Bakey,
Cooley and Creech7 have now applied this tech-
nic to large numbers of patients with eminently
satisfactory long term follow-up studies.
As the result of these pioneering efforts, elec-
tive resection of abdominal aneurysms with aortic
homograft or prosthetic replacement can now be
accomplished with remarkably low morbidity and
mortality rates (figs. 6 and 7). In view of the
excellent results attainable by operation and the
poor prognosis which obtains in the untreated
patient, it is urged that all patients with abdomi-
nal aortic aneurysms, whether or not symptomatic,
should be evaluated for operative correction. Only
those patients who exhibit renal insufficiency or
severe associated cardiovascular or cerebrovascular
disorders should be categorically denied surgical
treatment.
The importance of early elective surgical cor-
rection is emphasized by the uniformly high mor-
tality rates (30 to 50 per cent) associated with
the surgical treatment of ruptured abdominal
aneurysms. Although only an occasional patient
will recover from the initial episode of rupture
without operation, most patients survive for peri-
ods of six hours or more from the onset of symp-
toms of rupture. This brief survival period allows
the performance of emergency surgical resection.
One has only to deal with a few such cases to real-
ize the immense advantages of early elective opera-
tion. Even the rare patient who survives the ini-
tial episode of rupture may subsequently present
almost insuperable problems of therapy. In one
such patient in the experience of one of us
(H.C.S) there developed a large aorta-caval arteri-
ovenous fistula following the rupture of the ab-
dominal aortic aneurysm into the inferior vena
cava. Although in refractory cardiac decompensa-
tion as the result of the fistula, he survived a
difficult operative procedure during which the rup-
tured aneurysm was resected and a homograft in-
serted with concomitant repair of the site of rup-
ture into the inferior vena cava. This complicated
problem is cited to emphasize the desirability of
elective operation early in the development of the
disease, prior to the occurrence of rupture and its
sequelae.
The following case reports are presented to
illustrate some of the points raised in the preced-
ing discussion.
Fig. 4.— Intravenous pyelogram in ruptured aneurysm
(case 2) showing characteristic mural calcification sur-
rounded by diffuse density which obliterates left psoas
shadow.
Report of Cases
Case 1. — A 66 year old white woman was admitted
to the hospital on Jan. 7, 1957 for investigation of com-
plaints of pain in the left flank of five days’ duration.
The pain was of dull aching nature, without radiation
Fig. 5. — Retrograde pyelogram illustrating patency
of urinary tract and its relationship to ruptured aneu-
rysm (case 3).
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SPEAR et al: ABDOMINAL AORTIC ANEURYSM
Volume XI, IV
XuMBKR 10
Fig. 6. — Large abdominal aortic aneurysm as seen at operation,
on each side.
Tapes surround the common iliac arteries
Fig. 7. — Same case as in figure 4 following resection of aneurysm and insertion of aortic homograft, with
nylon reinforcement of anastomoses,
J. Florida M.A.
April, 1958
SPEAR et al: ABDOMINAL AORTIC ANEURYSM
1095
Fig. 8. — The unopened (A) and opened (B) specimen from case 2 showing the discrepancy in size be-
tween the graft and the host vessels, the relationship to the renal arteries (clamped in B) and the pronounced
atheromatous degenerative changes in the host arteries.
and without associated gastrointestinal symptoms. The
past medical history was significant in that she had been
treated for an acute coronary occlusion in 1953 and had
had significant hypertension prior to that time. Since the
coronary attack, she had remained in good cardiac com-
pensation without the use of cardiac drugs. She gave no
history of angina pectoris.
On physical examination, the blood pressure was 160/
100 in both arms. The lungs were clear. The heart was
markedly enlarged. The cardiac rhythm was regular and
there was a grade II basal systolic murmur. Abdominal
examination revealed a large, fixed, rounded, nontender,
left midabdominal mass which either pulsated or trans-
mitted aortic pulsations. All peripheral pulses were pal-
pable.
A complete blood count, urinalysis and blood chem-
istry studies were within normal limits. Electrocardio-
grams revealed evidence of left ventricular hypertrophy
and old myocardial damage. Flat films of the abdomen
confirmed the presence of a large left midabdominal mass
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SPEAR et al: ABDOMINAL AORTIC ANEURYSM
Volume XLIV
Number 10
suggestive of an aneurysm Out without the characteristic
murai calcification (fig. 2). A complete gastrointestinal
series and intravenous pyelograms revealed the mass to be
retroperitoneal and extrinsic to both the intestinal and
urinary tracts. Both kidneys functioned well. A trans-
lumbar aortogram confirmed the diagnosis of abdominal
aortic aneurysm arising just below the renal arteries
(fig. 3)- , . , ,
On Jan. 14, 1957, with the patient under general an-
esthesia, the abdomen was explored through a long left
paramedian incision. A large bosselated abdominal aneu-
rysm with two distinct thin-walled aneurysmal compo-
nents was present, the larger and more superior of which
arose just below the renal arteries and measured 15 cm.
in diameter. The aortic bifurcation was uninvolved so
that, following resection of the aneurysm, replacement
with a straight abdominal aortic segment preserved by
the freeze-dry process was accomplished.
Postoperatively, the lower extremity pulses were en-
tirely normal throughout. Except for a transient episode
of cardiac decompensation on the second postoperative
day which responded promptly to medical therapy, the
patient made an uneventful recovery.
This case is typical of the many abdominal
aortic aneurysms which have been successfully
resected at an elective operation. As in this in-
stance, selected patients with serious complicating
cardiovascular disease can be safely carried
through the operation by careful medical manage-
ment.
Case 2. — A 58 year old retired postal clerk was ad-
mitted to the hospital on Jan. 12, 1957 in profound shock.
He had experienced the sudden onset of severe pain in the
left flank with radiation into the left scrotal area several
hours previously. The past medical history was significant
in that he had been treated for a kidney infection in
1947. In addition, he had noted vague discomfort in the
left flank during the month prior to admission.
Physical examination revealed a well nourished middle-
aged white man who was cold, clammy and suffering
acute pain in the left flank. The blood pressure was 70/0
and the pulse, 120. There was some abdominal guarding,
but an ill-defined, deep midabdominal pulsatile mass which
was not tender could be felt. Both femoral and both
popliteal pulses were palpable.
The state of shock responded to intravenous fluid
therapy followed by two units of blood. Flat films of
the abdomen on admission revealed an ill-defined mid-
abdominal density obliterating the left psoas outline.
There was a calcific density just to the left of the upper
lumbar spine which, in the light of the antecedent history
of renal disease and the characteristic radiation of the
pain, was thought to represent a ureteral calculus. Ac-
cordingly, intravenous pyelograms were performed which
revealed both kidneys excreting dye without delay. On
these pyelograms a definite abdominal aortic aneurysmal
mass with mural calcification could be visualized. Sur-
rounding the aneurysm a diffuse density was noted which
was consistent with retroperitoneal extravasation of blood
(fig. 4).
The patient was operated upon without further delay.
An abdominal aortic aneurysm measuring 12 cm. in di-
ameter was present, arising immediately subjacent to the
renal arteries. The aneurysm had ruptured posteriorly
into the retroperitoneal tissues, which were intensely con-
gested with fresh and clotted blood. Although it was
possible to resect the aneurysm and insert a bifurcation
homograft which functioned satisfactorily, the patient re-
mained in critical condition throughout the operation and
expired 12 hours later of cardiovascular collapse with as-
sociated renal shutdown. Postmortem examination revealed
the graft to be intact and the anastomoses patent (fig. 8)
despite the extensive atheromatous degenerative changes
in the host vessels.
This case illustrates the difficulties encountered
once rupture occurs. Although it is generally pos-
sible to carry the critically ill patient through a
successful operative procedure wherein the aneu-
rysm is resected and continuity is restored by
means of a homograft or plastic cloth prosthesis,
the postoperative mortality rate from cardiovas-
cular and renal complications is uniformly high.
The most effective means of reducing the mortality
rate at the present time is by the development of
an awareness of the problem of abdominal aneu-
rysm and by the institution of early elective surg-
ical treatment.
Case 3. — A 67 year old white man was hospitalized on
Feb. 14, 1955, three days after the sudden onset of severe
midabdominal pain. Previously he was known to have
hypertensive-arteriosclerotic cardiovascular disease and,
in 1952, underwent right midthigh amputation for arterial
insufficiency.
Upon admission, the patient was in mild shock, and
a large pulsating midabdominal mass was palpable. Fol-
lowing supportive therapy including blood transfusion,
his general condition improved although the abdominal
mass grew larger. He was transferred to the service of one
of us (H.C.S.) 48 hours later. The clinical diagnosis of
ruptured abdominal aortic aneurysm was confirmed by
flat films of the abdomen, and emergency retrograde
pyelograms were performed to rule out urinary obstruc-
tion, in view of a history of no urinary output over the
preceding 24 hours (fig. 5). Operation was carried out
immediately thereafter. A large abdominal aortic aneurysm
which had ruptured posteriorly into the retroperitoneal
tissues was resected, and a bifurcation homograft was
inserted. Except for an initial period of oliguria with as-
sociated nitrogen retention, the postoperative convales-
cence was uneventful.
As was previously mentioned, most patients
survive for more than six hours following rupture
of an abdominal aneurysm. This is related to the
universal presence of a laminated organizing mural
thrombus which, together with dense perianeu-
rysmal inflammatory reaction, tends to avert free
rupture and to result in a sinuous pathway of
extravasation. Case 3 illustrates the occasional
prolonged interval which may be available follow-
ing rupture, during which salvage may still be ac-
complished.
Summary
The problem of abdominal aortic aneurysm is
discussed from the standpoint of pathologic phy-
siology, prognosis, diagnosis and surgical treat-
ment. Three cases are reported to illustrate dif-
ferent aspects of the discussion.
In view of the rapid progression of the majori-
ty of these lesions to fatal rupture, and in view of
the current low mortality rate for elective surgical
treatment, it is recommended that all patients with
abdominal aortic aneurysms be evaluated for op-
eration as soon as the diagnosis is made. Once
J. Florida M.A.
April, 1958
HINTON: GASTROSCHISIS
1097
rupture has occurred, operative intervention, al-
though offering virtually the only hope for sur-
vival, is fraught with at least a fourfold increase
in mortality rate.
References
•*. Estes, J. E. : Abdominal Aortic Aneurysm; Study of 102
Cases, Circulation 2:258-264 (Aug.) 1950.
2. Crane, C. : Arteriosclerotic Aneurysm of Abdominal Aorta;
Some Pathological and Clinical Correlations, New England
J. Med. 253:954-958 (Dec.) 1955.
3. De Bakey, M. E.; Creech, O. Jr., and Morris, G. C. Jr.:
Aneurysm of Thoracoabdominal Aorta Involving the Celiac,
Superior Mesenteric and Renal Arteries; Report of Four
Cases Treated by Resection and Homograft Replacement,
Ann. Surg. 144:549-573 (Oct.) 1956.
4. Crawford. E. S. ; Beall, A. C.; Moyer, J. H., and De Bakey,
M. E. : Complications of Aortography, Surg., Gynec. & Obst.
104:129-141 (Feb.) 1957.
5. Dubost, C. ; Allary, M., and Oeconomos, N. : Resection of
Aneurysm of Abdominal Aorta; Reestablishment of Contin-
uity by Preserved Human Arterial Graft, With Result After
Five Months, A. M. A. Arch. Surg. 64:405-408 (March)
1952.
6. Gross, R. E. ; Bill, A. H. Jr., and Peirce, E. C. II: Methods
for Preservation and Transplantation of Arterial Grafts;
Observations on Arterial Grafts in Dogs; Report of Trans-
plantation of Preserved Arterial Grafts in 9 Human Cases,
Surg., Gynec. & Obst. 88:689-701 (June) 1949.
7. DeBakey, M. E. ; Cooley, D. A., and Creech, O. Jr.: Treat-
ment of Aneurysms and Occlusive Disease of Aorta by Re-
section; Analysis of Eighty-Seven Cases, J. A. M. A. 157:
203-208 (Jan. 15) 1955.
2615 Biscayne Boulevard.
Gastroschisis
Report of a Case
Forrest Hinton, M.D.
IMMOKALEE
Gastroschisis is a congenital anomaly in which
the abdomen remains open, with viscera protrud-
ing. This malformation occurs so rarely that
Moore and Stokes,1 in reviewing the literature,
found only five authenticated cases in living new-
born infants. In three of these cases surgery was
attempted, with a successful result in one. These
authors reported two cases, in both of which the
infant died.
This anomaly of the abdominal wall consists
of a large eviscerated mass- of discolored intestines
of leathery consistency. The intestines are often
embedded in a rather dense gelatinous matrix.
The defect is extraumbilical, as the insertion of
the umbilical cord is normal. No covering sac or
its ruptured remnants is present at birth. The
absence of a sac results in enlargement and thick-
ening of the intestines, with cyanosis, injection
and adhesions. The peritoneal cavity in such
cases is usually small, and malrotation of the in-
testines is a frequent feature.1 Hardaway2 at-
tributed the high mortality to massive dispropor-
tion between the volume of the eviscerated mass
and the capacity of the abdomen, infection due
to the lack of a protective covering as found in an
omphalocele, and the poor condition of the bowel
wall.
The rarity of gastroschisis and the gravity of
the problem encountered warrant presentation of
an additional case.
Report of Case
An 18 year old, white, transient, maternal, Spanish
woman, gravida III, Para II, was first seen on March 5,
1957. She was in labor. Her antepartum care had been
nil except for one visit to the County Health Depart-
ment Clinic when it was reported that the County
Health doctor had refused to allow her to be delivered
by a midwife. The reasons were poorly understood by the
patient, who spoke only broken English. The last men-
strual period was unknown. There was no contributory
history.
Examination revealed a thin but well developed, well
nourished white woman. The head, eyes, ears, nose,
throat, chest and heart were within normal limits ex-
cept for caries. The temperature, pulse rate, respirations
and blood pressure were normal. Examination of the
abdomen revealed a pregnant uterus extending half way
between the umbilicus and the xiphoid process. Uterine
contraction occurred every five to 10 minutes. The
position was judged as breech. Rectal examination re-
vealed the cervix to be 3 cm. dilated, and a breech
presentation LST was confirmed. The extremities showed
varicose veins but no edema. The urine was negative
for sugar and protein, and the hemoglobin was 10 Gm.
COURSE OF LABOR. — The fetal heart tones ranged
from 120 to 156 per minute throughout the course of
labor. The breech presentation later appeared as an in-
complete breech double footling presentation. Upon the
appearance of both feet at the introitus, they turned
cyanotic immediately. Spontaneous rotation began in a
reverse manner; if it had progressed in its spontaneous
attempt, the chin of the infant would have become im-
pinged behind the symphysis pubis of the mother. This
rotation was manually halted and reversed. Because
of the cyanosis, mild traction was placed on the thighs,
which were then at the introitus. Only partial descent
occurred when it became obvious that there was an ob-
structed labor. The back of the infant was quickly in-
spected by palpation and a diffuse soft tissue bulge was
noted over the lumbar area. It was apparent that this
soft tissue mass was not the cause of the obstruction be-
cause it was too soft, diffuse and small.
Cyanosis deepened and involved the buttocks now
presenting. The infant’s abdomen was quickly palpated,
and it was noted that a large pendulous soft tissue mass
filled the posterior birth canal. Blood began to flow
from the posterior canal. Upward pressure on the soft
tissue mass combined with traction upward and out-
ward on the buttocks brought the mass from the in-
troitus, and the second stage of labor was consummated
in the usual manner. Rotation and delivery of the first
shoulder appearing was followed by rotation and de-
livery of the remaining shoulder beneath the symphysis
pubis with the back of the infant hyperextended over
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HIXTON: GASTROSCHISIS
Volume XLIV
Number 10
the symphysis of the mother and pressure exerted on
the inferior maxilla. The placenta, either spontaneously
or traumatically detached from the infant, delivered
immediately and spontaneously. The total, time of de-
livery was three minutes from the first sign of cyanosis.
The estimated blood loss was .500 cc.
The infant died two hours and 10 minutes after
delivery.
GROSS INSPECTION.— The infant weighed 4
pounds.
Placenta. — The placenta was free of scars and
intact. It was smaller than normal. The cord measured
S cm. This probably accounts for the intrapartum
hemorrhage and the immediate delivery to the placenta.
The cord was small, had a velamentous attachment to the
placenta and consisted of a thin membrane enveloping a
small amount of Wharton’s jelly and three visible vessels.
Two of these were seen to arise out of the pelvis of the
infant and one to enter the liver.
Head and Chest. — Respirations were shallow,
irregular and 10 to 20 per minute. There was no cyanosis
of the upper portion of the trunk or of the face. The
heart rate was regular and 140 per minute.
The skull and face bones were compressed on the
right surface. The compression apparently was incurred
from the fetus having lain in one position for a long
time. The chest was well formed and normal.
Abdomen and Viscera. — There was a thick
serous membrane over the viscera. No skin or muscles
had formed from the costal margins superiorly to the
symphysis below or between the anterior axillary lines.
The arrested skin growth was sharply demarcated. The
liver was large and bluish in color. The lobes were in-
dentified. No gallbladder was demonstrable, but a large
common duct was seen communicating between the small
intestine and the liver. The stomach was small and ret-
roperitoneal. It was immobile. The small intestine
measured 2 feet and was retroperitoneal and fixed. The
colon was all retroperitoneal and fixed except for the
cecum and the most distal portion (10 cm.), which was
extraperitoneal, open and inverted revealing mucosal
folds. The appendix was identified as a small button-like
appendage attached to the cecum by a thin fibrous
band. The appendix was mobile and extraperitoneal. The
spleen, kidneys and pancreas were small and located in
the correct anatomic position. The kidneys and the
pancreas were retroperitoneal. The adrenal glands were
identified and were normal in size and position. The
anal area was imperforate. There was slight invagina-
tion but no dimpling.
Genitourinary Tract. — The bladder was well formed,
and a short, flat, membranous tube 1 cm. wide and
2 cm. long was protruding from the anterior-inferior
border. No gonads were demonstrable. The genitalia
were absent except for two dark pendulous folds of
skin which protruded from the external surface of the
lateral perineum. They contained no gonads and resem-
bled folds of labia majora.
Extremities. — The legs were bowed and crablike in
posture. The knee and ankle joints were rigid. The
legs could not be moved, and the hips were fixed.
Back. — There was a large diffuse mass over the
lumbosacral area which was fluctuant and apparently
contained a small amount of fluid.
The postpartum course of the mother was uneventful.
Summary
A case is reported in which the characteristic
features of gastroschisis were present. The in-
fant lived only two hours.
References
1. Moore, T. C., and Stokes. G. E. : Gastroschisis: Report of
Two Cases Treated by Modification of Gross Operation
for Omphalocele. Surgery 33:112-120 (Jan.) 1953.
2. Hardaway, R. M. Ill: Gastroschisis, Am. J. Surg. 87:636-
638 (April) 1954.
Box 226.
J. Florida M.A.
April, 1958
1099
Choledochal Cyst
Frederick H. Bowen, M.D.
JACKSONVILLE
The most important abnormality of the liver
and biliary passages which necessitates surgery in
the young infant and child is chronic jaundice
caused by biliary obstruction due to atresia of the
bile ducts in the early months of life. A less com-
mon condition is choledochal cyst. A unique case
in which atresia of the bile ducts was associated
with choledochal cyst was reported by Ripstein
and Miller.1 Choledochal cyst also occurs in adult
life. This condition is more correctly known as
idiopathic dilatation of the common bile duct.
This is a congenital lesion in which an enormous
dilatation of the lower part of the extrabiliary
duct system occurs, and the etiology is often ob-
scure. In some cases there is a stenosis, a valve-
like fold in the ampulla of. Yater or lower common
bile duct, or angulation in the lower part of the
common bile duct. In other cases there is no ab-
normality of the junction of the common bile duct
with the duodenum. The duct may be as large
as a grapefruit or an orange, or in exceptional
cases it may be larger. Once the dilatation has
occurred, its weight makes it hang to one side
and angulate the lower end to produce further
obstruction. Approximately 200 cases of this
condition had been reported in 1953, and cases
continue to be added. An artist’s depiction of
this condition is seen in figure l.3-3
Pathology
The chief finding is dilatation of the common
bile duct and this occurs as a marked rounded en-
largement of all or part of the choledochal duct.
This dilatation may involve only the common duct,
or the juncture of the cystic, hepatic and common
ducts may be involved. Only one duct, therefore,
may be found entering the cyst (the superior part
of the choledochus) ; or the hepatic and cystic
ducts may enter the cyst at two different points,
and their openings may be separated by a distance
of 2 or 3 cm. The cyst is joined to the duodenum
by the lower part of the common duct. Occasion-
ally, the enlargement involves so distal a part of
the common duct that the choledochal cyst is
entered directly by the pancreatic duct. The
localized enlargement of the biliary ducts is dis-
Read before the Southern Surgical Association, Hot Springs,
Va., Dec. 5, 1955.
tinguished from dilatations which occur in purely
obstructive conditions of the inferior common
duct, as when the common bile duct is obstructed
by carcinoma of the head of the pancreas in the
adult. In these conditions the distention of the
bile duct involves the whole biliary tree; tV
common bile duct is hardly ever bigger than a
small intestinal loop, and the gallbladder is great-
ly dilated. In choledochal cyst the gallbladder is
rarely enlarged.
The cyst is very large and it may contain 1 to
2 liters of bile. In a case reported by Reel and
Burrell4 the cyst contained 8,000 cc. of bile. The
larger cysts are usually found in older patients,
but this is not a constant relationship. The wall
of the cyst is tough and measures 2 to 4 mm. in
thickness. It is made up of dense connective tis-
sue, and the elastic substance and smooth muscle
are often absent. Epithelium is usually lacking in
the lining of the cyst. The lining may be irregular
and roughened, and there may be dried bile pig-
ment deposits over the lining; at times pus is
present with an exudate indicating secondary in-
fection. The dilatation of the cystic and hepatic
ducts and the gallbladder which occurs is minimal
compared to the enormous size of the common bile
duct. The liver is often enlarged and cirrhotic, and
in a few cases the intrahepatic ducts are greatly
enlarged. Microscopic examination of the liver
reveals cirrhosis with an increase in periportal
connective tissue, overgrowth of bile capillaries
and rarely biliary stasis. Infection is frequent,
and white blood cell infiltration of the portal
areas may be present. There may be marked
cholangitis, and pus may be found in the bile
duct.
Etiology
Obstruction has been found in many cases,
but the enormous dilatation of the common duct
points to a local defect in the wall of the common
duct which permits it to dilate enormously. The
following theories have been advanced:
1. The common duct takes an anomalous
course through the lower duodenum which pro-
duces a “kink” in the duct and causes biliary
obstruction.
1100
BOWEN: CHOLEDOCHAL CYST
Volume XLIV
Number 10
Fig. 1. — Choledochal cyst.
2. Congenital stenosis of the lower part of the
choledochus.
3. Achalasia of the sphincter of Oddi.
4. Congenital weakness of the common bile
duct permits dilatation under normal intraductal
pressure. This condition is comparable to con-
genital idiopathic hydronephrosis.
5. The common bile duct lacks the ability
to contract and bulges out locally after an ob-
struction in the lower part of the duct.
6. Others believe that the cyst is of con-
genital origin and is in reality an anomalous mal-
formation, and that the valve which has been de-
scribed is secondary to this cyst.
7. The cyst is due to diverticulum of the com-
mon duct such as the one which produces a ven-
tral pancreas.
None of these explanations explain all cases
of choledochal cyst, but many of the cases are
explained by one or more of these various theories.
It is possible that there may be a group of condi-
tions which are similar, but whose etiology is dif-
ferent. The most likely theory seems to be that
which postulates a congenital weakness of the
ductal wall which permits dilatation only when
obstruction occurs.
Symptoms and Signs
The clinical picture is marked by the triad of
abdominal pain, tumor and jaundice. Pain occurs
in 65 per cent of the cases. It was absent in the
first case reported here until two days prior to
operation. Usually, it is present in the epigastrium
or in the right upper quadrant. The pain is not
severe; at times it is accompanied by nausea, but
vomiting rarely occurs. There is no connection
between the severity of the pain and the size of
the cyst. In about 90 per cent of the cases ab-
dominal tumor is present. A mass is felt just be-
low the liver area in about half of the cases. The
cyst may be displaced to the left by an enlarged
liver. Often, the cyst has a solid feel on palpation,
and the tightness and the size of the cyst may
vary on different examinations. It has been noted
that several hours following a meal the cyst be-
comes larger and firmer, probably because of in-
creased biliary secretion during this time.
Jaundice is present in about 90 per cent of
the cases. Highly colored urine and acholic stools
have been present at times in one third of the
cases. Fever is often present and is probably due
to cholangitis or hepatitis. The fever range r
from 101 to 102 F., but in occasional cases it has
been as high as 104 F. Any one of the triad of
symptoms may be present alone, or may be pre-
sent in combination with the other symptoms. The
order of appearance of these symptoms varies.
The average duration of symptoms is about three
years before the choledochal cyst is found. The
symptoms tend to be intermittent, and the general
course of the disease is one of exacerbations and
remissions, but one or more of the symptoms may
have been constant. Females are affected about
four times as commonly as males.
Differential Diagnosis
Echinococcus cyst of the liver may be confused
with this condition, but usually in echinococcus
disease there is a mass in the liver which does
not markedly affect the patient’s health. The
swelling in echinococcus cyst is often the only
complaint, but if infection occurs, fever and leuko-
cytosis are present. In a very large echinococcus
cyst jaundice may be present. An echinococcus
cyst tends to become progressively larger or re-
main stationary, and the choledochal cyst usually
varies in size especially after eating. An echino-
coccus cyst of the liver moves with respiration
and seldom causes pain. Negative complement-
fixation tests are helpful in ruling out an hydatid
cyst, and the limited geographic distribution of
echinococcus disease is also helpful in differential
diagnosis.
T. Florida M.A.
April, 1958
BOWEN: CHOLEDOCHAL CYST
1101
Gallstones are rare in children, and roentgen
examinations of the gallbladder are helpful in
making or excluding this diagnosis. Cholelithiasis
in children is usually due to a hemolytic blood
dyscrasia, and the absence of a hemotologic con-
dition makes a diagnosis of gallstones unlikely.
Abdominal carcinoma in children usually is
progressively and rapidly fatal. In a patient,
therefore, who has had an abdominal mass for
more than a year and is still well nourished and
active, it is unlikely that a neoplasm will be
present. Neoplasm may be ruled out if the mass
beneath the liver has frequently and definitely
varied in size.
Congenital atresia of the bile ducts is usually
excluded by the age incidence of these two con-
ditions. The mean age of patients with congenital
atresia of the bile ducts is from one to three or
four months. The patients who cannot be helped
by operation usually die in less than a year. Only
5 per cent of choledochal cyst patients have had
symptoms prior to six months of age. The patient
with choledochal cyst tends to be considerably
older than the patient with congenital atresia of
the bile duct.
Treatment
The outcome of operation depends upon how
soon the surgeon recognizes the nature of the
choledochal cyst. To quote Gross:5 “It is, there-
fore pertinent to emphasize that the surgeon
must be familiar with the pathology of this con-
dition, for only then can he quickly recognize the
lesion and rapidly promote drainage of the biliary
system into the intestine which has proved to be
so efficacious in curing these individuals.”
External drainage of the common bile duct
cyst has resulted in very high mortality rates.
Excising these cysts should not be attempted.
Abdominal tapping should be avoided because of
the danger of causing the cyst to leak into the
general peritoneal cavity and because of the dan-
ger to other viscera. Cholecystoduodenostomy or
cholecystogastrostomy may be performed, but the
treatment of choice is to anastomose the cyst to
the duodenum. A cystostomy may give an added
safety factor. Connection of the cyst to a side
arm of the jejunum in a Roux Y procedure is un-
necessary, according to Gross.5 Attar and Obeid,6
however, collected nine cases in which the cyst was
anastomosed to the jejunum by means of the
Roux Y procedure with no mortality or cholangitis.
In contrast, they stated there is a 24 per cent mor-
tality with choledochojejunostomy.
Results of Treatment
The mortality in 52 children was 69 per cent,
but in a group treated by anastomosing the biliary
tract and intestine the mortality was only 9 per
cent.
Report of Cases
Case 1. — An 11 year old Negro girl was admitted to
Brewster Hospital on April 18, 1955 complaining of
jaundice of 48 days’ duration. Jaundice which began
seven weeks before admission, progressively increased
in intensity. Vomiting accompanied by fever occurred
for one week at the onset of the illness. The child
had vomited an adult Ascaris lumbricoides worm on
one occasion. Blood of unknown color had been passed
in the stool three times since the jaundice appeared.
Epistaxis occurred three days before admission. The
stools had been white and the urine dark since the
icterus began.
The child was born at home and weighed 6 y2 pounds
at birth. Jaundice had not been present before this ill-
ness, but one of the mother’s 10 siblings had had jaun-
dice as a baby. Two siblings were born dead. One sibling
died at the age of 11 months of unknown cause.
The patient was a well developed and nourished
child whose sclerae were yellow. The temperature was
97 F. and the pulse rate 100. The skin showed scratch
marks, and the nostrils contained dry blood. The liver
was felt 3 to 4 cm. below the thoracic cage in the
anterior axillary line, the midclavicular line and the
midepigastric line. On a subsequent examination, the mass
in the midclavicular and midepigastric line was not
believed to be the liver, and the possibility of its being
the gallbladder was considered.
The admission urine was bile-stained and cloudy.
The albumin was 1 plus, and there was a trace of
sugar; the specimen was positive for bile. Many coarsely
granular casts were present. Four and seven days after
admission the urine was negative for urobilinogen.
The leukocyte count was 5,400 with 64 per cent poly-
morphonuclear neutrophils and 36 per cent lymphocytes.
There was a 2 per cent eosinophil count. The hemo-
globin was 10.3 Gm. on admission and 9 Gm. four days
after admission. There was a 4 per cent reticulocyte
count, platelets numbered 252,000, and no nucleated red
blood cells were seen. On admission, the blood showed
90 per cent sickling in eight hours, and four days later
100 per cent latent sickling was noted. The mother’s
blood showed no immediate sickling and 1 per cent latent
sickling.
The coagulation time was four minutes and the
bleeding time one and one-half minutes. The prothrombin
time was 14 seconds with a control of 13.5 seconds. Seven
days after admission, the agglutination for typhoid O
and brucellosis was negative, and 10 days after admission
agglutinations were positive in a 1:40 dilution for typhoid
O.
The blood sugar was 89 mg. per hundred cubic cen-
timeters. The reaction to the van den Bergh test was
7.7 units direct and 10.8 units indirect. Eight days fol-
lowing admission, the van den Bergh reaction was 11.7
units direct and 15.9 units indirect. Fifteen days after ad-
mission. the direct van den Bergh reaction was 11.9 units
and the indirect reaction 17.2 units. The alkaline phospha-
tase was 13 Bodansky units seven days after admission, 1
Bodanskv unit 16 days after admission and 21 King- Arm-
strong units in another laboratory 19 days after admis-
sion. The icterus index, 16 days after admission, was 76
units. Twenty days following admission, the blood choles-
terol was 286 mg. per hundred cubic centimeters, and the
serum protein was 8 Gm. (3.90 Gm. of albumin and 4.1
Gm. of globulin). The thymol turbidity was 4 units, the
thymol flocculation at 18 hours was negative, and the
thymol turbidity ratio at 18 hours was 103 per cent.
The serum showed inhibited flocculation of a known pos-
itive hepatitis case.
1102
BOWEN: CHOLEDOCHAL CYST
Volume XLIV
Number 10
Fig. 2. — This roentgenogram shows barium enter-
ing the choledochal cyst from the jejunum.
The stool was negative tor bile four days after ad-
mission, and two stools examined 11 days after admission
were negative for bile; one stool was negative for ova
and parasites. Examination of the gastric juice was
negative for bile.
Flat films of the abdomen and chest were negative.
The gallbladder was not visualized after the administration
of Telepaque. The gallbladder and hepatic ducts were not
visualized by Cholografin. Roentgenograms of the stomach
and duodenum were negative. A roentgen study of the
right and left tibia showed no evidence of disturbance of
growth, periosteal reaction, or localized bone disease.
Course in Hospital. — A few days after admission, the
child had epistaxis which continued during the day, and
it was thought that she lost about 250 cc. of blood. The
nasal bleeding was controlled by cauterization and pack-
ing, and transfusions were given.
One month after being admitted to the hospital and
four days after surgical consultation, a U-shaped trans-
verse incision was made across the upper abdomen.
There was an enormous cystic dilatation of the common
bile duct which measured 20 cm. in diameter. This cyst
pushed the liver to the right and pushed the stomach to
the left. The duodenum was probably behind and in-
ferior to the cyst and was not readily visualized. Filmy
adhesions between the stomach and the cyst were dis-
sected away. As this dissection was continued, the serosa
was stripped from the stomach in a small area, and the
dissection was stopped. A loop of jejunum was grasped
about 12 inches beyond the ligament of Treitz, and the
jejunal serosa was sutured to the serosa of the cyst with
interrupted sutures of 0000 black silk. The cyst and
jejunum were then opened, and the full thickness of these
structures was sutured together by a continuous suture of
00 chromic atraumatic gut. This was carried anteriorly as
a Connell stitch. The anastomosis was completed by ap-
proximating the anterior serosal surfaces with 0000 black
silk. A piece of omentum was sutured over the anterior
suture line. The abdomen was closed in layers.
Following the operation, the temperature ascended to
103 F'., and the pulse rate was ranging between 130 and
140. It was feared that the suture line might be leaking.
Three days following the operation, however, the patient
began to pass flatus and took fluids and a soft diet by
Fig. 3. — The barium was still present in the cyst at
the end of two hours.
mouth. Eight days following the operation, the tempera-
ture was elevated to 102.8 F. rectally and again 11 days
following the operation. Twenty-five days after the opera-
tion, a roentgenographic examination of the upper intes-
tinal tract showed the barium to enter the cyst and be
retained there for four hours (figs. 2, 3 and 4). This influx
of barium into the cyst may explain the occurrence of
Fig. 4. — Barium was still present at the end of
four hours. The outlines of the enormous cyst are
seen.
T. Florida M.A
A rim., 1958
BOWEN: CHOLEDOCHAL CYST
1103
cholangitis alter anastomosis of the cyst to the upper in-
testinal tract. One author stated that if the anastomotic
opening is made large, there will be no cholangitis. There
has been no cholangitis in this patient in the six months’
follow-up period. Aspiration of the wound obtained 4 cc.
of old dark blood which was negative on culture. The
temperature was frequently elevated during the postopeia
five period, but 22 days after the operation the tempera-
tur descended to normal and remained so until the pa
tient’s discharge on June 21. The icterus index gradually
descended to normal. The child was treated by hema-
tinics, Terramycin, streptomycin, penicillin and testoster-
one propionate during the postoperative period.
The patient was seen in the office nine days following
her discharge; she had no jaundice and weighed 85J/>
pounds. She was seen again a month later and had gained
pounds. Her appetite was good. She had had no
abdominal pain, and no jaundice was present. The incision
was well healed. Five months following discharge, her
weight was 99 ]A pounds, and her general health and ap-
p?tite were excellent. Figure 5 shows the incision used and
the general state of health six months following the
operation.
Case 2.— The second patient, from the practice of Dr.
Frederick J. Waas, was a nine year old white child who
was admitted to St. Vincent’s Hospital on September 13,
1950 complaining of abdominal fullness and loss of
appetite.
The mother stated that the child was jaundiced at
birth and remained jaundiced for 10 to 14 days. The
patient was well until one year prior to admission when
a generalized pruritus with no eruptions developed. The
pruritus usually lasted about one week at a time. She had
been having episodes of pruritus every month for the
year preceding admission. During one of these episodes,
she was seen by a doctor who examined her carefully and
found her liver to be enlarged. Three months prior to
admission, the child had an episode of pruritus during
which her skin and eyes became yellow. The urine dur-
ing this period was dark, but there was no change in the
color of the stools. The child had frequently had a
‘‘stomach-ache” and told her mother that she had to
vomit. She never vomited, however, until six days before
admission. The episodes of pruritus had been accom-
panied by fever. The last episode occurred six days be-
fore admission. At that time, she was noted by her
teacher to be scratching herself constantly in school. A
little later she became nauseated and vomited a material
whose color could not be determined. A weight loss of
about 5 pounds had occurred in the 10 months preceding
admission. Her weight had fluctuated markedly. During
the episodes of pain in the right upper quadrant of the
abdomen, the patient had had difficulty in breathing. One
year before admission, she had had inflammation of the
ear, which was treated by an otolaryngologist.
On physical examination, the patient was noted to be
a moderately well nourished and moderately well de-
veloped white female child who was in no apparent pain.
The pulse rate was 84, and the respirations were 18. The
-clerae were yellow. There was a mass 3’/z finger breadths
below the right costal margin. This was nontender and
blunt in feel, and the relative area of liver dullness ex-
tended down to this level. The skin was gray, and there
were several excoriated areas over both buttocks.
The red blood cell count was 4,750,000 with 6,750
white blood cells, and there were 52 per cent poly-
morphonuclear neutrophils, 4 per cent eosinophils and 44
per cent lymphocytes. The fragility test and the pro-
thrombin time were normal. The cephalin flocculation test
gave negative results after 48 hours. The blood sugar
was 96 mg. The total protein was 7 Gm. per hundred
cubic centimeters. The icterus index was 6. There was
0.2 mg. of bilirubin per hundred cubic centimeters.
Examination of the urine gave negative results. The
urobilinogen was negative.
Roentgenograms of the chest gave negative evidence.
Roentgenographic examination of the gallbladder, after the
oral administration of Priodax, showed norifunction of the
gallbladder. Examination of the upper gastrointestinal
Fig. 5. — This photograph shows the incision used
and the general appearance of the patient six months
following the operation.
Fig. 6. — Flattening of the first portion of the duo-
denum with displacement of the duodenum downward
and toward the left, suggesting a mass in the right
upper quadrant.
1104
BOWEN: CHOLEDOCHAL CYST
Volume XLIV
Number 10
tract revealed the esophagus and stomach to be normal,
but the duodenum was flattened in its first portion and it
was displaced downward and toward the left, suggesting
a mass in the right upper quadrant (fig. 6). The stomach
emptied normally, and within three hours the meal had
reached the splenic flexure. There was no displacement of
the hepatic flexure or proximal transverse colon.
Twelve days following admission, the abdomen was
opened by means of an upper right rectus incision. There
was a smooth spherical mass about the size of a grape-
fruit, measuring 16J4 cm. in diameter, located in the hep-
atoduodenal ligament. The mass was attached above to
the hilus of the liver and below to the first portion of the
duodenum. There was no adherence of the mass anterior-
ly, and the lesser peritoneal cavity could easily be enter-
ed through the foramen of Winslow. Aspiration of the
mass showed it to contain cloudy green bile with numer-
ous white threads. The liver was enlarged and firmer than
normal. No common duct or hepatic duct was identified.
The stomach and duodenum were grossly normal, but the
gallbladder was represented by a small fibrous mass l/i
cm. in its greatest dimension. The cyst was anastomosed
to the duodenum using 0000 cotton for the seromuscular
sutures and continuous 0000 chromic catgut for the inner
sutures. A No. 16 T tube was introduced through
the wall of the cyst, and one of the limbs of the
tube was left in place through the anastomosis. The ab-
domen was closed in layers, using interrupted 0000 cotton
for peritoneum, fascia and skin. A Penrose drain was
placed in the wound.
A biopsy specimen of the wall of the cyst consisted of
a single, greenish-gray, irregular piece of tissue 3 cm. in
its greatest dimension. Sections showed fibrous tissue with
large numbers of inflammatory cells, including neutrophils
and extravasated red cells. No definite epithelial surfaces
were identified. The pathologic diagnosis was: Wall
of choledochus cyst, showing benign inflammatory tissue.
Four days following the operation the drain was re-
moved. Fifteen days following the operation, the irri-
gation of the T tube produced thin bile. The patient was
discharged from the hospital on October 14 with the T
tube still in place. The T tube was removed 31 days
following the operation.
Since the operation, the patient has had, about every
nine to 12 months, an episode of pain in the right upper
quadrant of the abdomen. This pain usually subsides with-
out any treatment. In 1953 the pain was severe and ac-
companied by fever, and she was given an antibiotic and
antispasmodic with relief of symptoms. These ep sodes
of pain usually last four to five days. She has not
been jaundiced since the operation. She had not had an
episode of abdominal pain in the year preceding October
1955.
Summary
Two cases of choledochal cyst are presented.
The pathology, etiology, differential diagnosis and
treatment of this condition are reviewed.
References
1. Ripstein, C. II., and Miller, G. G. : Choledochus Cyst As-
sociated with Congenital Atresia of Bile Ducts (Report of
Case), Ann. Surg. 128:1173-1177 (Dec.) 1948.
2. Graham, K. A., editor: Surgical Diagnosis. By American
Authors, 3:459;1082, Philadelphia, W. B. Saunders Com-
pany. 1930.
3. McWhorter, G. L. : Congenital Cystic Dilatation of Com-
mon Bile Duct, Arch. Surg. 8:604-626, 1924.
4. Reel, P. J., and Burrell, N. E. : Cystic Dilatation of Com-
mon Bile Duct, Ann. Surg. 75:191-195 (Feh.) 1922.
5. Gross, Robert E. : The Surgery of Infancy and Childhood,
Its Principles and Techniques, Philadelphia, W. B. Saunders
Company, 1953.
6. Attar, S., and Oheid, S.: Congenital Cyst of Common Bile
Duct: Review of Literature and Report of Two Cases, Ann.
Surg. 142:289-295 (Aug.) 1955.
2000 Park Street.
f. Florida M.A.
April, 1958
1105
Benign Myalgic Encephalomyelitis
Syndrome Mimicking Anterior Poliomyelitis
Irvin M. Greene, M.D.
MIAMI BEACH
The syndrome known as benign myalgic en-
cephalomyelitis is so named mostly for expediency.
Other names that have been advanced are Akur-
eyri disease1 or Iceland disease because it was
first described in Akureyri, Iceland, by Sigurdsson
and others2 in 1950. Since, then outbreaks have
occurred in several towns in England, a recently
described one being that at the Royal Free Hos-
pital in London in 1955. The outbreaks in Florida
at Tallahassee in 1954 and later in Punta Gorda
seem to be nosologically similar to the English
entity. Because of its apparently recent arrival in
southern Florida, I wish to describe a case of
this nature, which may perhaps alert the practi-
tioners of this area for further possible incidence
of the disease.
Report of Case
A 47 year old Comptometer operator and former
ballet dancer was admitted to Mt. Sinai Hospital of
Greater Miami on Aug. 2, 1956, because of sore throat,
vague malaise and dizziness. On the second day of hospi-
talization she was still afebrile but drowsy, and a dry
irritative cough developed. A diagnosis of infection of the
upper part of the respiratory tract was made.
After five days of treatment with mostly aspirin for
a slight elevation of temperature and symptomatic medi-
cation, the patient improved. Then on August 10, nine
days after admission, a painful swelling over the left
parotid gland at its infra-auricular portion appeared. This
vanished the following day, but was followed by nausea,
vomiting and a temperature of 102 F. There was tender-
ness along both parotid glands and the postcervical glands,
but no evidence of mumps was observed. At this time
headache, nuchal rigidity, pain on movement of the neck,
and Kernig’s sign were noted. Lumbar puncture was per-
formed, and although this relieved the headache, the
cerebrospinal fluid was normal except for a slight trau-
matic bloody tinge. The protein was 50 mg. per hundred
cubic centimeters, and the fluid was not remarkable for
any other positive findings in view of the traumatic punc-
ture.
On the tenth day of hospitalization, paresis of both
legs was present. This involved the extensors of the thighs
and calves of both legs. Nuchal rigidity became less pro-
nounced, but a certain amount of nuchal resistance was
present. The muscles of the back and chest were painful
and tender. Tendon reflexes were brisk bilaterally. No
ankle clonus, Babinski or Hoffman sign could be elicited.
The patient had frequent crying spells, which was “unlike
her usual self.”
After a neurologic consultation, it was decided to
transfer the patient to Children’s Variety Hospital for
treatment of anterior poliomyelitis. At that hospital on
August 12 another lumbar puncture was performed, with
negative findings including a protein content of 25 mg.
From the General Practice Section of Mt. Sinai Hospital of
Greater Miami, Miami Beach.
and no pleocytosis. By this time an improvement in the
paresis of both legs was observed. The resident staff at
Variety Hospital stated that the disease was not polio-
myelitis, and arrangements were made for the patient’s
return to Mt. Sinai Hospital.
The further course of the illness after readmission of
the patient to the hospital was characterized by six days
of low grade fever, abdominal cramps and diarrhea for
two days. On August 17 she was afebrile. There were,
however, complaints of weakness of the legs and some
difficulty in walking. She was discharged from Mt. Sinai
Hospital on August 18. At home she again had a mild
fever and severe weakness of the legs, whereupon the
local physician hospitalized her at Doctor’s Hospital. The
course there was one of gradual subsidence of the fever
and general improvement. Following her discharge she
returned to work. Her only complaint at this date is
some residual weakness of her legs.
Virus studies were made on two separate specimens of
blood which were sent to the special virus laboratory at
Variety Hospital during the first few days of illness, and
then again during convalescence. Evidence of the following
virus diseases was looked for, but was not found: lymph-
ocytic choriomeningitis, mumps, eastern equine and St.
Louis equine encephalitis, APC virus and Coxsackie group
B 1-5. Agglutination tests for infectious mononucleosis
and atypical pneumonia also gave negative results. Blood
culture and cephalin flocculation tests likewise gave neg-
ative results.
Comment
The Guillain-Barre syndrome was considered
because of the bilateral nature of the paresis;
however, the usual high protein content of the
cerebrospinal fluid was lacking. Lymphocytic
choriomeningitis and a meningitic form of in-
fectious mononucleosis could not be supported
clinically or by laboratory tests. It is possible that
there are several as yet undifferentiated entities
which simulate anterior poliomyelitis. The case
described, however, corresponds in important re-
spects to the outbreaks described in London in
1955, in Berlin in 1954, 3 and in Iceland in 1948-
1949. The possibility of this disease being non-
paralytic poliomyelitis is negated by the cerebro-
spinal fluid and the onset of paresis.
Summary
A symptom complex recently delineated 4 '!>
and simulating anterior poliomyelitis is exemplified
by the case described. It is the purpose of this
presentation to direct attention to a syndrome
relatively new in this area in order to stimulate
further investigation into a disease which may be
confused with anterior poliomyelitis.
1106
ABSTRACTS
Volume XLIY
X UMBER 10
Laboratory Studies
Red
White
Poly-
Blood
Hemo-
Blood
morpho-
Band
Lympho-
Mono-
Eosino- Basophils
Date
Cells
globin
Cells
nuclears
Cells
cytes
cytes
phils
Aug. 2
• 4.1
12.15
9,950
61
1
20
5
1 2
Aug. 5
4.2
12.6
5,900
56
5
29
6
3 1
Aug. 9
4.4
12.6
6,600
43
14
40
0
3
Aug. 11
4.3
13.4
14,500
80
13
3
2
References
1. Sigurdsson, B., and others: Disease Epidemic in Iceland
Simulating Poliomyelitis, Am. J. Hyg. 52:222-238 (Sept.)
1950.
2. Sigurdsson, B., and Gudmundsson, K. R.: Clinical Findings
Six Years After Outbreak of Akureyri Disease, Lancet
1:766-767 (May 26) 1956.
3. Sumner, D. Vv . : Further Outbreak of Disease Resembling
Poliomeylitis, Lancet 1:764-766 (May 26) 1956.
4. Aclieson, E. D. : Encephalomyelitis Associated with Polio-
myelitis Virus; An Outbreak in a Nurses’ Home, Lancet 2:
1044-1048 (Nov. 20) 1954.
5. McAlpine, D. ; Buxton, P. II. ; Kraemer, M., and Cowan,
D. J.: Acute Poliomyelitis with Special Reference to Early
Symptomatology and Contact Histories, British M. J. 2:1019-
1023 (Dec. 27) 1947.
6. Macrae, A. D., and Galpine, J. F. : Illness Resembling Polio-
myelitis Observed in Nurses, Lancet 2:350-352 (Aug. 21)
1954..
7. Pellew, R. A. A.: Clinical Description of Disease Resem-
bling Poliomyelitis, Seen in Adelaide, 1949*1951, M. J. Aus-
tralia 1:944-946 (June 30) 1951.
8. Warin, J. F. : Davies, J. B. M. ; Sanders, F. K., and Vizoso,
A. I).: Oxford Epidemic of Bornholm Disease, 195 1, But.
M. J. 1:1345-1351 (June 20) 1953.
9. White, D. N., and Burtch, R. B.: Iceland Disease; New
Infection Simulating Acute Anterior Poliomyelitis, Neu-
rology 4:506-516 (July) 1954.
311 Lincoln Road.
ABSTRACTS
A Critique on the Therapeutic Value of
Lumbar Sympathectomy. By Arthur R. Nel-
son, M.D., and I. Ridgeway Trimble, M.D.
Surgery 39:797-804 (May) 1956.
This report concerns an effort to evaluate ther-
apeutic results in 192 patients treated by lumbar
sympathectomy for various disorders at The Johns
Hopkins Hospital between 1946 and 1951, and
followed for a minimum of two years. The great
majority were followed for four and five year
periods. The total group of 251 in this study was
evaluated from the standpoint of operative
mortality and postoperative complications. The
series of 192 which was adequately followed rep-
resents 272 extremities subjected to operation,
and forms the basis for the statistical appraisal
of therapeutic results.
Of particular interest was the use of labora-
tory tests to predict the therapeutic result. It
was found that predicting the result of operation
for an individual patient was impossible by any
clinical or laboratory procedure used for preoper-
ative evaluation in this series, including the pres-
ence or absence of pedal pulses and the use of the
skin-resistance test.
Poor results of sympathectomy were noted in
59 to 74 per cent of all patients with arterio-
sclerosis, arteriosclerosis complicated by diabetes
mellitus, Buerger’s disease, and the postphlebitic
syndrome. The presence of any tissue necrosis de-
creased the likelihood of a good result. The oper-
ative mortality in 251 patients (364 extremities)
undergoing lumbar sympathectomy was 1.2 per
cent. All deaths occurred among patients with
diabetes mellitus.
It is urged that in the light of these results,
a more vigorous attempt be made to screen pa-
tients for possible direct attack on the offending
occlusion.
Serial Electrocardiographic Changes of
Myocardial Infarction Occurring in a Case
of Cerebral Hemorrhage. By Maurice Rich,
M.D., and Martin S. Belle, M.D. South M. J.
50:799-802 (June) 1957.
A case of cerebral hemorrhage, with serial
electrocardiographic changes highly suggestive of
acute myocardial infarction but without post-
mortem findings of myocardial infarct, is de-
scribed. There is a short review of possible elec-
trocardiographic patterns encountered in cere-
brovascular accidents. Also, brief comment is
made regarding the possible explanations of the
electrocardiographic alterations noted in this case,
as well as changes in the cardiovascular dynamics
secondary to factors of the central nervous sys-
tem.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411. Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
al Convention
Bal Harbour
1108
Y’olu m e XL1V
Number 10
Program of Eighty -Fourth
Annual Convention
General Information
y Registration
The Registration Desk, located in the Theatre Audi-
torium, Americana Hotel, will be open Sunday, Monday
and Tuesday 8 : AO a.m. to 5:30 p.m. and Wednesday
8:30 am. to 12:30 p.m. Each member is required to
register and obtain identification badge before attending
any sessions. Guests and ladies are also required to regis-
ter. There is no fee. Printed programs are available at
the Desk.
^ T echnical Exhibits
The Technical Exhibits will be located in the Theatre
Auditorium of the Americana Hotel and may be visited
Sunday, Monday and Tuesday from 8:30 to 5:30 and on
Wednesday from 8:30 to 12:30 p.m. These Exhibits are
an important part of the Eighty-Fourth Annual Conven-
tion, and each physician will be well repaid by spending
some time inspecting them.
y Convention Headquarters
Headquarters are the Americana Hotel where most
activities are scheduled. Specialty groups, approved by
the Board of Governors, will also hold their meetings
concurrently.
1> Association Dinner
The Annual Dinner is scheduled for 7:30 p.m. Tuesday
in the Bal Masque Room.
Tickets are $10.50 per person and are available at the
Association’s Registration Desk.
^ President's Reception
If weather permits, the President’s Reception will be
held on the Starlite Patio. In case of inclement weather,
the Reception will be held in the Medallion Room.
Tickets are $3.00 per person available at the Associ-
ation’s Registration Desk. The time is 6:30 to 8:00 p.m.,
Monday.
^ Blue Shield
The Annual Meeting of Blue Shield is being held at
4:00 p.m. Monday afternoon in the Bal Masque Room.
There will be no conflicting meetings. All delegates seated
at the First Session of the House of Delegates on Sunday
are urged to attend. Delegates are Active Members of
Blue Shield.
^ County Society Presidents
and Secretaries
Dr. Jere W. Annis, President-Elect, has requested all
component county medical society presidents and secre-
taries to meet with him for breakfast Tuesday morning
at 8:00 in the Caribbean Room. Executive secretaries are
especially invited.
^ Council
A meeting of the members of the Council of the Flo-
rida Medical Association has been scheduled for Tuesday,
May 12, at 2:00 p.m. in Rooms 202-203, Americana
Hotel.
y Anglers
Physicians desiring to arrange a fishing trip should
contact the Superintendent of Services or the Bell Captain
at the Americana the day before the planned trip. Rates
vary from $35 to $75 a day, tackle furnished. Those
interested in bone or tarpon fishing on the Keys should
contact a member of the Anglers Committee: Drs. Robert
F. Dickey, Chairman, John W. Dix, John R. Hilsenbeck
and John T. Kilpatrick.
^ Florida Medical Committee
for Better Government
The annual meeting and election of officers for the
Florida Medical Committee for Better Government is
scheduled for Sunday beginning at 8:00 p.m., Rooms 204-
205, Americana Hotel.
» Golf
The Golf Tournament will be held at the Westview
Country Club, May 12-13. The Club is located near Opa
Locka. Dr. Julian A. Rickies, of Miami, is chairman of
the Golf Committee. Other members include Drs. Max-
well M. Sayet, Sanford Levine and Truxton L. Jackson.
Participants in the Tournament are encouraged to bring
their own equipment.
Competition will be for the Duval County Medical
Society Trophy, won last year by Dr. Edson J. Andrews,
of Tallahassee, and the Orlando Loving Cup, awarded to
Dr. Paul J. McCloskey, of Tampa.
Members of the Woman’s Auxiliary will hold their
annual tournament at the same course with a separate
list of prizes including the Orange County Medical
Society Trophy for low gross.
Convention Committees
Anglers
Robert F. Dickey, Chairman
John W. Dix
John R. Hilsenbeck
John T. Kilpatrick
Golf
Julian A. Rickies, Chairman Sanford Levine
Maxwell M. Sayet Truxton L. Jackson
T. Florida M.A.
April, 1958
1109
Meetings of Specialty Societies
Saturday and Sunday
FLORIDA ALLERGY SOCIETY
Norris M. Beasley, President Fort Lauderdale
George F. Hieber, Pres.-Elect St. Petersburg
I. Irving Weintraub, Secy.-Treas Gainesville
Sunday , May 11
Americana — Room 210
10:00 a.m. Business Meeting
8:00 p.m. “Treatment of Severe Allergic Reactions to
Insect Stings and Bites,’’ J. Warrick Thomas, Di-
rector, Thomas Clinic, Richmond, Va.
FLORIDA SOCIETY OF
ANESTHESIOLOGISTS
Stanley H. Axelrod, President Miami Beach
Breckinridge W. Wing, Pres.-Elect Orlando
Richard S. Hodes, Vice Pres Tampa
George C. Austin, Secy.-Treas Miami
Saturday, May 10
Americana — Room 206
8:00 p.m. Executive Committee Meeting
Sunday, May 11
Americana — Westward Room
10:00 a.m. Business Meeting and Election of Officers
FLORIDA CHAPTER, AMERICAN
COLLEGE OF CHEST PHYSICIANS
Clarence M. Sharp, President Jacksonville
George L. Baum, Vice Pres Coral Gables
M. Eugene Flipse, Secy.-Treas Miami
Ivan C. Schmidt, Program Chairman West Palm Beach
Sunday, May 1 1
Americana — Bermuda Room
8:45 a.m. Business Meeting
9:10 a.m. “The Association of Chronic Obstructive
Pulmonary Emphysema with Chronic Peptic
Ulceration,” Louis Zasly, Delray Beach
9:35 a.m. “A Comparison of Clinical with X-Ray and
Pulmonary Function Laboratory Estimation, Timed
and Total Vital Capacity," Milton B. Cole, Bay
Pines
10:00 a.m. “Dysphagia," Myron I. Segal, Hollywood
NOTE: Rooms have been assigned to the various specialty
groups in the Americana Hotel. The Florida Medical Associa-
tion is not to furnish projecting lanterns or any' of the equip-
ment necessary for the holding of such meetings.
10:25 a.m. “ Clinical Significance of Solitary Pulmonary
Nodules: 60 Collected Cases with Roentgenologic
and Pathologic Correlations,” Franklin G. Norris,
Orlando
10:50 a.m. “Anticoagulants in Impending Myocardial
Infarction," E. Sterling Nichol, Miami
11:15 a.m. “The Use of Prednisolone in Far Advanced
Pulmonary Tuberculosis: Report of Four Seriously
III Colored Females Who Had Failed to Respond
to Conventional Therapy," Mary Lou Mcllhany,
Lantana
11:40 a.m. “ Management of Carcinoma of the Lung
in Elderly and Poor Risk Patients," DeWitt C.
Daughtry, Miami
12:00 Luncheon — Bermuda Room
1:00 p.m. “Fungus Diseases of the Lungs," David T.
Smith, Chairman of the Department of Bacteriol-
ogy, Duke University School of Medicine, Durham
1:50 p.m. “Surgical Aspects of Diaphragmatic Hernia,”
James D. Moody, Orlando
2:15 p.m. X-Ray Seminar
Those in attendance are requested to bring x-rays
for discussion after presenting a brief and pertin-
ent clinical history.
3:00 p.m. Adjournment
FLORIDA ACADEMY OF
GENERAL PRACTICE
Henry L. Harrell, President Ocala
Charles R. Sias, Pres.-Elect Orlando
Charles D. Cooksey, Vice Pres Jacksonville
A. MacKenzie Manson, Secy.-Treas. Jacksonville
Elmer B. Campbell Sr., Program Chair. St. Petersburg
Sunday, May 11
Americana — Rooms 202-203
10:00 a.m. Board Meeting
8:00 p.m. General Meeting and Business Session — Flor-
idian Room
“Cancer Detection in the Office of the Generalist,”
John S. DeTar, Milan, Mich., Immediate Past
President, American Academy of General Practice
FLORIDA SOCIETY OF DERMATOLOGY
The Florida Society of Dermatology will not hold its
annual meeting at the time of the Eighty-Fourth Annual
Convention of the Florida Medical Association. This
specialty society is having a combined meeting with the
Southeastern Dermatological Association on April 19-20
at the Balmoral Hotel, Bal Harbour.
1 110
MEETINGS OF SPECIALTY SOCIETIES
Volume XL1\
N I'MRFP 10
FLORIDA HEALTH OFFICERS’ SOCIETY
Paul W. Hughes, President Fort Lauderdale
Henry I Langston, Vice Pres Marianna
Lorenzo L. Parks, Secy.-Treas Jacksonville
Sunday, May 1 1
Americana — Carioca Room
10:00 a.m. “Research in Public Health in Florida ,”
Albert V. Hardy, Assistant State Health Officer,
Jacksonville
Discussion
10:25 a.m. “Use and Value oj a Tumor Clinic Register,’’
John J. Fomon, Director, Tumor Clinic, Jackson
Memorial Hospital, Miami
Discussion
10:50 a m. “Treatment of Tuberculosis,” Roberts Davies,
Director, State Tuberculosis Board, Tallahassee
Discussion
11:15 a.m. “Alcoholism and Public Health,” Mr. Ernest
A. Shepherd, Administrator, State of Florida Al-
coholic Rehabilitation Program, Avon Park
Discussion
11:40 a.m. “Nutrition - Role of the Health Department
in a Weight Control Program,” Miss Ramona
Powers, Regional Nutrition Consultant, Miami
Discussion
12:00 Business Session
FLORIDA ASSOCIATION OF
INDUSTRIAL AND RAILWAY SURGEONS
Francis T. Holland, President Tallahassee
William G. Harris, Pres. -Elect Jacksonville
Gordon H. McSwain, Vice Pres Arcadia
John H. Mitchell, Secy.-Treas Jacksonville
Sunday, May 1 1
Americana — Floridian Room
10:40 a.m. Panel Discussion
“Man with Trauma Versus Trauma in Man - Back
and Head Injuries,” Drs. John D. Ferrara, Mod-
erator; Frank L. Fort, James C>. Lyerly Sr., Wil-
liam H. McCullagh and G. Frederick Oetjen, Jack-
sonville
Business Meeting; Election of Officers
FLORIDA SOCIETY OF INTERNAL
MEDICINE
Donald F\ Marion, President Miami
W. Dean Steward, Pres. -Elect Orlando
Charles K. Donegan, Secy.-Treas. St. Petersburg
Sunday, May 11
Americana — Barbados Room
9:00 a.m. Program to be announced
The Technical Exhibits are an important part of the
Eighty-Fourth Annual Convention. They are located in
the Theatre Auditorium. Be sure to spend some time
there as an expression of your appreciation to the firms
represented.
FLORIDA OBSTETRIC AND
GYNECOLOGIC SOCIETY
S. Carnes Harvard, President Brooksville
Joseph W. Douglas, Pres. -Elect Pensacola
T. Bert Fletcher Jr., Secy.-Treas Tallahassee
Saturday, May 10
Americana — Medallion Room
5:00 p.m. Flxecutive Committee Meeting
6:00 p.m. Cocktail Party - Starlite Patio
7:30 p.m. Dinner - Medallion Room
“Luke's Case - Diagnosis in Retrospect," S. Bu-
ford Word, Assistant Professor of Obstetrics and
Gynecology, Medical College of Alabama, Birm-
ingham
Sunday, May 11
Americana— Lower Ball Room, North Section
9:00 a.m. Business Meeting and Election of Officers
10.00 a.m. “Pitfalls of Uterine Curettage,” Buford
Word, Assistant Professor of Obstetrics and Gyne-
cology, Medical College of Alabama, Birmingham
FLORIDA SOCIETY OF
OPHTHALMOLOGY AND
OTOLARYNGOLOGY
Carl S. McLemore, President Orlando
Edson J. Andrews, Pres. -Elect Tallahassee
G. Dekle Taylor, 1st Vice Pres Jacksonville
Kenneth S. Whitmer, 2nd Vice Pres Miami
Joseph W. Taylor Jr., Secy.-Treas Tampa
Sunday, May 11
Americana — Medallion Room
9:00 a.m. President’s Address
Scientific Session
“Practical Points in Ophthalmic Surgery,” John
M. McLean, Professor of Ophthalmology, Cornell
University Medical College, New York City
“Diagnosing the Child Without Speech,” James
W. McLaurin, Professor of Otolaryngology, Tulane
University School of Medicine, New Orleans
“Localized Diathermy in Traumatic Hyphemia,"
Benjamin Glaser, Orlando
“Cancer of the Larynx; The Need for Early and
Accurate Diagnosis and Treatments," Color Movie,
Laryngofissure Operation, Orville N. Nelson, St.
Petersburg
General Session
Annual Report, Florida Council for the Blind, Mr.
Harry E. Simmons, Executive Director
Presentation of Past President’s Key
Business Meeting; Election of Officers
6:30 - 7:30 p.m. Cocktail Party, Westward Room, Amer-
icana
J. Florida M.A.
April, 1958
MEETINGS OF SPECIALTY SOCIETIES
1111
FLORIDA ORTHOPEDIC SOCIETY
Robert P. Reiser, President Coral Gables
Harry W. Beller, Vice Pres. Miami
Elwin G. Neal, Secy.-Treas. Miami
Theodore Norley, Program Chairman West Palm Beach
Fred H. Albee Jr., Program Co-Chair. Daytona Beach
Saturday, May 10
Americana — Floridian Room
1:00 p.m. Business Session (Florida Orthopedic Society)
2:00p.m. “Slipped Capital Femoral Epiphysis’’ Wal-
lace E. Miller, Chairman and Professor of Ortho-
p.dic Surgery, University of Miami
6:00 p.m. Cocktail Party — Carioca Terrace
Sunday, May 11
Americana — Gaucho Room
Joint Meeting with Florida Pediatric Society for those so
desiring.
9:00 a.m. “Spastic Paralysis of Early Childhood; Its
Detection, Significance and Treatment,” Temple
Fay, Consultant in Neurosurgery, Philadelphia
General Hospital, Philadelphia.
9:45 a. m. “Natural Course of Brain-Injured Child,”
William Berenberg, Chief, Cerebral Palsy Unit, City
Hospital, Boston ; Associate Professor of Pedia-
trics, Harvard Medical School.
10:30 a.m. Round Table Discussion.
FLORIDA SOCIETY OF PATHOLOGISTS
Wray D. Storey, President Tampa
W. Ansell Derrick, Vice Pres. Orlando
James B. Leonard, Treasurer Clearwater
Clarence W. Ketchum, Secretary Tallahassee
Sunday, May 11
Americana — Room 310
9:00 a.m. Business Session, to be followed with Slide
Seminar
FLORIDA PEDIATRIC SOCIETY
Henry G. Morton, President Sarasota
Burns A. Dobbins Jr., Pres. -Elect Fort Lauderdale
Fred I. Dormon Jr., Treasurer Lakeland
Harry M. Edwards, Secretary Ocala
Saturday, May 10
Americana — Westward Room
2:00 p.m. “Early Recognition and Management of
Brain-Injured Child,” William Berenberg, Chief,
Cerebral Palsy Unit, City Hospital, Boston; Asso-
ciate Professor of Pediatrics, Harvard Medical
School
3:15 p.m. “Ancient and Modern Views on Epilepsy with
Prevailing Measures for Its Treatment and Con-
trol,” Temple Fay, Consultant in Neurosurgery,
Philadelphia General Hospital, Philadelphia
5:30 p.m. Cocktail Party — Eastward Room
7:00 p.m. Banquet — Location to be announced.
Sunday, May 11
Americana — Gaucho Room
Joint Meeting with Florida Orthopedic Society
9:00 a.m. “Spastic Paralysis of Early Childhood: Its
Detection, Significance and Treatment,” Temple
Fay, Consultant in Neurosurgery, Philadelphia
General Hospital, Philadelphia
9:45 a.m. “Natural Course of Brain-Injured Child,”
William Berenberg, Chief, Cerebral Palsy Unit,
City Hospital, Boston ; Associate Professor of Pedi-
atrics, Harvard Medical School
10:30 a.m. Round Table Discussion
12:00 Business Session (Florida Pediatric Society)
FLORIDA SOCIETY OF PLASTIC
AND RECONSTRUCTIVE SURGERY
George W. Robertson III, President Miami
Grover W. Austin, Vice Pres St. Petersburg
Bernard L. N. Morgan, Secy.-Treas. Jacksonville
Sunday, May 11
Americana — Room 206
10:00 a.m. Annual Business Meeting; Election of Officers
FLORIDA PROCTOLOGIC SOCIETY
George Williams Jr., President Miami
Thomas F. Nelson, Vice Pres Tampa
Sam N. Sulman, Secy.-Treas. Orlando
Saturday, May 10
Americana — Barbados Room
12:00 Luncheon — To be announced
1:00 p.m. Business Meeting
Discussion of Blue Shield and Report of Commit-
tee of Seventeen, John J. Cheleden, Daytona Beach
Election of Officers
3:00p.m. Scientific Meeting
Round Table Discussions:
“Newer Drugs Related to Proctology, such as Ad-
renosem Salicylate, Cortisone Derivatives and Mus-
cle Relaxants”
“Newer Drugs Related to Pruritis Ani and Coccy-
godynia”
7:00 p.m. Cocktail Party — To be announced
8:00 p.m. Dinner — To be announced
1112
MEETINGS OF SPECIALTY SOCIETIES
Volume XI.lV
Number 10
FLORIDA PSYCHIATRIC SOCIETY
William H. Everts, President West Palm Beach
Tames L. Anderson, Pres. -Elect Miami
Samuel G. Hibbs, Secretary Tampa
Saturday, May 10
Americana — Bermuda Room
10:00 a.m. “Emotional Stress and Epinephrine — Nor-
epinephrine Metabolism," Peter F. Ragan III,
Chairman, Department of Psychiatry, College of
Medicine, University of Florida, Gainesville
“Neurology and Psychiatry in Private Practice,”
William M. C. Wilhoit, Pensacola
“Programs in Psychiatry, School of Medicine,”
John M. Caldwell, Chairman, Department of Psy-
chiatry, School of Medicine, University of Miami,
Coral Gables
Sunday, May 1 1
Americana — Rooms 204-20S
10:00 a.m. “Neurologic Diagnosis in Psychiatric Pa-
tients,” Theodore J. C. Von Storch, Miami
“Report of Activities of the Committee of Mental
Health Training and Research,” John T. Benbow,
Clinical Director, Florida State Hospital, Chatta-
hoochee
“Treatment Programs at the South Florida State
Hospital," Arnold H. Eichert, Director, South
Florida State Hospital, Hollywood
Business Meeting; Election of Officers
FLORIDA RADIOLOGICAL SOCIETY
Donald H. Gahagen, President Fort Lauderdale
C. Robert DeArmas, Vice Pres Daytona Beach
Russell D. D. Hoover, Secy.-Treas. West Palm Beach
Saturday, May 10
Americana — Eastward Room
1:30 p.m. Film Session
Sunday, May 11
Americana — Eastward Room
9:00 a.m. Business Meeting
FLORIDA UROLOGICAL SOCIETY
W. Dotson Wells, President Fort Lauderdale
Melvin M. Simmons, Pres. -Elect Sarasota
Edwin W. Brown, Secy.-Treas West Palm Beach
Sunday, May 11
Americana — Lower Ball Room, South Section
10:00 a.m. Program to be announced
FLORIDA CHAPTER, AMERICAN
COLLEGE OF SURGEONS
Julius C. Davis, President Quincy
Morris H. Blau, Vice Pres Miami
C. Frank Chunn, Secy.-Treas Tampa
Walter C. Jones, Program Chairman Miami
Sunday, May 11
Americana — Bal Masque Room
10:00 a.m. Scientific Session
“ Fallacies of Tetanus Prophylaxis,” Norman M.
Kenyon, Resident Surgeon, Jackson Memorial
Hospital, Miami
“Carcinoma of the Colon," Dr. Samuel F. Mar-
shall, Lahey Clinic, Boston, Mass.
BLUE SHIELD OF FLORIDA
Russell B. Carson, President Fort Lauderdale
George S. Palmer, Vice Pres. Tallahassee
Hunter B. Rogers, Vice Pres. Miami
John T. Stage, Secretary Jacksonville
Mr. H. A. Schroder, Asst. Secretary Jacksonville
Floyd K. Hurt, Treasurer Jacksonville
Samuel M. Day, Asst. Treasurer Jacksonville
Saturday, May 10
Americana — Rooms 202-203
2:30 p.m. Board of Directors Meeting
FLORIDA MEDICAL COMMITTEE
FOR BETTER GOVERNMENT
Americana — Rooms 204-205
8:00 p.m. Annual Meeting; Election of Officers
Charles F. Henley, State Chairman, Jacksonville
O. E. Harrell, Secy.-Treas., Jacksonville
FLORIDA CANCER COUNCIL
Ashbel C. Williams, Chairman Jacksonville
Lorenzo L. Parks, Secretary Jacksonville
Millard B. White Sarasota
Turner E. Cato Miami
Samuel B. D. Rhea Pensacola
Joseph J. Zavertnik Miami
Courtlandt D. Berry Orlando
Sunday, May 11
Americana — Room 206
8:30p.m. Business Meeting
STATE BOARD OF HEALTH
Sunday, May 11
Americana — Room 207
9:00 a.m. Meeting
J. Florida M.A.
April, 1958
1113
First Meeting House of Delegates
Sunday, 2:30 p.m.
Bau Masque Room
Delegates assemble at the Credentials Committee table
at the entrance to the Bal Masque Room at 2:30
p.m. to present their credentials, fill out attendance
cards and receive special badges from the Credentials
Committee:
Louis M. Orr, Chairman
Ralph W. Jack
Herbert L. Bryans
Delegates are to occupy seats in the designated sec-
tion. Other members of the Association and guests
are requested to occupy seats in the other sections
of the room.
3:00 p.m., President Roberts in the Chair
Invocation: Homer L. Pearson Jr.
Parliamentarian for the President — George F. Schmitt Jr.
Number of eligible Delegates present, report by Louis M.
Orr
Motion to seat Delegates if quorum is present
Approval of minutes of 1957 Annual Meeting as pub-
lished in July, 1957 Journal
Approval of minutes of called meeting Dec. 8, 1957 as
published in February, 1958 Journal
Gavel to First Vice President, Ralph W. Jack
President’s Address, William C. Roberts
President Resumes Chair
Recognition: John S. DeTar, Immediate Past President,
American Academy of General Practice
Recognition: Woman’s Auxiliary and other guests
Report: Homer L. Pearson Jr., Secretary, State Board
of Medical Examiners '
Report on Medicare: John D. Milton
Report: Representative to Student A. M.A. Convention
Election of two Delegates and two Alternates to A.M.A.
House of Delegates for two year terms beginning
Jan. 1, 1959
(Terms expiring Dec. 31, 1958: Delegate Reuben
B. Chrisman; Alternate Frank D. Gray; Delegate
Francis T. Holland; Alternate Walter E. Murphree)
(A.M.A. By-Laws, Chapter IX, Sec. 1: “In order
to be eligible for election to membership in the
House of Delegates, a physician must have been an
Active or Service Member of the American Medical
Association for at least two years immediately pre-
ceding the session of the House in which he is to
serve”)
Reference Committee Personnel announced by President
Roberts
1. HEALTH AND EDUCATION
Floridian Foyer
C. Frank Chunn, Chairman
Walter E. Murphree
Walter J. Glenn Jr.
Kenneth A. Morris
Paul F. Baranco
2. PUBLIC POLICY
Eastward Room
Robert F. Dickey, Chairman
Leo M. Wachtel
Robert L. Tolle
Norval M. Marr Sr.
Marion W. Hester
3. FINANCE ANG ADMINISTRATION
Barbados Room
Herbert E. White, Chairman
Edward W. Cullipher
Egbert V. Anderson
H. Phillip Hampton
Donald F. Marion
4. LEGISLATION AND MISCELLANEOUS
Bermuda Room
L. Washington Dowlen, Chairman
Burns A. Dobbins Jr.
Joseph J. Lowenthal
Millard P. Quillian
Edward R. Annis
5. BLUE SHIELD
Westward Room
Thomas C. Kenaston, Chairman
S. Carnes Harvard
Ernest R. Bourkard
W. Dean Steward
Wm. F. Humphreys Jr.
Presentation of Resolutions and Supplemental Reports
(Resolutions not included in House of Delegates
Handbook and supplemental additions to annual re-
ports of chairmen of committees should be typed in
duplicate and placed on the Speaker’s table immedi-
ately after they are presented.)
Reports of Committee Chairmen and Resolutions:
(To Reference Committee No. 1)
Scientific Work, George T. Harrell Jr.
Medical Postgraduate Course, Turner Z. Cason
Cancer Control, Ashbel C. Williams
Venereal Disease Control, C. W. Shackelford
Tuberculosis and Public Health, Lorenzo L. Parks
Maternal Welfare, E. Frank McCall
Child Health, Warren W. Quillian
Report of Secretary, State Board of Medical Ex-
aminers, Homer L. Pearson Jr.
Report: Representative to Student A.M.A. Conven-
tion-
(To Reference Committee No. 2)
Conservation of Vision, Carl S. McLemore
Medical Education and Hospitals, Jack Q. Cleveland
Medical Economics, Robert E. Zellner
Representatives to Industrial Council, Pascal G.
Batson Jr.
Grievance, Frederick K. Herpel
Nursing, Thomas C. Kenaston
Blood, James N. Patterson
(To Reference Committee No. 3)
Address of President, William C. Roberts
Board of Governors, William C. Roberts
Necrology, J. Basil Hall
Advisory to Woman’s Auxiliary, Merritt R. Clements
Councilor Districts and Council, S. Carnes Harvard
Advisory to Selective Service for Physicians and
Allied Specialists, J. Rocher Chappell
Civil Defense and Disaster, J. Rocher Chappell
Resolution: Discontinuance of District Meetings
Report on Medicare John D. Milton
1114
GENERAL SESSION
Volume XI.IV
Number 10
(To Reference Committee No. 4)
Legislation and Public Policy, H. Phillip Hampton
Mental Health, Sullivan G. Bedell
State Controlled Medical Institutions, William D.
Rogers
Poliomyelitis Medical Advisory, Richard G. Skinner
Jr-
Resolution: BB Guns To Be Declared Illegal
Resolution: Forand Bill
(To Reference Committee No. 5)
Advisory to Blue Shield, Henry J. Babers Jr.
Resolution: Blue Shield Board of Directors
Other Business
Announcements
Adjournment
Genera i Session
Monday, May 12
Bal Masque Room
9:30 a.m. Call to Order, William C. Roberts, President
Invocation
Address of Welcome, Nelson Zivitz, Miami Beach, Presi-
dent, Dade County Medical Association
Introduction, Fraternal Delegates and other eminent
guests
Announcements
9:55 a.m. “Civil Defense, Past, Present and Future,"
J. Rocher Chappell, Orlando, Chairman, Committee
on Civil Defense and Disaster, Florida Medical
Association
10:10 a.m. “Is the Game Worth the Candle?’’ David B.
Allman, Atlantic City, President, American Medi-
cal Association
10:40 a.m. “The Greatest Problem of Medical Education
and Its Relation to Medical Practice,” O. W. Hy-
man, Dean, LJniversity of Tennessee College of
Medicine, Memphis; Vice President in Charge of
Medical Units (Guest of President Roberts)
11:00 a.m. Recess to visit the Technical and Scientific
Exhibits
General Scientific Addresses
11:30 a.m. “Organ Transplantation — Past, Present and
Future,” David M. Hume, Richmond, Ya., Chair-
man of the Department of Surgery, Medical Col-
lege of Virginia
12:00 noon “ The Role of the General Physician in the
Changing Picture of Tuberculosis,” David T. Smith,
Durham, N. C., Chairman of the Department of
Bacteriology, Duke University School of Medicine
Adjournment
LUNCHEONS
12:30 to 2:00 p.m.
Alumni, Fraternity, Specialty Groups
THETA KAPPA PSI
Americana — Dominion Coffee House
12:30 p.m. Luncheon
All attending must register with young lady at
marked table in the lobby
REFERENCE COMMITTEES
2:00 to 4:00 p.m.
No. 1 Health and Education — Floridian Foyer
No. 2 Public Policy — Eastward Room
No. 3 Finance and Administration — Barbados Room
No. 4 Legislation and Miscellaneous — Bermuda Room
No. 5 Blue Shield — Westward Room
BLUE SHIELD
Americana — Bal Masque Room
4:00 p.m. Annual Meeting; Election of Officers
PRESIDENT’S RECEPTION
Americana — Starlite Patio
6:30-8:00 p.m. No formal program. Tickets $3.00 per
person, available at Association’s registration desk
during registration hours or entrance to Patio
prior to Reception. If weather is inclement, Recep-
tion will be held in Medallion Room
FLORIDA TULANE MEDICAL ALUMNI
Americana — Bermuda Room
6:00p.m. Cocktail Party followed by dinner
Dominating the circular lobby of the Americana
Hotel is a huge terrarium containing a miniature vol-
cano-type mountain and one of the most complete col-
lections of subtropical rain forest flora in existence.
J. Florida M.A.
April, 1958
1115
Scientific Assemblies
Tuesday, May 13
Bal Masque Room
Committee on Scientific Work: George T. Harrell Jr.,
Chairman, Gainesville; Franz H. Stewart, Miami; Don-
ald F. Marion, Miami; Richard Reeser Jr., St. Peters-
burg, and Gretchen V. Squires, Pensacola.
Attention is called to the following By-Laws:
“All papers read before the Association shall be its
property. Every paper shall be deposited with the Sec-
retary when read.
“No address or paper before the Association, except
those of the president and orator, shall occupy more than
fifteen minutes in its delivery, and no member shall speak
longer than five minutes , or more than once on any
subject."
FIRST SESSION
Presiding: George T. Harrell Jr.
9:30 a.m. “Hearing Loss in Persons of Advanced Age”
Abraham R. Hollender and Otto S. Blum, Miami
Beach. Presented by Dr. Hollender.
Discussion: G. Dekle Taylor, Jacksonville
9:55 a.m. “An Analysis of the Causes of Blindness in
Florida”
Nathan S. Rubin, Pensacola
Discussion: William Y. Sayad, W. Palm Beach
John F. McKenna, South Miami
10:20 a.m. “False Positive Pregnancy Tests Caused by
Sparine and Thorazine”
Gerard H. Hilbert, Pensacola
Discussion: Daniel O. Hammond, Miami
10:45 a.m. Recess to visit exhibits
Presiding: Richard Reeser Jr.
11:00 a.m. Panel: Recent Advances in Modern Methods
of Diagnosis and Therapy
Moderator: David M. Hume, Chairman of the
Department of Surgery, Medical College of Vir-
ginia, Richmond
“Reversal of Intractable Cardiac Edema”
David A. Newman, Palm Beach
“The Use of Carbon Dioxide in the Treatment of
Postconcussion Syndromes”
Michael M. Gilbert, Miami
“The Value of Bone Marrow Examination in the
Diagnosis of Malignant Disease”
Robert G. Cushman, Jacksonville
SECOND SESSION
Presiding: Donald F. Marion
2:00 p.m. “Physiologic Basis for Ulcer Surgery”
Edward R. Woodward, Gainesville
Discussion: Robert F. Dickey, Miami
John J. Farrell, Miami
2:25 p.m. “Ventricular Aneurysm”
Richard G. Connar, Tampa
Discussion: Samuel P. Martin, Gainesville
Robert S. Litwak, Miami
2:50 p.m. Recess to visit exhibits
Presiding: Franz H. Stewart
3:00p.m. Panel: Medical and Surgical Aspects of
Chest Diseases
Moderator: David T. Smith, Chairman of the
Department of Bacteriology, Duke University
School of Medicine, Durham
“Differential Diagnoses of Pulmonary Tuberculosis”
George H. Hames, Lantana
“Office and Bedside Evaluation of Pulmonary
Function”
William W. Stead, Gainesville
“Surgery in the Relief of Dyspnea of Ventilatory
Origin”
John G. Chesney, DeWitt C. Daughtry and Harold
C. Spear, Miami. Presented by Dr. Chesney.
“Pulmonary Surgery in Infants and Children”
Hawley H. Seiler, Tampa
CONFERENCE OF
COUNTY MEDICAL SOCIETY
PRESIDENTS AND SECRETARIES
Americana — Caribbean Room
8:00 a.m. Breakfast
Jere W. Annis, President-Elect, Florida Medical
Association, presiding.
ASSOCIATION DINNER
Americana — Bal Masque Room
7:30 p.m. No formal program. Tickets $10.50 per per-
son available at Association’s registration desk.
The tropical garden of the Americana Hotel has
tended areas in abstract geometric patterns, separated
by reefs of native Florida coral.
1116
Volume XLlV
Number 10
Second Meeting House of Delegates
Wednesday, 9:00 a.m.
Bal Masque Room
Delegates sign official attendance cards at 9:00 a.m. at
the table of the Credentials Committee, Louis M.
Orr, Chairman, Ralph W. Jack and Herbert L.
Bryans, located at entrance to the Bal Masque Room.
No alternates are to be seated for Delegates attend-
ing Sunday’s meeting.
9:30 a.m., President Roberts in the Chair
Number of eligible Delegates present, report by Louis
M. Orr
Recognition: President, Florida Bar, Baya M. Harrison
Jr.
Presentation of Life Certificates
Recommendations of Reference Committees:
No. 1 Health and Education
C. Frank Chunn, Chairman
No. 2 Public Policy
Robert F. Dickey, Chairman
No. 3 Finance and Administration
Herbert E. White, Chairman
No. 4 Legislation and Miscellaneous
L. Washington Dowlen, Chairman
No. S Blue Shield
Thomas C. Kenaston, Chairman
Other unfinished business
Election of Association Officers, 12:00 noon
President-Elect
First Vice President
Second Vice President
Third Vice President
Secretary-Treasurer
Editor of The Journal
Dr. Jere W. Annis escorted to the Chair as new President
Presentation of Personal Gavel to Dr. Annis
Presentation of Past President’s Button and Certificate of
Honor to Dr. William C. Roberts by Dr. Jere W.
Annis, President
Benediction: Homer L. Pearson Jr.
Adjournment
BOARD OF PAST PRESIDENTS
Americana — Gaucho Room
8:00 a.m. Breakfast
Election of a Chairman and Secretary
Leigh F. Robinson, Chairman, and Francis H.
Langley, Secretary
(According to precedence, Walter C. Jones will
succeed the present chairman and William C. Rob-
erts the present secretary.)
The Bal Masque Room of the Americana Hotel will be the location for the principal activities of the Eighty-
Fourth Annual Convention.
f. Florida M.A.
April, 1958
1117
Technical Exhibits
Technical exhibits will be located in the Theatre
Auditorium of the Americana Hotel. They have a real
scientific value, and physicians who wish to keep abreast
of the times and be familiar with the latest development
in drugs and medical appliances should spend some time
with these exhibits; a surprising amount of useful in-
formation can be procured in this way.
Many exhibitors make no attempt to sell, the repre-
sentatives of the firms being there primarily to give the
latest information regarding their products. Those who
have items for sale will gladly give information whether
there is a purchase or not. Be sure to register your name
with the various representatives who are exhibiting. The
following firms have arranged for exhibits at the Bal
Harbour meeting:
Exhibitors Booth
Abbott Laboratories 85
A. S. Aloe Company 81
American Ferment Co., Inc. 98
Anderson Surgical Supply Co 112
Arlington-Funk Laboratories 124
Atlas Pharmaceutical Labs., Inc. 89
Audio-Digest Foundation 66
Ayerst Laboratories 28
Baxter Laboratories, Inc 104
The Borden Company 60
Brayten Pharmaceutical Co. 118
Burroughs Wellcome & Co 124
S. H. Camp & Co 75
Chicago Pharmacal Co 52
Ciba Pharmaceutical Products, Inc 63
The Coca-Cola Co 140
Continental X-Ray Corp. & Standard X-Ray Co. 108
Coreco Research Corp 76
Desitin Chemical Co 51
Dictaphone Corp. 10
Doho Chemical Corp 74
Dome Chemicals, Inc 11
Drug Specialties, Inc 12
Eaton Laboratories 101
Eisele and Co 128
Encyclopaedia Brittannica, Inc 92
Encyclopedia Americana 59
Enfield’s 14
Executone, Inc 9
C. B. Fleet Co., Inc 138
Florida Brace Corp 79
Geigy Pharmaceuticals 126
Guild of Prescription Opticians of Fla 8
Hart Drug Corp 91
Hartsfield-Barnett Co 57
Charles C. Haskell & Co., Inc 133
Hoffmann-LaRoche, Inc 96
Holland-Rantos Co., Inc 83
Keisacker 50
Keleket X-Ray of Florida 130
Knoll Pharmaceutical Co 113
Kremers-Urban Co 127
Lederle Laboratories 71
Eli Lilly & Co 82
J. B. Lippincott Co 109
Lloyd Brothers. Inc 115
Loma Linda Food Co 73
J. A. Majors Co Ill
Maltbie Laboratories 61
S. E. Massengill Co 55
Mead Johnson & Co 46
Medical Protective Co 117
Medical Supply Co. of Jacksonville 136
Medical Supply Co 139
Merck, Sharp & Dohme, Inc. 62
The Wm. S. Merrell Co 65
C. V. Mosby Co 100
The National Drug Co 119
Nordmark Pharmaceutical Laboratories, Inc. 102
Organon. Inc 67
Ortho Pharmaceutical Corp 15
Parco Surgical Supplies 135
Parke-Davis & Co 97
Pepsi Cola Co 90
Pet Milk Co 110
Pfizer Laboratories 99
Pitman-Moore Co 86
Wm. P. Poythress & Co., Inc 48
The Purdue Frederick Co. 53
R. J. Reynolds Tobacco Co. 16
Richards Manufacturing Co 72
Riker Laboratories 106
Ritter Co., Inc 120-121
A. H. Robins Co., Inc. 129
Ross Laboratories 123
Sanborn Company 87
Sandoz Pharmaceuticals 84
Schering Corp 47
Julius Schmid, Inc 56
Joseph E. Seagram & Sons, Inc. 107
G. D. Searle & Co 132
Smith, Kline & French Laboratories 95
E. R. Squibb & Sons 137
The Stuart Co 13
Surgical Equipment Co. 70
Surgical Equipment Co. of Tampa 69
Surgical Supply Co 131
Tablerock Laboratories 122
The Upjohn Co 64
Van Pelt & Brown, Inc 54
Walker Laboratories 80
Warner-Chilcott Laboratories 77
Westwood Pharmaceuticals 105
White Laboratories, Inc 49
Winthrop Laboratories 125
Zenith Radio Corp 103
Scientific Exhibits
Americana — Theatre Auditorium
1. Middle Ear and Mastoid Complications Despite the
Antibiotics, G. Dekle Taylor, M.D.
2. Transplant of Digital Nerve Combined with Tailor’s
Bunionectomy, Edward L. Farrar Jr., M.D.
3. Hypothermia in the Correction of Intracranial Vas-
cular Abnormalities, J. Gerard Converse, M.D., Al-
bert J. Ehlert, M.D. and David Reynolds, M.D.
4. Intestinal Recirculation as an Aid to Absorption, H.
Clinton Davis, M.D., M. W. Wolcott, M.D., and D.
Golder, M.D.
5. Treatment of Facial Injuries, Thomas J. Zavdon,
M.D.
6. Diagnostic Research in Cancer Cytology, J. Ernest
Ay re,. M.D.
7. The Migrant Worker, George W. Karelas, M.D.
7A. Dade County Medical Association, Nelson Zivitz,
M.D., President
17. Florida Medical Foundation, Edward Jelks, M.D.
18-19. Food Flim-Flams, Mr. George B. Larson, Ameri-
can Medical Association
20. Blue Shield, Russell B. Carson, M.D.
21. The Dependents’ Medical Care Program, Major
Ralph O. Anderson, Office of Dependents’ Medical
Care
22. Recruitment Future Nurse Clubs, Allied Health
Fields, Woman’s Auxiliary, Mrs. Frederick B. Zaugg
23-24. Non-penetrating Injuries of the Heart and Aorta,
Brig. Gen. Thomas W. Mattingly and Walter Reed
Army Hospital
25-26. Auto Crash Injury Research, Sgt. E. C. Paul,
Indiana State Police
27. Rheumatic Heart Disease Prophylaxis, Simon D.
Doff, M.D., Florida State Board of Health
28. Low Sodium Diets, Florida Dietetic Association,
Mrs. Rebecca Norfleet, and Florida Heart Associ-
ation, Mr. Tom Phillips
1118
PROGRAM OF WOMAN’S AUXILIARY MEETING
Volume XI. IV
Number 10
29. The Manifestations of Muscular Dystrophy, Melville
H. Manson, M.D., Muscular Dystrophy Association
30. Cancer of the Cervix, Mr. L. H. Peterson, Florida
Division, American Cancer Society
31. Sunland Training Center, Charles H. Carter, M.D.
32. Accident Prevention in Hospitals, Florida Hospital
Association and Florida State Board of Health
33. Case Demonstrations — Pathological Bone Lesions,
Wallace E. Miller, M.D., Department of Surgery,
University of Miami
34. General Practice Section in a Department of Medi-
cine, Ralph Jones, M.D., Department of Medicine,
University of Miami
35. Mass in Neck (Clinical Significance), John J. Fo-
mon, M.D., and Victor Dembrow, M.D., Depart-
ment of Surgery, University of Miami
36-37. Arthritis and Rheumatism, David S. Howell, M.D.
37A. Physical Examination and Screening Laboratory
Tests for Physicians, Lorenzo L. Parks, M.D., Flor-
ida State Board of Health
37B. Phosphate Ester Insecticide Poisoning, D. O. Ham-
blin, M.D., and H. H. Golz, M.D.
38. Bureau of Professional Relations, College of Phar-
macy, University of Florida, Mr. Charles S. Haupt
39. Nursing Education, Dorothy M. Smith, R.N., College
of Nursing, University of Florida
40. The J. Hillis Miller Health Center, Russell S. Poor,
Ph.D., University of Florida
40A. Florida Medical Association Insurance Plan, Mr.
Leyton B. Hunter, Marsh & McLennan
41 Automation in Cytology Screening, Nelson A. Mur-
ray, M.D.
42. Trichomonas Vaginalis Infections — Relation to Ab-
normal Cytology, Carl H. Davis, M.D. and C. G.
Grand, M.D.
43. The Use of Radioactive B-12 in Clinical Diagnosis,
Raymond E. Parks, M.D.
44. Otoplasty, Richard T. Farrior, M.D.
45. Skin Cancer About the Face and Eyelids, Wesley W.
Wilson, M. D.
Program
Thirty-First Annual Meeting
Woman’s Auxiliary to the Florida Medical
Association
May 11-13, 1958
Hostess Auxiliary: Woman’s Auxiliary to the
Dade County Medical Association
Chairman Mrs. Robert F. Dickey
Co-chairman Mrs. William P. Smith
GENERAL INFORMATION
GENERAL REGISTRATION will be held
along with registration of members of the Florida
Medical Association at the Americana Hotel. Sun-
day, Monday and Tuesday, 8:30 a.m. to 5:30
p.m., Wednesday, 8:30 a.m. to Noon.
REGISTRATION FOR DELEGATES TO
AUXILIARY House of Delegates
S:30 a.m. to 9:30 a.m., Monday, May 12 (Lo-
cation to be announced)
All activities are to be held at the Americana
Hotel, Bal Harbour
AUXILIARY MEETINGS
SUNDAY, MAY 1 1
1:00 p.m. Pre-Convention Board of Directors
Meeting, Floridian Foyer
3:00 p.m. First session of Florida Medical As-
sociation House of Delegates
MONDAY, MAY 12, Caribbean Room
9:30 a.m. Annual Meeting of House of Dele-
gates, Woman’s Auxiliary to the
Florida Medical Association. All
Auxiliary members invited to at-
tend.
1:00 p.m. Annual Auxiliary Luncheon
6:30 p.m. President’s Reception, Florida Medi-
cal Association
TUESDAY, MAY 13, Floridian Foyer
9:30 a.m. Post-Convention Board of Directors
Meeting
Mrs. Perry D. Melvin
President, Woman’s Auxiliary
J. Florida M.A.
April, 1958
TECHNICAL
EXHIBITS
1119
;i nilHr
Mrs. Lee Rogers Jr.
President-Elect, Woman’s Auxiliary
10:30 a.m. School of Instruction (Open to all
Auxiliary Board members, District
Chairmen, County Officers and
Chairmen
7:30 p.m. Annual Dinner, Florida Medical
Association, dress optional
Technical Exhibit
A feature that adds materially to the success
of the annual convention is the technical exhibits.
Each firm represented features products of partic-
ular interest to the physician. Make a special
effort to visit each booth at some time during the
convention and register your name with the at-
tending representative.
The Technical Exhibit Hall will be open Sun-
day, Monday and Tuesday, 8:30 a.m. to 5:30
p.m., and on Wednesday from 8:30 a.m. to 12:30
p.m. The booths may be dismantled after 12:30
p.m.
GUILD OF PRESCRIPTION OPTICIANS OF
FLORIDA — 8
EXECUTONE, INC. — 9
DICTAPHONE CORP. — 10
DOME CHEMICALS, INC. — 11
Dome Chemicals, Inc. is proud to present its ACID
MANTLE group of products, including the new COR-
TAR-QUIN CREME for stubborn and infectious der-
matoses; HIST-A-CORT-E CREME for senile vaginitis,
pruritus vulvae and kraurosis vulvae; CORT-DOME and
NEO-CORT-DOME CREME and LOTION for inflam-
matory and infectious dermatoses, including otitis ex-
terna; the most extensive line of wet dressings, including
SOYALOID COLLOID BATH; the new principle of vit-
amin utilization by buccal absorption in VI-DOM-A
BUCCAL TABLETS and VI-DOM-A-C ORAL-TABS;
and the new, safer prednisolone K-PREDNE-DOME.
The pool and an exterior view of the Americana Hotel.
1120
TECHNICAL EXHIBITS
Volume XLIV
Number 10
DRUG SPECIALTIES, INC. — 12
NICOZOL— A cerebral stimulant and tonic for the aged,
indicated in senile psychoses, cerebral arteriosclerosis
with mild memory defects, abnormal behavioral pat-
terns, and presenility.
NICOZOL WITH RESERPINE— An analeptic tranquil-
izer for senile psychoses with agitation.
THE STUART CO. — 13
ENFIELD’S — 14
ORTHO PHARMACEUTICAL CORP. — 15
ORTHO cordially invites you to booth #15. Fea-
tured will be DELFEN Vaginal Cream, ORTHO’s most
spermicidal contraceptive. Also on display will be
RARICAL Iron-Calcium Tablets, a compound for use
in iron-deficiency anemias and in all cases requiring
calcium supplementation. ORTHO representatives wel-
come this opportunity to meet you and discuss their
products with you.
R. J. REYNOLDS TOBACCO CO. — 16
Welcome to the R. J. Reynolds Tobacco Company
Exhibit! You are cordially invited to receive a cigarette
case (monogrammed with your initials) containing your
choice of CAMEL, WINSTON F'ilter, Menthol Fresh
SALEM, or CAVALIER King Size Cigarettes.
MEAD JOHNSON & CO. — 46
SCHERING CORP. — 47
The Schering exhibit will feature TRILAFON, ex-
tremely potent tranquilizer and antiemetic, capable of
alleviating manifestations of emotional stress without
apparent dulling of mental acuity.
Extraordinary potency in behavioral effects without
corresponding increase in autonomic hematologic or hepa-
tic side effects provides a favorable therapeutic ratio and
excellent versatility in clinical use.
WM. P. POYTHRESS & CO., INC. — 48
A cordial welcome awaits you at the Poythress booth.
Solfoton and its companion products, Antrocol and Sol-
foserpine, will be featured. Also featured will be Mud-
rane, outstanding Poythress antiasthmatic drug; Tro-
cinate, Poythress distinctive antispasmodic ; Panalgesic,
leading ethical local analgesic and counterirritant ; and
other well-known Poythress specialty products. Liter-
ature will be available, and your request for trial sup-
plies of any of these drugs is invited.
WHITE LABORATORIES, INC. — 49
KEISACKER — 50
Sculpture and Illustrations by a qualified Medical
Artist, who completed studies in Anatomy at University
of Miami Medical School and has done outstanding
work in the field. This exhibit will bring to your atten-
tion the services of an artist in our own area dedicated
to serving mankind through the doctor.
DES1TIN CHEMICAL CO. — 51
DESITIN OINTMENT, the pioneer cod liver oil oint-
ment for treatment of burns, ulcers, wounds, diaper
rash. DESITIN POWDER, cod liver oil dusting powder
for treatment of intertrigo, diaper rash, exanthema,
abrasions, etc. DESITIN HEMORRHOIDAL SUP-
POSITORIES, relieve pain and itching, promote heal-
ing, give comfort in uncomplicated hemorrhoids, fissures.
Contain no anesthetics or styptics. RECTAL DESITIN
OINTMENT, for effective relief in simple hemorrhoids,
pruritus and fissures. DESITIN LOTION, soothing pro-
tective, mildly astringent for treatment of pruritus,
poison ivy and nonspecific dermatitis. DESITIN COS-
METIC & NURSERY SOAP, supermild, nonallergenic,
pleasantly scented, deodorant.
CHICAGO PHARMACAL CO. — 52
Chimedic featured items are URISED, nationally
known and clinically proven tablet for thorough anti-
sepsis plus comfortable sedation in all types of genito-
urinary affections. MERLENATE, the dual action anti-
fungus infection formula in ointment, powder and liquid
form; LIPOMIC Injection for a modern effective treat-
ment of atherosclerosis; plus a complete line of tablets,
ointments, liquids and injectables awaiting your inspec-
tion.
THE PURDUE FREDERICK CO. — 53
We cordially invite you to visit our booth where you
will find our Special Representative on hand to answer
your questions and offer you latest information and
samples of our featured specialty pharmaceuticals:
Glutazyme Capsules and Powder — a nutritive supple-
ment for the patient over 40.
Senokot Tablets and Granules — time proven con-
stipation correctives, with their allied products, Senokap,
Senobile and Senokot with Psyllium.
Pre-mens (plain and with d-Amphetamine) for
multidimensional therapy of premenstrual tension.
Somatovite Liquid and Tablets — for promoting weight
gain and appetite in the undernourished, underweight,
hyperexcitable child.
Sippyplex — for comprehensive, peptic ulcer manage-
ment.
VANPELT & BROWN, INC. — 54
VanPelt and Brown extend a cordial invitation to
visit their exhibit where representatives will be happy
to answer questions and supply clinical samples of their
products.
S. E. MASSENGILL CO. — 55
Best wishes to the members of the Florida Medical
Association for a successful and enjoyable convention.
Should you desire, Massengill Representatives will be
honored to discuss any Massengill Speciality Products
with you. Featured are Adrenosem (the unique systemic
hemostat) ; Obedrin (effective aid in weight control and
fatigue states) ; Homagenets (the only homogenized vit-
amins in solid form) ; The Salcort Family (offering a
complete range of therapy for arthritic disorders) ; Safer-
on (the peptonized iron).
JULIUS SCHMID, INC. — 56
An interesting and informative exhibit featuring
RAMSES Flexible Cushioned Diaphragm ; RAMSES
Vaginal Jelly; VAGISEC Jelly and Liquid, two new
products embodying “Carlendacide,” the recent develop-
ment of Carl Henry Davis, M.D., and C. G. Grand for
vaginal trichomoniasis therapy; and XXXX (FOUREX)
Skin Condoms, RAMSES and SHEIK Rubber Condoms
for the control of trichomonal re-infection.
HA RTS FI ELD-B ARNETT CO. — 57
UNASSIGNED — 58
ENCYCLOPEDIA AMERICANA — 59
THE BORDEN CO. — 60
MALTBIE LABORATORIES — 61
The Maltbie Laboratories booth features Desenex®
Night and Day treatment of athlete’s foot, Bifran® for
control of obesity and biliary disturbance, Cholan V for
effective hydrocholeresis with superior spasmolysis, Mal-
cotran®, the effective anticholinergic with wide thera-
peutic range, Nesacaine®, the first local anesthetic more
potent yet less toxic than procaine, and Caldesene®
Medicated Powder for diaper rash.
J. Florida M.A.
April, 195S
TECHNICAL EXHIBITS
1121
MERCK, SHARP & DOHME, INC. — 62
A new and very promising diuretic is featured at the
Merck Sharp & Dohme booth. Since the principal action
of ‘DIURIL’ is a marked enhancement of the excretion
of sodium, chloride and water, it has been designated
a salureticagent. This new compound achieves a pro-
found electrolyte and water diuresis without attendant
toxic effects and other disadvantages peculiar to the
mercurials and certain other diuretic agents.
Technically trained personnel will be present to discuss
this and other subjects of clinical interest.
CIBA PHARMACEUTICAL PRODUCTS, INC. — 63
THE UPJOHN CO. — 64
Professional representatives of The Upjohn Company
are eager to contribute to the success of your meeting.
We are here to discuss with you products of Upjohn re-
search that are designed to assist you in the practice of
your profession. We solicit your inquiries and comments.
THE WM. S. MERRELL CO. — 65
Bendectin, a new and exceptionally effective anti-
nauseant for treatment and prevention of vomiting in
pregnancy will be featured.
You are invited to discuss this and other Merrell re-
search products with our representatives.
AUDIO-DIGEST FOUNDATION — 66
Audio-Digest Foundation — a subsidiary of the Cali-
fornia Medical Association — gives the busy physician an
effortless tour through the best of current medical litera-
ture each week. This medical tape-recorded “newscast”
— compiled and reviewed by a professional Board of
Editors — may be heard in the physician’s automobile,
home or office. The Foundation also offers medical lec-
tures by nationally-recognized authorities.
ORGANON, INC. — 67
Physicians are cordially invited to visit the Organon
booth for information on new therapeutic specialties.
Among these will be LIQUAMAR, the new and highly
potent oral anticoagulant; CORTROPHIN-ZINC, the
long-acting, aqueous ACTH; ADRESTAT, the complete
systemic hemostat; WIGRAINE, the rapid-acting and
complete migraine treatment; and NUGESTORAL, the
aid for the abortion-prone patient. Organon representa-
tives will be happy to discuss these advances in therapy
with all interested physicians.
UNASSIGNED — 68
SURGICAL EQUIPMENT CO. — 69, 70
We invite you to visit our booth where our repre-
sentatives will be in attendance to show you the latest
medical and surgical items.
LEDERLE LABORATORIES — 71
RICHARDS MANUFACTURING CO. — 72
An interesting and informative display of the finest
in orthopedic equipment, featuring the new Campbell
Boyd Pneumatic Tourniquet, the Boyce Parker Table for
hand surgery, and many other invaluable time and work
savers for the General Practitioner as well as the General
and Orthopedic Surgeon.
LOMA LINDA FOOD CO. — 73
With the background of years of experience in perfect-
ing a hypoallergenic milk powder, and also a newly de-
veloped concentrated liquid milk the protein of which is
fully derived from the soybean and formulated with other
essential additives to care for the needs of babies, grow-
ing children, and adults, the Loma Linda. Food Company
will be happy to welcome you to their exhibit. Attend-
ants will be pleased to discuss the values of Soyalac
powder and concentrated liquid. Samples of this flavor-
ful product will be served at the exhibit.
THE DOHO CHEMICAL CORP. — 74
Doho Chemical Corporation is pleased to exhibit:
AURALGAN, ear medication in Otitis Media and removal
of cerumen. OTOSMOSAN, effective nontoxic fungicidal
and bactericidal in suppurative and aural dermatomycotic
ears. RHINALGAN, nasal decongestant free from sys-
temic or circulatory effect and safe to use on infants.
NEW LARYLGAN, soothing throat spray and gargle for
infectious and noninfectious sore throat.
S. H. CAMP AND CO. — 75
There are many new and interesting developments in
CAMP Appliances and Supports being displayed. See the
new lightweight maternities, supports for geriatric pa-
tients, new orthopedic supports, abduction pillows, arm
sleeves, hospital binders, cervical collars, traction apparatus
— pelvis, leg and head. Representatives will be present
to answer queries on these very effective agents.
CORECO RESEARCH CORP. — 76
WARNER-CHILCOTT LABORATORIES — 77 -
Warner-Chilcott Laboratories will feature: Pacatal,
the new phrentorophic agent. Pacatal’s tranquilizing
effect is unique because it produces a deeper calm with
sedation. In depressed patients, Pacatal unlike other
ataratic agents, produces a decided euphorogenic effect.
Pacatal permits a normal active life to the tense, anxious
or disturbed patient. Side effects are minimal with
Pacatal, and its dosage schedule is simple and convenient
for the patients.
Peritrate Sustained Action is a new dosage from the
long-acting coronary vasodilatator. For the first time
the angina patient is provided with round-the-clock pro-
tection against attack.
AYERST LABORATORIES — 78
Physicians are invited to visit Booth No. 78 where
Averst representatives will be on hand to welcome them
and discuss any Ayerst specialties of interest to them.
FLORIDA BRACE CORP. — 79
WALKER LABORATORIES — 80
VIACETS, HEDULIN, BACIMYCIN PRODUCTS,
PRECALCIN and PRECALCIN LACTATE will be dis-
played at the WALKER Booth. VIACETS are multi-
vitamin chewable CANDISPHERES available in five
fresh fruit flavors — each flavor presented in its own color.
HEDULIN is the oral anticoagulant described in recent
papers and complete reprint portfolios will be available
to all registered physicians.
A. S. ALOE CO. — 81
A cordial welcome is extended to the members of the
Florida Medical Association to visit the A. S. Aloe Com-
pany exhibit. A unique array of Surgical, Physio-Thera-
py, X-Ray and Laboratory equipment will be displayed.
ELI LILLY AND CO. — 82
You are cordially invited to visit the Lilly exhibit.
The Lilly sales people in attendance welcome your ques-
tions about Lilly products and recent therapeutic devel-
opments.
HOLLAND-RANTOS CO., INC. — 83
Simplicity with security keynotes the Koromex ex-
hibit; H-R representatives will gladly explain: . . . WHY
patients can easily and correctly place KORO-FLEX
DIAPHRAGMS; . . . SIGNIFICANT features of KORO-
MEX Vaginal Jelly when “jelly-alone” is advised;
1122
TECHNICAL EXHIBITS
Volume XLIV
Number 10
. . . Three-fold effectiveness of NYLMERATE Jelly and
Solution Concentrate; Clinical value, in minor skin dis-
orders, of HOLLANDEX Silicone Ointment.
SANDOZ PHARMACEUTICALS — 84
Sandoz Pharmaceuticals cordially invites you to visit
our display.
BELLERGAL: Space Tabs — assures around the clock
control of functional complaints (example — menopause
symptoms) in the periphery where they originate.
SANDOSTENE: Space Tabs around the clock con-
trol of itching and hay fever.
BepHan Space Tabs new approach to prolonged main-
tenance of low gastric acidity.
Any of our representatives in attendance, will gladly
answer questions about these and other Sandoz products.
ABBOTT LABORATORIES — 85
Members of the medical profession will be cordially
welcomed at Abbott Laboratories’ exhibit of leading spec-
ialties and new products. Our representatives will be
available at the exhibit to give information on the pro-
ducts and to answer any questions you may have.
PITMAN-MOORE CO. — 86
Please accept our invitation to visit the Pitman-Moore
booth. We are showing a new product that has intrigued
and interested us for some time— and we believe your
interest will more than match our own.
We also have product information on our well known
specialties Novahistine and Neo-Polycin.
SANBORN CO. — 87
Featured at the Sanborn exhibit will be the new and
outstandingly successful Model 300 VISETTE — a com-
plete electrocardiograph of full diagnostic accuracy that
weighs only 18 pounds. The familiar Model 51 Viso-
Cardiette will also be available for comparison — as will
the famous Sanborn Metabulator.
For those interested in research, full data will be
available regarding Sanborn Recording Systems (single
and multi-channel; direct, photographic and tape), Moni-
toring Oscilloscopes and Transducers.
UNASSIGNED — 88
ATLAS PHARMACEUTICAL LABS., INC. — 89
PEPSI COLA CO. — 90
HART DRUG CORP. — 91
ENCYCLOPAEDIA BRITANNICA, INC. — 92
UNASSIGNED — 93
UNASSIGNED — 94
SMITH, KLINE & FRENCH LABORATORIES — 95
AMERICAN FERMENT CO., INC. — 98
PFIZER LABORATORIES — 99
The Pfizer exhibit spotlights its recent and original
therapeutic concepts represented by SIGNEMYCIN V
CAPSULES, a combination of oleandomycin and tetra-
cycline phosphate buffered; Signemycin I.V.; ATARAX-
OID, the first ataraxic-corticoid; TETRABON V, the
orange flavored phosphate buffered tetracycline syrup;
MAGNACORT and NEO-MAGNACORT, the first water
soluble corticoid; and LINODOXINE CAPSULES and
EMULSION, the new Pfizer hypocholesterolemic agent.
C. V. MOSBY CO. — 100
The C. V. Mosby Company invites physicians attend-
ing the Florida Medical Association Meeting to inspect
a score or more of new titles on display. Included among
these new titles will be the following brand new releases:
Williamson “Practical Use of Office Laboratory and
X-Ray,” Ryan “Headache,” Lisser-Escamilla “Atlas of
Clinical Endocrinology,” Allen “Symposium on Strabism-
us,” Forster “Modern Therapy in Neurology,” Ball
“Gynecologic Surgery and Urology,” Kenney-Larson
“Orthopedics for the General Practice,” Jacobi-Hagen
“X-Ray Technology,” Sherman-Kessler” Allergy in Pedi-
atric Practice,” Modell “Drugs of Choice,” Patton
“Pediatric Index,” Miale “Laboratory Medicine — Hema-
tology-,” Willson “Obstetrics and Gynecology,” Burdette
“Etiology and Treatment of Leukemia,” Stephenson
“Cardiac Arrest and Resuscitation” and Morris-Scully
“Endocrine Pathology of the Ovary.
EATON LABORATORIES — 101
Furadantin®, a specific for urinary tract infections,
provides rapid bactericidal action against a wide range of
gram-positive and gram-negative bacteria and organisms
resistant to other agents including Proteus and certain
strains of Pseudomonas. In six years of extensive use
in the treatment of genitourinary tract infections, de-
velopment of bacterial resistance remains negligible with
Furadantin.
An advance in the treatment of vaginitis — Tricofuron®
Improved Vaginal Suppositories and Powder. Simple
two-step treatment swiftly brings relief and control of
vaginal moniliasis and trichomoniasis. Rapid relief of
burning and itching often within 24 hours. Eliminates
malodor, esthetically acceptable.
NORDMARK PHARMACEUTICAL LABORATORIES,
INC. — 102
LEYONOR, a new compound for suppression of ap-
petite without C.N.S. over-stimulation, will be featured.
The smooth action of LEVONOR permits its use during
evening hours; it may be given as late as 8 P.M. without
interfering with sleep. Also, recent reprints of clinical
studies on FERRONORD will be available. Ferroglycine
sulfate provides more rapid hemoglobin response with
virtually no undesirable side-effects.
S.K.F. Representatives will be happy to discuss with
you two new long-acting products for ulcer and other
G.I. disorders, ‘DARBID’ Tablets and ‘COMBID’ Span-
sule Capsules. ‘DARBID’ (isopropamide, S.K.F.) is a
potent new anticholinergic with inherent long-lasting
effects. ‘COMBID’ combines ‘DARBID’ with ‘COM-
PAZINE’ (S.K.F.’s outstanding tranquilizer and anti-
emetic) in sustained release form. Both products offer
b.i.d. dosage convenience and protect the patient all day
and all night. The S.K.F. Booth also features injectable
solutions of ‘COMPAZINE’ and ‘THORAZINE’ in the
new MULTIPLE DOSE VIALS.
ZENITH RADIO CORP. — 103
fenmL
AIDS
BAXTER LABORATORIES, INC. — 104
HOFFMANN-LAROCHE, INC. — 96
PARKE DAVIS & CO. — 97
Medical service members of our staff will be in at-
tendance at our booth to discuss important Parke-Davis
specialties which will be on display.
WESTWOOD PHARMACEUTICALS
DIVISION OF FOSTER-MILBURN CO. — 105
FOSTEX CREAM and FOSTEX CAKE are new,
easy to use, therapeutically effective medications for the
treatment of acne, dandruff and seborrheic dermatitis.
They contain Sebulytic© (lauryl sulfoacetate, alkyl aryl
J. Florida M.A.
April, 1958
TECHNICAL EXHIBITS
1123
polyether sulfonate, and dioctyl sulfosuccinate) , a unique
combination of penetrating anionic soapless cleansers and
wetting agents which are highly antiseborrheic and exert
antibacterial and keratolutic effects . . enhanced by sulfur,
salicylic acid and hexachlorophene.
Fostex Cream is applied as a therapeutic skin wash
in the initial treatment of acne, when maximum degreas-
ing and peeling are desired. Fostex Cake is used as a
therapeutic skin wash for maintenance therapy to keep
the skin dry and substantially free of comedones. Fostex
Cream is also used as a therapeutic shampoo in dandruff.
RIKER LABORATORIES — 106
Riker Laboratories presents DISIPAL, a new spas-
molytic drug for skeletal muscle spasm and rigidity of
Parkinsonism. Orally effective, long-lasting, minimal side
actions, non-soporific and no known contraindications.
Our exhibit also features its list of pioneering firsts: RAU-
WILOID (alseroxylon) and its combinations in the
management of hypertension ; PENTOXYLON in angina
pectoris; MEDIHALER-EPI and MEDIHALER-ISO,
measured-dose aerosol nebulization for effective asthma
control. Visit Booth 106 for complete information.
JOSEPH E. SEAGRAM & SONS, INC. — 107
CONGENERS: MEANING— ANALYSIS
Congeners (fusel oil, aldehydes, acids, etc.) are com-
pounds found in all alcoholic beverages that provide the
taste, bouquet and color. In too high concentrations,
however, they can cause undesirable after effects. This
exhibit, based on analyses by Foster D. Snell, Inc., con-
sulting chemists, shows how leading brands of various
alcoholic beverage types differ in their congeneric con-
centration. Physicians who advise moderate drinking for
some of their patients, can be guided by these findings.
CONTINENTAL X-RAY CORP.
STANDARD X-RAY CO. — 108
J. B. LIPPINCOTT CO. — 109
PET MILK CO. — 110
J. A. MAJORS CO.— Ill
The latest editions of W. B. Saunders Company’s pub-
lications will be available for your examination: Levine-
Clinical Heart Disease; 1958 Current Therapy; Andresen-
Office Gastroenterology; Orr-Operations in General Sur-
gery and many others. Mr. G. E. Finch in charge.
ANDERSON SURGICAL SUPPLY CO. — 112
Be sure and come by Anderson Surgical Supply Com-
pany’s Booth #112 and meet the “Baroness.”
KNOLL PHARMACEUTICAL CO. — 113
VITA-METRAZOL is indicated where apathy is the
predominating symptom. It improves appetite, regulates
sleep pattern and increases sociability. VITA-METRA-
ZOL is METRAZOL Liquidum with prophylactic
amounts of selective Vitamin B complex components.
Information concerning VITA-METRAZOL as well as
QUADRINAL, DILAUDID and the other KNOLL prep-
arations is available for your review.
UNASSIGNED — 114
LLOYD BROTHERS, INC. — 115
RONCOVITE-MF, DOXINATE, and DOXINATE
with DANTHRON, original products of Lloyd research,
will be featured at this display.
RONCOVITE-MF provides the new concept of com-
plete anemia therapy due to the unique marrow activat-
ing effect of theapeutic cobalt, acting through erythro-
poietin (the erythropoietic hormone).
The DOXINATE family of products affords the phy-
sician a complete choice of medication for the manage-
ment of all types of constipation.
UNASSIGNED — 116
MEDICAL PROTECTIVE CO. — 117
MALPRACTICE PROPHYLAXIS . . . Professional
Protection Exclusively by The Medical Protective Com-
pany achieves new records of security for the doctor.
Complete program of PREVENTION, DEFENSE and
PROPER PROTECTION against LOSS has reduced
average per capita incidence of suits to less than one-
third that of 30 years ago. “Specialized Service makes
our doctor safer.”
BRAYTEN PHARMACEUTICAL CO. — 118
THE NATIONAL DRUG CO. — 119
The National Drug Company exhibit highlights PAR-
ENZYME AQUEOUS and PARENZYME B (Buccal).
The efficiency of the anti-inflammatory, anti-edema
agents PARENZYME AQUEOUS and PARENZYME B
is clearly substantiated for the treatment of traumatic
wounds, ulceration, phlebitis, ocular inflammation and
for loosening of bronchial plugs in severe pulmonary dis-
ease. Our representatives anticipate discussing with you
the latest advance in Enzyme therapy in the form of
PARENZYME B (Buccal).
RITTER CO., INC. -120-121
This preferred Ritter office equipment enables you
to treat more patients more thoroughly with less effort
in less time.
More and more Physicians are finding routine exami-
nations and treatments in Gynecology, Proctology, Urol-
ogy, E.E.N.T., and all other phases of Medicine, easi-
er through using Ritter Motor Operated ‘Multi-level’
Tables.
Visit the Ritter display and let us demonstrate and
explain to you the many benefits derived from this in-
vestment in a lifetime of convenience and comfort for
both doctor and patient.
TABLEROCK LABORATORIES — 122
Table Rock Laboratories has been serving the Medical
Profession in the southeast for 30 years. We have
developed many drug specialties, the best known being
BISMUTH VIOLET. Other valuable contributions in-
clude: TABOREA, first of its kind, a daytime sedative;
DILOCOL, another first in its field for cough control;
SEDALGESIC, non-narcotic, non-barbiturate analygesic
and sedative; and SENAZOL, a geriatric hormone tonic.
We greatly appreciate the Profession’s support.
ROSS LABORATORIES — 123
ROSS LABORATORIES: CURRENT CONCEPTS
IN PEDIATRICS stressing the critical aspects of preven-
tive care and the development of the infant as a whole
being. Your SIMILAC representative will be happy to
discuss the role of physiologic feeding in providing op-
timum clinical benefits. Copies of the latest Ross Pedia-
tric Research Conference Reports are displayed.
BURROUGHS WELLCOME & CO.— 124
The extensive research facilities of ‘B. W. & Co.’, both
here and in other countries, are directed to the develop-
ment of improved therapeutic agents and techniques.
1124
TECHNICAL EXHIBITS
Volume XI. IV
Number 10
An informed staff will be at our booth to discuss our
products and latest developments.
WINTHROP LABORATORIES — 125
Dilcoron, a new “flavor-timed,” dual-action, coronary
vasodilator for angina pectoris; orally for dependable
prophylaxis and sublingually for immediate relief. The
sublingual— oral tablet has a quick acting layer of nitro-
glycerin 0.4 mg. over a central core of prolonged acting
pentaerythritol tetranitrate 15 mg.
GEIGY PHARMACEUTICALS— 126
The Geigy exhibit will feature BUTAZOLIDIN and
BUTAZOLIDIN-ALKA, potent non-hormonal anti-
arthritic and anti-inflammatory agent also effective in the
treatment of superficial thrombophlebitis; and PRELU-
DIN, non-amphetamine appetite suppressant virtually
without CNS stimulation. Also on display will be
STEROSAN HYDROCORTISONE Cream and Ointment,
for comprehensive control of a wider range of dermatoses;
MEDOMIN, the hypnotic which provides “natural”
sleep; and SINTROM, potent oral anticoagulant with
intermediate duration of action.
KREMERS-URBAN CO. — 127
The Kremers-Urban booth will feature the ultimate
in smooth dependable spasmolytic-sedative timed release
therapy, LEVSINEX/PHENOBARBITAL Extended Ac-
tion Tablets. MILKINOL, modern constipation cor-
rectant for all age groups . . . KUTAPRESSIN for rebel-
lious skin diseases and in prevention of capillary hemor-
rhage.
EISELE & CO. — 128
Eisele & Co. will display their regular line of Hypo-
dermic Syringes, both Regular and Interchangeable,
Clinical Thermometers, and Hypodermic Needles. In
addition Eisele & Co. will display their line of Eco
Bandages and Specialty Glassware.
A. H. ROBINS CO., INC. — 129
KELEKET X-RAY OF FLORIDA — 130
Keleket X-Ray of Florida will have on exhibit the
new Philips Surgex apparatus with the electronic image
intensifier.
This is one of the physicians most valuable mobile
x-ray diagnostic tools in surgery, x-ray department and
emergency room.
With the introduction of the image intensifier, fluoros-
copy can be done at a safe radiation level (}/■ MA) and
without dark adapting the eyes.
Applications: Hip pinning, fluoroscopy and spot
radiography. Exact locating of tumors prior to x-ray
therapy. Emergency Room fluoroscopy.
Moving picture films of unique uses of apparatus will
will be shown during the convention.
Hans B. Heether
SURGICAL SUPrLY CO. —131
G. D. SEARLE & CO. — 132
You are cordially invited to visit the Searle booth
where our representatives will be happy to answxr any
questions regarding Searle Products of Research.
Featured will be Enovid, the new synthetic steroid for
treatment of various menstrual disorders; Zanchol, a new
biliary abstergent ; Nilevar, the new anabolic agent, and
Rolicton, a new safe, non-mercurial oral diuretic.
Also featured, will be Vallestril, the new synthetic
estrogen with extremely low incidence of side reactions;
Pro-Banthine, the standard in anti-cholinergic therapy;
and Dramamine, for the prevention and treatment of
motion sickness and other nauseas.
CHARLES C. HASKELL & CO., INC. — 133
Representative will be present to welcome visiting
physicians and to answer any inquiries regarding our
ethical prescription specialties, such as our BELBARB
family (sedative-spasmolytic), HASAMAL-HASACODE
(analgesic), IROSUL-C (hematinic with vitamin C),
PANTABEEROID (thyroid therapy), and other rational
therapeutic combinations.
ARLINGTON-FUNK LABORATORIES DIVISION
U. S. VITAMIN CORP. — 134
Exhibit features C.V.P., an exclusive water-soluble
citrus bioflavonoid compound with ascorbic acid . . . for
restoring and maintaining capillary integrity. Corrects
or minimizes capillary abnormality and bleeding asso-
ciated with diabetes, hypertension, epistaxis, purpura, gin-
givitis and certain forms of gastro-intestinal, rectal and
vaginal bleeding. Effective therapy in habitual and
threatened abortion.
Professional samples and literature distributed also on
our complete line of nutritional and pharmaceutical
specialties.
FARGO SURGICAL SUPPLIES — 135
MEDICAL SUPPLY COMPANY OF JACKSONVILLE — 136
E. R. SQUIBB & SONS — 137
C. B. FLEET CO., INC. — 138
Fleet will exhibit CLYSMATHANE, its most recent
contribution in the field of medication by rectum — an
advanced method of xanthine therapy. CLYSMATHANE
is a stable solution of theophylline monoethanolamine ;
easily retained ; rapid and uniform absorption ; prompt
and predictable blood levels; with no rectal irritation
after prolonged use. CLYSMATHANE, in a disposable
rectal unit, makes self administration easy any time and
any place — and assures prompt therapeutic blood levels.
Examine the unit and ask for samples and literature.
MEDICAL SUPPLY CO. — 139
THE COCA-COLA CO. — 140
Ice-cold Coca-Cola served through the courtesy and
cooperation of the Miami Coca-Cola Bottling Company,
Miami, Florida and The Coca-Cola Company.
J. Florida M.A.
April, 1958
1125
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON, M.D., Editor
STAFF
Assistant Editors Managing Editor
Webster Merritt, M.D. Editorial Consultant rnesi . ibson
Franz H. Stewart, M.D. Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman. . . .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
Association’s Annual Convention
Bal Harbour, May 10-14, 1958
When the Eighty-Fourth Annual Meeting of
the Florida Medical Association convenes next
month, it will be meeting for the fourteenth time
in the Greater Miami area. The dates this year are
May 10 to 14, and the place is the Bal Harbour
section of Miami Beach. The headquarters is the
fabulous resort hotel, the Americana — Hotel of
the Americas. Dedicated to the art and culture
of the 21 nations of the Western Hemisphere, this
new cosmopolitan oceanfront hotel offers a unique
setting and is ideally appointed to serve the Asso-
ciation for its annual gathering.
Conforming to the schedule instituted last
year, the first session of the House of Delegates
will take place on Sunday afternoon, May 11, in
the Bal Masque Room of the hotel from 3 to 5
o’clock. No other meetings will be held that after-
noon. All specialty groups will hold their meetings
on Saturday and on Sunday morning and evening.
The Association will be honored by the pres-
ence of Dr. David B. Allman, of Atlantic City,
N. J., President of the American Medical Asso-
ciation. “Is the Game Worth the Candle?” is the
title of the address he will present at the General
Session, which will convene at 9:30 on Mon-
day morning. The special guest speaker who comes
at the invitation of President Roberts is O. W.
Hyman, Ph.D., of Memphis, Tenn., Dean of the
College of Medicine and Vice President in charge
of Medical Units of the University of Tennessee.
He has chosen the timely subject, “The Greatest
Problem of Medical Education and Its Relation
to Medical Practice” for his address on Monday
morning. Also scheduled to address the General
Session is Dr. J. Rocher Chappell, of Orlando,
whose subject is “Civil Defense, Past, Present and
Future.” Dr. Chappell is the chairman of the
Association’s Committee on Civil Defense and
Disaster.
Following last year’s innovation, the whole day
on Tuesday will be devoted to two scientific ses-
sions. The entire scientific program for the conven-
tion will be presented at these two sessions. Six-
teen members of the Association will preside, pre-
1126
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 10
sent papers, moderate, or serve on panels. Two dis-
tinguished guest speakers will present scientific
addresses. Dr. David M. Hume, of Richmond, Ya.,
Chairman of the Department of Surgery of the
Medical College of Virginia, will speak on “Organ
Transplantation — Past, Present and Future,”
and Dr. David T. Smith, of Durham. - X. C.,
Chairman of the Department of Bacteriology of
Duke University School of Medicine, has selected
for his subject “The Role of the General Physician
in the Changing Picture of Tuberculosis.”
The second session of the House of Delegates
ts#
y\
will be the concluding session of the convention. It
will take place on Wednesday morning.
The President’s Reception is scheduled for
6:30 on Monday evening. The annual dinner,
omitted last year, will be resumed this year at 8
p.m. on Tuesday.
The scientific and technical exhibits are of
perennial interest. They are particularly good this
year and will be a popular attraction. The added
attractions of the recreational facilities of the
resort area give promise of a convention no mem-
ber of the Association will want to miss.
Orren Williams Hyman, Guest Speaker
Orren Williams Hyman, Ph.D., of Memphis,
Tenn., is a native of North Carolina. The son of
Aquilla Pierce and Margaret Williams Hyman, he
was born in Tarboro on Dec. 21, 1890.
Dr. Hyman attended the University of North
Carolina, where he was awarded the A.B. degree
in 1910 and the M.A. degree in 1911. Princeton
University conferred upon him the Ph.D. degree
in 1921, and Southwestern College in Memphis
honored him with the L.L.D. degree in 1938.
Making a career of teaching, Dr. Hyman
served first as the principal of the public schools
in Salisbury, N. C., for a year and then as Assist-
ant Professor of Biology at the University of Dr. Hyman
J. Florida M.A.
April, 1958
EDITORIALS AND COMMENTARIES
1127
Mississippi the next year. In 1913 he joined the
staff of the University of Tennessee College of
Medicine in Memphis, as Assistant Professor of
Histology and Embryology; he was advanced to
Associate Professor in 1917 and to Professor in
1921. continuing in that capacity to the present
time. Since 1925 he has been Dean of Admin-
istration of the Memphis Division of the Univer-
sity and Dean of the College of Medicine, and
since 1948 he has served as Vice President of the
University in charge of Medical Units.
During the 45 years of his association with
the University of Tennessee College of Medicine,
Dr. Hyman has contributed numerous articles to
medical journals.
Dr. Hyman was married in 1921 to Miss Jane
Johnston. They have three children, a daughter
and two sons.
Is It Martyrdom To Serve?
How long can we attract young men to our
organization if they see disadvantages rather than
advantages in serving their medical association?
Are we making it practically impossible for con-
scientious young physicians to serve?
Time was when it was an honor to serve as
an officer, an editor, a delegate, a committee
chairman, or a member of one of the working
boards or committees of the Florida Medical As-
sociation, the county medical societies and allied
groups. Those who served were rewarded by a
show of appreciation on the part of their fellow
members. Times change, but we question how
much for the better in our particular case.
Too often in the recent past we have seen
subversives gain control of important organiza-
tions in our nation because of the laissez-faire
attitude of ‘‘Let John do it.” Already inroads
have been made in medicine on the same basis.
Service in our organizations is a gratifying experi-
ence in itself, but with the possible exception of
some who are financially independent, the phy-
sician of today depends upon the practice of medi-
cine for his livelihood. Anything that interferes
with that practice must warn him of possible dis-
aster. Today’s trend of rewarding work with more
work with little regard for individual problems is
discouraging the individual we need from partici-
pating in our affairs.
It is not a healthy attitude to have no com-
petition for our higher offices. Too soon it may
become necessary for us to coax doctors to run
in order to fill a position.
Today organized medicine is BIG. It had to
become strong to prevent us from being engulfed
by government and labor, and even management
in many cases. We must be ever alert to watch
for new inroads on our way of life. We must be
prepared to counter these with positive measures.
What is wrong? How can these practices be
remedied? Primarily, we believe some show of
appreciation must make it rewarding for those
who serve. Let them know that you are familiar
with what they do and that you approve or dis-
approve, but also that you appreciate their ef-
forts. And try to be a little familiar with those
efforts.
Much is now being said about paying the
expenses of those who go away from home on
work for our organization. This will be a help,
but it can mean great expense to the Florida
Medical Association, even to the point of an in-
crease in dues if carried far. It is small recom-
pense, however, to the individual doctor who has
given of his time and talents. The loss of time
with patients is the great cost to him. Repeated
trips away on medical association business can
iuin his practice unless his medical colleagues are
thoughtful enough to see that the loss of patients
is more than made up when he returns. It is not
suggested that incompetents be benefited in this
way, but be sure to become familiar with the pro-
fessional work of the “working doctor” and see
that he is not penalized for his service.
Lmfortunately, an opposite attitude is too of-
ten practiced today. Doctors have even been heard
to say “I might send that patient to John Doe,
but John is too busy with medical association af-
fairs.” So the patient goes to a doctor who con-
cerns himself only with his own affairs. Few
things can do more to wreck our way of life.
Fortunately, some who work are dedicated indi-
viduals and are willing to endure hurts and hard-
ships, but must we make martyrs of those who
serve us most?
Program of Annual Convention
The complete program of the Eighty-Fourth
Annual Convention of the Florida Medical Asso-
ciation being held May 10-14 at Hal Harbour on
north Miami Beach is published in this issue of
The Journal beginning on page 1107.
1128
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 10
The County Medical Society
Lay Executive Secretary
A select group of the laity has in recent years
established itself within the structure of organized
medicine and, in ever growing numbers, has made
for itself an enviable place in guiding the profes-
sion’s greatly broadened activities. Less than a
quarter of a century ago, most medical societies
found the part time voluntary services of their
elected physician-secretary sufficient to transact
what little business there was between regular
society meetings. Hardly a score of county socie-
ties and only three or four state associations at
that time employed executive secretaries, most of
whom were laymen. The profession as a whole
was uncertain, even mistrustful, of the idea of
laymen becoming affiliated with its organizational
pattern.1
As medicine’s activities rapidly broadened
and its administrative problems became increas-
ingly complex, more and more state and county
societies employed full time nonmedical directors
to manage their business affairs and coordinate
their programs. Within two decades the attitude
of the profession has been so completely reversed
that today all but a handful of the state societies
and most of the larger county units employ lay
executive secretaries. Initially, the medical socie-
ties chose well, so well, in fact, that almost with-
out exception their executive secretaries earned
their admiration, confidence, respect and often
genuine affection.
The lay executive secretary is today assured
of a permanent place in the world of medicine.
The men and women serving in this capacity
have earned the distinction now accorded them
and are making a unique contribution to the
profession. The demand for their services in
county medical societies grows steadily as the
activities and responsibilities of these organiza-
tions continue to increase. A recent survey showed
that 121 county societies employed a full time
executive secretary, an increase of 54 over the 67
employed two years earlier.2 Approximately
two-thirds of the societies having a membership
of over 300 reported having an executive secretary.
Significant gains, however, were apparent in the
lay executive trend in all society membership
groups, and three societies with less than 50
members employed an executive secretary.
Florida is fortunate to have four lay executive
secretaries serving component county societies of
the Florida Medical Association and doubtless
soon will have others. It recently lost to Texas
one such executive of national prominence, whose
accomplishments were legion and will ever remain
legendary, when Mr. John C. Lee, Executive
Secretary of the Dade County Medical Associa-
tion since 1953, resigned to assume a similar
post with the Harris County Medical Associa-
tion in Houston.
The Dade County Medical Association early
this year welcomed Mr. M. John Hanni Jr. as
its new Executive Secretary. A native of Youngs-
town, Ohio, where he was born in 1924, Mr.
Hanni came to his Florida post from Cleveland.
In that city he had served as executive secretary
of the Academy of Medicine of Cleveland since
1953. After attending the State University of
Executive secretaries presently serving component societies of the Florida Medical Association include (left
to right) Mr. Marshall Brainard, Duval; Mrs. Marie K. Crowell, Pinellas; Mr. M. John Hanni, Dade, and Mrs.
Berneice T. Mathis, Orange.
J. Klorida M.A.
April, 1958
EDITORIALS AND COMMENTARIES
1129
Iowa as an air corps premeteorology cadet in
1943-1944 he continued his academic training at
Ohio Wesleyan University, receiving the B.A.
degree magna cum laude in 1948. His honorary
fraternities are Phi Beta Kappa, Omicron Delta
Kappa and Pi Delta Epsilon, and his social
fraternity Phi Gamma Delta. In 1950 he was
awarded the M.A. degree by Western Reserve
University and for two years thereafter was
Assistant Dean of Men at that institution. During
World War II he was in the Army Air Corps for
more than three years, serving with the Inspector
General in the China theater. He has had
experience in newspaper work and also in adver-
tising and public relations in the industrial field.
Mr. Hanni and his wife, the former Joan Thomas
of Cleveland, have three sons — twins, Christo-
pher and Jonathan aged seven, and Timothy, who
is two years younger.
When the Orange County Medical Society
decided in 1955 to establish a central office and
publish a bulletin, it employed Mrs. Berneice T.
Mathis as Executive Secretary and Managing
Editor. A Floridian, Mrs. Mathis was born in
Pomona Park in 1920 and received her academic
training at Rollins College. In 1950, she became
active in the radio field, writing and producing
programs, one of which she originated for her
two daughters and herself. She entered public
relations work in 1954, serving as instructor and
assistant to the director of the Central Florida
Dale Carnegie Enterprises until she became asso-
ciated with the Orange County Medical Society
in May 1955.
Mrs. Marie K. Crowell is the Executive Sec-
retary of the Pinellas County Medical Society,
and the Managing Editor of its Picomeso Mail
Bag. A native of St. Louis, Mo., Mrs. Crowell
was interested in U.S.O. work there and served as
a sponsor. She worked with the Red Cross and
United Givers and was a Den Mother for Cub
Scouts for five years. Before coming to St. Peters-
burg, she was associated with the New England
Home, a child placing agency in Pittsfield, Mass.
Air. Marshall Brainard, Executive Secretary
of the Duval County Medical Society, has served
in this capacity for three years. Born in Buffalo,
N. Y., in 1918, he received his higher education
in California. In 1939, the College of Business
Administration of the University of California
at Los Angeles conferred upon him the B.S. de-
gree. He is a licensed public accountant and is
the senior partner and manager of the Physicians
Service Bureau of Jacksonville. He also serves
the Florida Society of Anesthesiologists and the
Florida Academy of General Practice in an exec-
utive capacity. He was recently elected a director
of the Medical Dental Hospital Bureaus of
America. The son of a practicing physician, Dr.
Forest J. Brainard of San Fernando, Calif., he
is married to Dorothy Brewster of Callahan,
whose late father, Dr. Warren A. Brewster, was
a country doctor of northern Florida. They have
two children.
The lay executive in medicine at whatever
level — county, state or national — is confronted
with a delicate and a difficult task in accepting
the challenge to serve largely as a bridge between
medicine and the public. He is described as pur-
suing a career dedicated to providing competent
service to medicine, serving best in a role of
conspicuous anonymity, directing but never
officiating, originating but never advocating, pro-
viding continuity of interest and growth, even
though the official leadership of the society
changes every year.1 If imaginative and enough
of a philosopher, the layman in this field has
an unprecedented opportunity to interpret his
medical associates and their objectives and en-
deavors to the laity and, in turn, to lead them
to a better understanding of lay reaction to
them and their society undertakings. In addition,
he renders invaluable service in providing coord-
ination of function among the many volunteer
officers and committeemen who serve their medi-
cal society. As coordinator within the society and
between the society and the public, the gifted and
competent lay executive secretary has much to
offer any county medical society large enough to
warrant and afford his services.
1. Bryan, James E. : Public Relations in Medical Practice,
Baltimore, The Williams & Wilkins Company, 1954, pp.
195-196.
2. American Medical Association: 1955 Nationwide Survey
on County Medical Society Activities, pp. 17-18.
First Permanent Disability
Guide Published
In a special edition of The Journal of the
American Medical Association, issued on Feb. 15,
1958, there appeared A Guide to the Evaluation
of Permanent Impairment of the Extremities and
Back by the Committee on Medical Rating of
Physical Impairment. This committee is an ad
hoc committee of the Board of Trustees of the
American Medical Association appointed in Sep-
tember 1956 and authorized to establish guides
for the rating of physical impairment. This 115
1130
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 10
page publication is the first in a series of such
guides which the committee expects to develop
with the assistance of outstanding consultants. It
is the purpose in this and future reports of the
committee to correct a past confusion of terms
and to provide practical guidance to the evalua-
tion of various types of permanent impairments.
In dealing with this difficult and complex sub-
ject, much confusion has resulted from inadequate
understanding by physicians and others of the
scope of medical responsibility in the evaluation
of permanent disability and the difference between
permanent disability and permanent impairment.
It is obviously vitally important for every physi-
cian to be aware of his proper role in the evalua-
tion of permanent disability under any private or
public program for the disabled. It is equally im-
portant for him to have the necessary authorita-
tive material to assist him in fulfilling his par-
ticular responsibility in a competent manner. This
series of guides is a service of inestimable value
to the entire profession, and the first volume af-
fords an excellent example of a task superbly ren-
dered and offers a promise of future guides of
equal value. The committee deserves the highest
commendation and encouragement in this difficult
undertaking.
A. M. A. Administrative Changes
Following a management survey in the spring
of 1957, made by Robert Heller and Associates
of Cleveland, the American Medical Association
set about initiating certain organizational changes.
Effective on Jan. 1, 1958. Dr. George F. Lull of
Chicago was elevated to the newly created posi-
tion of assistant to the president of the Associa-
tion. For 11 years Dr. Lull had served as secre-
tary-general manager and he will continue until
June serving as secretary, which is an elective
office. In his new post, his experience will be
invaluable as he relieves the Association’s presi-
dent of many of the ever increasing burdens of
that office and applies his talents and skill to solv-
ing medical problems at the state and local as well
as the national level.
Dr. Lull, now 70 years of age, had a dis-
tinguished career in the Army before joining the
A. M. A. staff. Entering as a first lieutenant in
1912, he emerged as a major general of the Army
Medical Corps 34 years later. His last position
before retirement was deputy surgeon general of
the Army. During both World Wars he received
many honors, including the Distinguished Service
Medal. In 1951, the Cuban government gave him
its highest honor, the Order of Carlos Findlay, for
his humanitarian work in the field of medicine.
Florida medicine honors Dr. Lull for his out-
standing service and achievements and wishes him
well in his important new post.
Succeeding Dr. Lull as general manager
and busily engaged in his new duties since the
first of the year is Dr. F. J. L. Blasingame of
Wharton, Texas. It is expected that final action
will be taken at the June meeting of the A. M. A.
House of Delegates eliminating the title 'general
manager’ and substituting the title ‘executive
vice president,’ thereby making Dr. Blasingame
the first to bear the new title.
Active in state and national medical affairs
for many years, he takes over this key position
at the age of 50. When the A. M. A. House of
Delegates elected him as a member of the Board
of Trustees in 1949, he was one of the youngest
physicians ever chosen for membership in that
body. Since that time he has held many im-
portant A. M. A. committee appointments and
has represented the A. M. A. at several world
conferences of the World Medical Association
abroad. In 1955 he served as president of the
Texas State Medical Association.
Teaching and medical education hold partic-
ular interest for Dr. Blasingame. Upon gradu-
ation from the L'niversity of Texas Medical
School at Galveston in 1928, he taught there for
three years and thereafter maintained teaching
connection at the LTiiversity of Texas. He is
chairman of the medical advisory board of the
Sears-Roebuck Foundation, which encourages
young doctors to create new medical facilities
where they are needed. At the time of his ap-
pointment to the A. M. A. executive post, he was
president of Blue Cross-Blue Shield Plans of
Texas, and for 20 years had engaged in private
practice in the same location. Young, highly
experienced, he has made the change at great
personal sacrifice to dedicate himself to American
medicine as a whole and to the principles of good
medical care for all of the American people.
Possessing all the essentials of leadership, plus
knowledge, imagination and sound thinking, he
has the courage and initiative to shoulder respon-
sibility. The Florida Medical Association salutes
Dr. Blasingame and congratulates the American
Medical Association on its wise choice of a chief
executive officer.
J. Florida M.A.
April, 1958
EDITORIALS AND COMMENTARIES
1131
The special House committee, headed by Dr.
William A. Hyland of Grand Rapids, Mich.,
which had spent months studying the Heller re-
port, submitted its recommendations on improving
the A. M. A.’s organizational structure at the
Clinical Meeting in Philadelphia last December.
The House disapproved only one of these recom-
mendations, voting that the election of individual
trustees should continue to be based upon an at-
large nationwide principle rather than upon repre-
sentation from specific physician-population areas
of the country as favored by the Heller report and
the Hyland committee. Recommendations ap-
proved by the House included combining the of-
fices of secretary and treasurer into a post to be
filled by a trustee; discontinuing the post of
general manager in favor of an appointive Execu-
tive Vice-President as chief staff executive; and
creating a joint House-Trustees committee to
redefine “the central concept of A. M. A. objec-
tives and basic programs,” to place more em-
phasis on scientific activities, to study socio-
economic problems, and to take the lead in “creat-
ing more cohesion among national medical soci-
eties.” These constructive measures are noted with
interest and gratification by the component state
medical societies and should redound to the bene-
fit of American medicine as a whole.
Florida Medical Foundation
Progress Report
The Florida Medical Foundation was estab-
lished by the Board of Governors of the Florida
Medical Association at the direction of the House
of Delegates. This nonprofit organization, which
became operative last year, has for its purpose
the promotion of better medical care in Florida.
Its officers now report a successful first year mark-
ed by several milestones of progress.
A major accomplishment was the execution
of a trust agreement with the Florida National
Bank of Jacksonville. By this agreement, the
Foundation designates the bank as Trustee to
receive such property as the Foundation wishes
to turn over to it to be handled, managed, invested
and distributed as directed in the trust instru-
ment. Additional properties may be added by
the Foundation or may be accepted by the Trus-
tee direct from other sources, if for purposes ac-
ceptable to the Foundation. If specific purposes
are designated by persons making donations or
by the Foundation itself, the Trustee will, for
convenience, administer the trust property in
separate accounts. One division is general in
nature, dealing with undirected funds which will
be earmarked from time to time by direction from
the Foundation. A second division relates to ear-
marked funds, as, for example, an amount, the
income from which is to be used for a particular
medical school, or a donation directed to research
in cancer or some other disease. Any number of
separate accounts will be kept by the Trustee in
accordance with the directions of the donor or of
the Foundation if the donor does not specify or
is not sufficiently definite. This agreement assures
the safest, most business-like, and most expedi-
tious handling of the funds of the Foundation
and should encourage many Association members
and the laity to participate generously in the great
philanthropic endeavor the Foundation is under-
taking.
During the year, the Dade County Medical
Association requested the Foundation to accept
and administer its student loan fund. According-
ly, a letter agreement was drawn up consummat-
ing this noteworthy step by the Association’s
largest component county society. The stream-
lined agreement is similar to the trust agreement
with the Florida National Bank and was drawn
to permit the Dade County Medical Association
to give the Foundation a sum of money to be ad-
ministered in accordance with instructions in the
letter.
The Madison County Medical Society is an-
other component county society participating with
enthusiasm in the Foundation program. All ac-
tive members made contributions to the Founda-
tion. The sum of $300, sent in by the Marion
County Medical Society, was received so recently
that it is not included in the financial statement
here reviewed. The Foundation cause is one
which promises to have steadily growing appeal
to the county society as a group as well as to
the individual members.
While a large sum of money is not involved
in the first year’s financial statement, the figures
show a promising beginning in a worthy project
now firmly established on a sound basis. Eight
donations, ranging in amount from $25 to $200
and totaling $525, were received for and disbursed
to medical schools in the name of the donor. The
six donations designated for aid to needy medical
students amounted to $1,793, of which $1,578
represented the Dade County Medical Association
1132
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 10
Medical Student Loan Fund. A donation of $5
started the fund for assistance to destitute mem-
bers of the Florida Medical Association, and two
contributions totaling $110 were for sponsoring
medical research. One donor sent in $700 to be
used in furnishing a room in the Putnam County
Hospital. There were 24 donations with no desig-
nation, which totaled $910. For the year 1957
a total of $4,043 was received.
The Foundation has retained as legal counsel
the firm of Marks, Gray, Yates & Conroy and as
certified public accountants the firm of Smoak,
Davis & Nixon. Mr. W. Harold Parham was
elected to serve as executive secretary.
The Board of Governors of the Association
serves as the Board of Directors of the Founda-
tion. The Foundation’s nine objectives, as set
forth in the charter, are:
1. The improvement of the health and medi-
cal care of the people of Florida.
2. The fostering and sponsorship of graduate
and postgraduate medical education.
3. Financial aid for residents of Florida need-
ing assistance who are pursuing an educa-
tion in medicine.
4. The promotion of scientific knowledge in
medicine among members of the medical
profession.
5. The promotion of scientific knowledge in
medicine between the medical profession
and the public in Florida.
6. The promotion and sponsorship of medical
research.
7. Assistance, through charitable acts, to de-
serving indigent and destitute members of
the Florida Medical Association who shall
be ill, incapacitated, or superannuated and
in great need of aid.
8. The promotion among physicians of Flor-
ida of the principles of medical ethics.
9. Assistance to members of the Florida Medi-
cal Association, through a welfare defense
fund, in defeating charges without merit
of professional malpractice.
The Foundation welcomes donations to any
one or any combination of these projects. It is
also glad to accept undirected funds for use at
the discretion of the Board of Directors for the
objectives designated.
The programs of the specialty societies, meet-
ing in conjunction with the Florida Medical
Association at Bal Harbour, May 10-14, are pub-
lished in this issue of The Journal.
Southern Railway Surgeons
Meet in Jacksonville
April 14-15, 1958
The Association of Surgeons of the Southern
Railway System will hold its annual meeting at
the George Washington Hotel in Jacksonville on
April 14 and 15. This convention each year at-
tracts some 150 physicians and their families from
all of the Southern states east of the Mississippi
River and from a few of the border states. The
meeting was held in New Orleans last year. All
members of the medical profession are invited
to attend this meeting, and reservations may be
obtained by writing the hotel.
Dr. Cecil E. Newell of Chattanooga, Tenn.,
President, will preside at the opening session on
Monday morning. The program features a Sym-
posium on Thoracic Trauma, presented by The
J. Hillis Miller Health Center of the University
of Florida, with Dr. E. R. Woodward, Professor
and Chairman of the Department of Surgery of
the College of Medicine, presiding. The other
participants and their subjects are Dr. J. G.
Wilson, Professor of Anatomy, “Anatomy and
Mechanical Aspects of Respiration;” and Dr.
W. W. Stead, Professor of Medicine, “Physiologic-
al Alterations in the Respiratory Mechanism Fol-
lowing Trauma.” Dr. Woodward will conclude
the Symposium with a lecture on “Therapy as
Based on Anatomical and Physiological Consider-
ations.” Preceding the Symposium Dr. George
Bunch of Columbia, S. C., will present a paper on
“The Surgical Approach of Esophageal Hiatus
Hernia,” and following the Symposium Dr. Rob-
ert E. Mabe of Chattanooga, Tenn.. will discuss
“The Role of Anticoagulants in Vascular Dis-
ease.” The concluding feature of the morning
session will be the presidential address. Dr. New-
ell has chosen for his subject “Power Mower
Injuries.”
Dr. Rudolph M. Landry of Chattanooga,
Tenn., will preside at the afternoon session on
Monday. The program will open with a paper on
“The Treatment of Recurrent Breast Cancer”
by Dr. Carrington Williams Jr. of Richmond,
Va., which will be followed by a paper entitled
“Present Day Considerations of Thyroid Dis-
eases,” presented by Dr. Henry Poer of Atlanta,
Ga. The LTniversity of Miami School of Medicine
will then present a Symposium on Surgery of the
Upper Gastrointestinal Tract, with Dr. John J.
Farrell, Professor and Chairman of the Depart-
ment of Surgery, presiding. The other partici-
J. Florida M.A.
April, 1958
EDITORIALS AND COMMENTARIES
1133
pants and their subjects are Dr. Frank T. Kurz-
weg, Associate Professor of Surgery, “Physiologic
Basis of Gastric Surgery,” and Dr. Donald W.
Smith, Clinical Professor of Surgery, “Alimenta-
tion in Gastric Surgery.” Dr. Farrell will con-
clude with “Diagnosis and Management of Upper
Gastrointestinal Hemorrhage.” The session will
close with “Interview and Examination of General
Sailing, 111-Year Old Confederate Veteran,” a
tape recording by Dr. John Dougherty of Knox-
ville, Tenn.
Four panels will constitute the program on
Tuesday, April 15, three of them to be present-
ed in the morning at the Duval Medical Center.
The first one is a Vascular Clinic Panel, with
Dr. Arthur R. Nelson of Jacksonville serving as
moderator. The panel members are Drs. Wood-
ward, Gainesville, John H. Terry, Jacksonville,
Edward F. Parker, Associate Professor of Sur-
gery, Medical College of South Carolina, Char-
leston, S. C., and Mason Romaine III, Jackson-
ville.
A Tumor Conference will follow, with Dr. F.
Hardy Bowen of Jacksonville, Director of the
Tumor Clinic at the Duval Medical Center, act-
ing as moderator. Serving on the panel are Drs.
Wilbur C. Sumner, Chairman of the Department
of Surgery, Baptist Memorial Hospital, Benjamin
J. Philips Jr., and Lauren M. Sompayrac, Chief
of Dermatology, Duval Medical Center, all of
Jacksonville, and Dr. Farrell, Miami.
A Diagnostic Medical and Surgical Confer-
ence, with Dr. Edward Jelks of Jacksonville
serving as moderator, will conclude the Duval
Medical Center program. Panel members are
Drs. Mabe, Chattanooga, George T. Harrell Jr.,
Dean of the College of Medicine of the University
of Florida, Gainesville, William H. Prioleau,
Clinical Professor of Surgery, Medical College
of the State of South Carolina, Charleston, S. C.,
Arthur Chenoweth, Associate Professor of Sur-
gery, Medical College of Alabama, Birmingham,
Ala., and Karl Hanson, Chief of the Department
of Medicine, Baptist Memorial Hospital and Du-
val Medical Center, Jacksonville.
Following luncheon at the Duval Medical
Center, the final session will be held at the hotel.
“Man with Trauma Versus Trauma in Man —
Back and Head Injuries” is the subject of the
afternoon panel discussion. The moderator is Dr.
John D. Ferrara, and the panel members are
Drs. Frank L. Fort, James G. Lyerly, William H.
McCullagh and G. Frederick Oetjen, all of Jack-
sonville.
Florida is fortunate to have this convention of
surgeons with its excellent program within its
borders. The meeting should evoke wide interest
locally and statewide. Dr. F. Hardy Bowen is the
chairman of the local committee on arrangements.
1957-1958 Fair Exhibits
Attract Large Crowds
Demonstrating once more the public’s keen
interest in health and medicine, large crowds at-
tended the Florida Medical Association’s annual
round of fair exhibits held during the 1957-1958
fall and winter fair seasons.
Featured in three appearances in Florida dur-
ing the two fair seasons was the American Medi-
cal Association’s newest exhibit, entitled “Diges-
tion.” The exhibit illustrates the anatomy and
mechanics of the digestive processes by such
means as a stomach model which moves in peri-
staltic action when an hand crank is turned.
Tallahassee was the scene of this exhibit’s
first display. Sponsored by the Leon-Gadsden-
Liberty-Wakulla-Jefferson County Medical So-
ciety, the exhibit drew wide public acclaim in
the North Florida Fair, held Oct. 29-Nov. 2,
1957. Members of this society and its Woman’s
Auxiliary distributed some 3,000 voluntary health
insurance pamphlets to visitors during the fair.
More than 71,000 persons attended the five day
display. In charge of the project was Dr. George
H. Garmany, of Tallahassee, chairman of the
society’s committee on public relations. Woman’s
Auxiliary arrangements were supervised by Mrs.
David J. McCulloch, also of Tallahassee, presi-
dent of the group.
Th exhibit "Digestion” as shown at the Central
Florida Fair at Orlando. The display was sponsored
by the Orange County Medical Society with assistance
by members of the Woman’s Auxiliary.
98
THE NEW ENGLAND JOURNAL Of MEDICINE
Jan. 9. J958
U
melaphosphate produced markedly higher blood levels
than capsules containing either the corresponding
base or the hydrochloride alone. In addition, the
average levels derived from the tetracycline base or
the chlortetracycline base were higher than those pro-
duced by the corresponding hydrochloride though
lower than those resulting from the mixture contain-
ing the base and sodium metaphosphate. In the study
with chlortetracycline'1 capsules containing a mixture
of the hydrochloride and sodium metaphosphate were
also included in the crossover, and the average levels
produced by these capsules were the same as with the
mixture of chlortetracycline base with sodium meta-
phosphate.
Although the enhancement of blood levels of tetra-
cycline by phosphate, either complexed to the tetra-
cycline or mixed with the base or the hydrochloride,
thus seemed fairly well established, some doubts still
remained because certain reliable observers (includ-
ing many whose results have not been published)
failed to confirm the findings -with the materials and
methods they used. Further confusion seemed to be
added by a subsequent report of Welch et al., 7 who,
in repeating a crossover study with capsules of tetra-
cycline phosphate complex and tetracycline^ E’-drr/
chloride with and without sodi ^
phate, foup ' "
cyciine base. Dicalcium phosphate and food resulted
in lower, and sodium metaphosphate in higher, serum
antibacterial activity than was observed in their ab-
sence. Oil and sorbitol did not interfere with tetra-
cycline absorption.
Dicalcium phosphate is widely used as a filler in
various capsules, including those of the tetracyclines.
The authors cite a large number of other studies that
implicate the presence of calcium ions as the cause of
the reduced absorption of tetracyclines and show that
citric acid can partially neutralize this effect. The
depressing effect of food on the serum levels of tetra-
cycline is likewise explained by the goodly amount of
minerals contained in commercial laboratory diets,
and they postulate that the multivalent cations may
be responsible for the poorer absorption of the drug.
The authors could not explain the failure of citric
acid to enhance serum concentrations when admin-
istered with tetracycline base in contrast to :ts marked
effect when given as the hydrochloride. However,
they hypothesized that the ability of citric acid to
enhance serum levels of tetr^r ~,ine..;«
ability to form complex.®®'''
a
nd chric
a
„u>-*aVai]3hlf*fQr^v
Vme hydrochloride
,....TeoacVc'* e(J
stated m«ture, i
cid, in ^ encapsulate ^ urinary e*-
nd greater
^ concentrations
“„ce be««
creti°ns> “ ^ preparati„n stud*
than any
of tetracyclines,
vo its
\
en
he
ith
th
»>
i
t
d
s
99
, other prep
at
si
dd
of vverTpubfished simul
taneo^P^rsn* ml "Mist mentioned report of Welch
et al.7. These data were based on thoroughly con-
trolled studies both in rats8 and in man” and include
additional findings that serve to explain, fairly con-
clusively, the various discrepancies that have been
mentioned.
The experiments in rats*5 were carried out to study
the effects of citric acid, dicalcium phosphate, sodium
metaphosphate, food, oil and sorbitol on the serum
antibacterial activity produced by the administration
of tetracycline hydrochloride or tetracycline base.
Citric acid administered in equal weight with tetra-
cycline hydrochloride gave the highest concentrations
of all tile preparations studied. No enhancing effect
was obtained iiom citric acid when given with tetra-
paper of
al.7 indicates that in their study the capsules
tetracycline hydrochloride, chlortetracycline hydro-
chloride and tetracycline phosphate complex all con-
tained dicalcium phosphate as a filler, whereas the
capsules containing citric acid and sodium hexameta-
phosphate did not contain any dicalcium phosphate.
This could clearly explain the discrepancies noted in
that study. Likewise, the inconsistencies in other
studies may very well have been due to the presence
of calcium as fillers in some of the capsules and not
in. others.
This, however, fails to explain the most recent find-
ings of Welch and Wright,10 who compared the ab-
sorption of three capsules, each containing 250 mg. of
oxytetracycline hydrochloride — one without any ad-,
juvant, one with 250 mg. of citric acid and the third
with 380 mg. of sodium hexametaphosphate ; no other
filler was contained in any of these capsules. In triple
Vol. 258 No. 2
crossover studies, they
iected one, three and six<
found that sodium hexa
average serum concent^
three hours, whereas
average levels of oxyte
tested.
j
w
1. Eisner. H. J , Slim. F.,
Enhancement of serum Its
/. Pharmacol. Expcr. <jf \
2. Kaplan. M. A.. DickisonX
F. H. New. rapidly absorb
biotic Med. 3? Clin. Theraft\
3. Welch. H . Lewis, C. N., St'
concentrations of three tety
single oral dose in man. A
222. 1957.
4. Pulaski. E. J.. and Isokand
blood serum, bile, and yrratf
ministration of tetracycline
drochloride. Antibiotic M fi
5. Welch, H.. Wright. W. '
bloitd concentrations folio
hydrochloride, tetracycline
metaphosphate. Antibip
6. Welch. H.. Wright, WV
following oral admip
chlortetracycline b?
Antibiolic Med. &
7. Welch. H . Wrig
blood concent cy
and chlortetrty
Inc rap 4:62g
8. Dearborn, y
J. J- and/
sorption /
4:627-64
9. Sweeny
J. M.
certaif
1957.
10. Welch
hexaa
tered \
735-
Editorial.
The New England Journal of Medicine.
258:97-99, (January 9) 1958
ACHROMYCIN-V
TETRACYCLINE HCI BUFFERED WITH CITRIC ACID
TOBA
IS
tetracycline and citric acid
Like
monary-i
moves arl
confused \
cates who
countering of
vations about tfie.,
contrived aggression
medical credentials, th
reasons have become
“wealth of scientific t
of chain smokers at i„
and reiterate that whe?^
no one has yet proved th.
cause of cancer. Not con/
position like that of those
without denying the “evi
interests have shown they
sive. Now, they have /
including that of one
Tobacco and Health, ,-j
Looks at Smoking, di
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER, NEW YORK
*Reg. u. S. Pat. Off.
1136
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 10
The Hillsborough County Medical Association sponsored the exhibit "Digestion” at the Florida State Fair held
at Tampa. Co-sponsor was the Florida Medical Association. Members of the county medical society spent some
time at the exhibit each day to answer the questions of persons visiting the display.
The Florida State Fair in Tampa — the na-
tion’s largest winter exposition — provided the
site of the second showing of the ‘‘Digestion”
exhibit Feb. 4-15, 1958. The display was co-
sponsored by the Florida Medical Association and
the Hillsborough County Medical Association.
Physicians were on hand to answer the many
questions of persons visiting the exhibit. More
than one million persons attend the sprawling
State Fair each year. Members of the Woman’s
Auxiliary to the Hillsborough County Medical
Association planned and installed attractive dec-
orations in the display area. They also assisted
in staffing the exhibit and passing out nearly
5,000 A.M.A. “Family Health Record” booklets.
Dr. Malcolm D. Clayton Jr., of Tampa, chairman
of the county society’s committee on public serv-
ice, supervised the project. He was assisted by
Mrs. Leffie M. Carlton Jr., also of Tampa, presi-
dent of the Woman’s Auxiliary to the local so-
ciety.
The final appearance of the “Digestion” exhib-
it in the state this year occurred in Orlando,
Feb. 24-March 1, 1958, at the Central Florida
Fair. The exhibit was sponsored by the Orange
County Medical Society. Nearly 10,000 infor-
mational pamphlets were distributed to crowds
visiting the fair by members of the Woman’s
Auxiliary to the county society, who also pro-
vided decorations for the exhibit space. In
charge of the project was Dr. James A. McLeod,
of Orlando. Mrs. Royston Miller, also of Or-
lando. president of the Woman’s Auxiliary to the
society, supervised the Auxiliary preparations.
Fifth Biennial Cardiovascular Seminar
Miami, April 23-26, 1958
The Fifth Biennial Cardiovascular Seminar
will begin on Wednesday, April 23, 1958, and
continue through Saturday, April 26, at the Du-
Pont Tarleton Hotel, DuPont Plaza Center, Bis-
cayne Boulevard, in Miami. This Seminar is un-
der the sponsorship of the Florida State Board of
Health, The Florida Heart Association and the
Heart Association of Greater Miami, Inc. By at-
tending this meeting, members of the American
Academy of General Practice will receive 18 hours
of credit in Category II. The registration fee is
$25.
This biennial gathering is one of the outstand-
ing events in the cardiovascular field held in the
South. The distinguished medical lecturers serv-
ing on this year’s faculty are:
Michael E. DeBakey, M.D., Professor of
Surgery, Baylor University College of Medicine,
Houston; John B. Hickam, M.D., Associate Pro-
J. Florida M.A.
April, 1958
BLUE SHIELD
1137
fessor of Medicine, Duke University School of
Medicine, Durham, N. C.; Ancel Keys, Director
of the Laboratory of Physiological Hygiene, Uni-
versity of Minnesota, Minneapolis; John W.
Kirklin, M.D., Mayo Clinic, Rochester, Minn.;
Chas. E. Kossmann, M.D., Associate Professer of
Medicine, New York University College of Medi-
cine. New York; Richard Langendorf, M.D., Re-
search Associate, Michael Reese Hospital, Chica-
go; William Likoff, M.D., Associate Professor of
Medicine, Hahnemann Medical College, Phila-
delphia; John H. Moyer, M.D., Professor of
Medicine, Hahnemann Medical College, Philadel-
phia; and Robert W. Wilkins, M.D., Associate
Professor of Medicine, Harvard Medical School,
Boston.
BLUE
Blue Shield — The Doctors’ Plan
Frederick H. Good, M.D.
DENVER
President of Colorado Medical Service, Inc.
Blue Shield is big business. In 1955, voluntary
prepayment amounted to $10,000,000 a day.
Blue Shield averaged $1,400,000 a day. We think
there will probably be a 15 per cent increase in
those payments this year. The Blue Cross-Blue
Shield building we are meeting in today is no
two-by-four shanty we are dealing with; this is
quite a structure, and it is not complete. In many
ways, I doubt if it ever will be; we will keep
adding rooms until we can comply with public
demand. This is our Plan, it is a community
project, it commands much community interest,
and it is important that we take an interest in this
program to guide and develop Blue Shield as best
we can. Blue Shield started out as our baby, and
it is a little frightening, sometimes a little obstrep-
erous, but the Plan responds to guidance and
reason. It is known throughout the land as the
doctors’ plan, and I think this is as it should be,
because from Florida to every single Blue Shield
Plan in the United States, it exists under the
control of the medical profession.
Organization of Blue Shield
Let us go back quickly to the early develop-
ment of Blue Shield. I would like to give you
a run down on it, and some of the organizational
setup. In 1942, Blue Shield operated in about 11
states. Now there are actually 73 Blue Shield
Plans. As these Plans developed, it became ob-
vious that some sort of a national organization
was necessary because Blue Shield was operating
in virgin territory. It was doing something that,
as far as commercial insurance was concerned at
Information on pages 1 137-1147 completes a series on the
informational meeting of the Active Members of Blue Shield
held in Jacksonville, Dec. 7, 1957.
SHIELD
that time, was not feasible, and certainly not in-
surable. Consequently, a national organization
developed, which, as you undoubtedly know, is the
Blue Shield Commission. This is made up of 33
elected commissioners; 22 from the districts (11
physicians and 1 1 Plan directors) , eight at large,
and three appointed and accepted by the Ameri-
can Medical Association. While this sounds com-
plicated and it would appear that we were look-
ing at Blue Shield through a maze of “gobble de
gook,” actually, Blue Shield functions fairly sim-
ply in its local autonomy. Every plan is autono-
mous and owes its primary loyalty to its own area.
On the other hand, the national picture is growing
with such rapidity, so much responsibility, that
the demands and cooperation that must occur
nationally cannot be ignored.
Types of Blue Shield Plans
There are several types of Blue Shield Plans.
Forty-seven of them are partial service plans; in
other words, that is service and indemnity. In
Colorado, we would fall into that category because
we operate two contracts. One has a $6,000 in-
come limit, but if the individual makes over
$6,000, the physician has the right and privilege
to charge that patient more if he so desires. There
are 18 indemnity plans and seven full service
plans. With regard to this problem of service,
while it is an intriguing area, it is dangerous to
have the medical profession decide upon a given
set of fees that it will accept irrespective of in-
come. The big catch in it revolves around the fact
that during an inflation in the economy, the doctor
suddenly finds himself chained to static fees, the
inflationary process proceeds, his overhead goes up,
and he is dealing with what could ultimately be an
intolerable situation. It is my personal feeling that
a reasonable service income limit is to be desired.
Service benefits are the one thing that justify the
existence of Blue Shield. It is certainly the one
1138
BLUE SHIELD
Volume XL IV
Number 10
thing that separates us from commercial carriers,
and it does for the reason that only doctors can
control, develop, distribute and change fee sched-
ules. If we buy the service benefit principle, which
is the greatest thing we have to offer as far as
Blue Shield is concerned, we are immediately
faced with another interesting point. It is ex-
tremely important that we have a service benefit
contract, that we cover 80 to 85 per cent of our
eligible subscribers. The reasons for that follow.
Importance of Adequate Service
Benefit Contracts
First of all, as time goes on, and our economy
rises, we will find ourselves in a position where
our coverage does not reach 85 per cent. We are
in that problem right now in Colorado. Our state-
wide fee schedule advisory committee is going to
work next week on a $9,000 income limit, because
after a study we found that we are covering, on
the basis of this salary, approximately 65 per cent
of our eligible subscribers. First of all, only doc-
tors can determine fees, and these fees have to be
fair and equitable for the service income limit that
we are going to pick out. That is a must before
our staff can determine any sort of a rate. On
the other hand, in being fair and equitable, we
are also faced with the responsibility that we do
not get out in left field and start writing charges
that will put the rate of our contract beyond the
people that we are trying to serve.
Another thing is important. If 50 per cent
of the subscribers are not covered, in other words,
the income limit is inadequate, the doctor then
has to secure an adequate fee, because the one that
is in existence is usually inadequate. The doctor
may then have to increase the fee anywhere from
50 to 75 to 100 per cent. This appears to the
patient immediately as a tremendous mark up.
The doctor does not want to do that because he
may be embarrassed. He will take a smaller mark
up, or he will take the inadequacy and be dis-
satisfied with what he has and think he is being
inadequately paid. On the other hand, the patient
objects to paying this additional fee because he
thinks he has a service benefit contract, and his
bill ought to be paid. Probably the most important
part of all is that if we accept this situation in
which 50 per cent or more of these subscribers
are subjected to an additional charge, the very
fundamental principle of the service benefit is de-
feated, and we are, in effect, dealing with an in-
demnity type of contract. The patient concludes
that the doctors are sponsoring an inferior and
inadequate product.
Along this line, I might mention the so-called
‘no fee schedule.’ Actually, to the best of my
knowledge, there is no such thing as a ‘no fee
schedule.’ There are fee schedules that are not
published and for reasons that I think are reason-
able. I think you would agree that you would
not be much interested in going down to pick out
a new car and say, “Well, I like that blue and red
car. How much is it?” And the dealer says, “Oh,
don’t worry about that, I’ll bill you when I get
around to it. I’ll see how many I sell this week;
maybe it'll be more, maybe it’ll be less.” I am
sure none of you hire a bookkeeper or receptionist
on the basis of letting her determine her own
salary month by month, related to how kind or
indifferent you are, how many bills she has to get
out, and how many phone calls she has to answer.
You may say that these two situations are not
analogous, that in medicine, no two procedures
are alike. Or, as I used to hear so frequently in
Colorado, “Nobody’s going to tell me what to
charge.” This last statement is a valid argument
to a point. When we sit down to discuss problems
with our patients, we take into consideration their
economic status, their family problems, and a
myriad of other things that are related to what
they are able to pay. The charges are geared to
that sort of a situation, and the patient generally
insists on knowing what his obligations are. Now
this is true just about the same as in a Blue
Shield Plan. Before a rate is established, some
concept must be formed of what the charges are
going to be, because the rate is based on that
problem. Once again, only doctors can decide. The
doctor has to decide what is fair and equitable.
Doctors have to be reasonable to keep this sched-
ule in the area where it belongs.
Prepayment Without Fee Schedule a Misnomer
About the ‘no fee schedule,’ take for example
the Wisconsin Plan. That is no blue sky deal.
That is not a plan that exists so that the doctor
has the opportunity to charge anything that comes
to mind. The charges, in that situation, are geared
to the usual charges in the area in which the serv-
ice is rendered. In the Massachusetts prolonged
illness type of coverage, for example, there is no
published fee schedule, but the charges that are
paid are those that are usual for the area in
which the service is rendered. If you did not
have that you would have to adjudicate every
J. Florida M.A.
April, 1958
BLUE SHIELD
1139
single procedure on every bill that was submitted,
and that would either have to be done by a com-
mittee of Blue Shield or a committee of the state
society. Irrespective of who does it, the ultimate
thing that occurs is the establishment of the fee.
This fee has to be satisfactory to the patient, to
the doctor and to the Blue Shield Plan. Commer-
cial companies, on the other hand, with indemnity
contracts, present a different situation. The diffi-
culty in type of procedure needs bear abso-
lutely no relation to the fees they pay, because
all they are trying to do there is determine a cash
payment on which they can establish a rate. I had
a patient a month or two ago who came in with
a fancy-looking insurance contract with a widely
advertised commercial company that paid $750
for a pontine angle tumor and paid $25 for a
cystocele and/or rectocele. This case points out
that, in indemnity, there need be absolutely no
relationship to the price in a procedure and the
difficulty in performing the procedure.
Fee Schedule a Necessity
There is another area of debate and headache,
the problem of the internist and medical service
and the general practitioner. It revolves around
this situation. The internists decided they did not
want to be paid on a per diem allowance; they
wanted to be paid a flat fee per case. The pedia-
tricians were also interested in this, but not to
the extent at that time that the internists were.
Their society had several sessions, and I was in-
vited to one where they were wrapping this thing
up. The question arose, what about the general
practitioner out at Wagon Wheel Gap, Colo.,
who sees a patient who says he has a coronary
attack? Is he going to get $300 for that? Well
no, they did not think he ought to get $300 be-
cause he was not a member of the Society of In-
ternal Medicine. They could control him, how-
ever, because they had asked for the electrocardio-
grams, chest films, and the other laboratory pro-
cedures. They had decided what his payment
should be. I said, “That’s fine. I’ll tell you what
I’ll do. I’ll furnish the secretarial help, the sta-
tionery, and the postage and write letters for
you, but one of you fellows in this group is going
to sign the letter that tells that doctor that he
isn’t as good as you are and he only gets $200.”
They dropped it, and reconsidered it, and have
now gone back to the sort of a schedule that we
have. We pay $5 per day for 30 days and pay $3
per day for the next 40 days. In any three days
of any given hospitalization, the doctor can
receive an extra $20. In addition to that, if
he still thinks that is inadequate, he has the right
to petition the adjudication committee, which is
made up of three pediatricians and three intern-
ists, and ask for more money, for which we have
no maximum. Our experience has been rather
limited with this plan, but so far it seems to be
working very well, and we find no evidence of
anyone abusing it.
Actually, I am not too concerned about having
somebody tell me what I am going to charge,
particularly if I can sit down with confreres and
do it, because if we do not, I am sure somebody
in Washington is going to do it for us. I am not
as concerned about that as I am the fact that
we as doctors generally do not like to do that.
Our apathy is tremendous toward the idea of try-
ing to sit down and get together and do a reason-
able job on these fees, and yet that is the basic
thing that we must do if this project is going to
work. I would be the last one to say that every
procedure is alike, but I also know that some-
times I get paid for something that is pretty easy
and then I have a couple of tough ones. Taking
the bitter with the sweet, it all seems to average
out, and the fees are fair and equitable. There
is absolutely no room in medicine today for ‘pig
in the poke’ type of fee, any more than there is
for a horse and buggy on a freeway. We are go-
ing to have to stand up and be counted. We are
going to have to be responsible.
Blue Shield Not Truly Insurance
I think you will agree that Blue Shield is
still growing. Some of you may say, “Well, this
is all fine, but this is insurance, and doctors do
not have any business in the insurance business.”
In the classical sense of the word, it is not in-
surance and I would bury that ‘cliche’ here today,
once and for all, if I could. It is not insurance
in my mind, and it is not even third party, for
these reasons. First of all, we as doctors, control
it. Secondly, it is a public trust, and the trustees
serve without pay and in the public good. Third-
ly, it is nonprofit. Fourth, since we control it,
and it is a public trust, we hold the monies until
there is proof of service, with the expenditures
for overhead and the reserves being geared to
a nonprofit corporation. In my mind, as long as
doctors control it, it is not truly insurance and it
is obviously not a third party problem.
Doctor’s Sponsorship Important
The fact that it is not truly insurance is not
1140
BLUE SHIELD
Volume XI- IV
Number 10
the only reason that Blue Shield is here to stay.
The public acceptance and demand for this plan
of ours has taken us far past the point of no re-
turn. There are 40 million people enrolled in Blue
Shield. Figures like 40 million lead us to believe
this is a going concern we talk about. On the other
hand, this problem is far from solution because
there are many people who are eligible for cover-
age who do not have it. I think one of the funda-
mental reasons for inadequate coverage revolves
around the fact that people are not educated to
budget for health insurance like they should be.
They understand it better than they did when
Blue Shield started, but they still have a long
way to go. They are perfectly willing to go on the
installment plan system for the TV set, a home,
a boat, and a membership in the golf club, but
when it comes to budgeting for health, this sort
of leaves them cold, and they are prone to say,
“Well, there aren’t any good plans,” or “The ones
that are being sold are inadequate.”
In 1955, the American public spent 28.6 bil-
lion dollars for being well. Yet in that same year,
they spent only 9.1 billion dollars for well being.
I think it is our responsibility to educate our pa-
tients and the people to the importance of bud-
geting for potential illness and sickness. In the old
days you could stick a few dollars in the sugar
bowl for the catastrophy that was going to hap-
pen, but I am sure all of you will agree that those
days are long gone and the money that could be
saved in that particular category is totally inade-
quate and unfeasible.
One way you can help in this problem of tell-
ing the Blue Shield story to your patients is to
talk about its economic operation. Eighty-six per
cent of every dollar of these 44 plans was returned
as benefits to the subscriber. Roughly 9.7 per cent
was used as overhead; the remainder was put in
subscriber reserve. In contrast, let us consider
three commercial companies, one of the best, the
middle one, and one of the poorest. They pay 87
cents, 63 cents, and 45 cents on every dollar turn-
ed in. This, on the surface, looks excellent. The
angle in the situation is that their group pay-
ments are a great deal better than their nongroup
payments, which makes the picture look a little
better. Blue Shield and Blue Cross, being com-
munity enterprises, have to take all comers and
face all risks with little selection. I think you
would be interested to know that out of 671 com-
panies, 47 per cent of them paid 50 cents or less
back for benefits. Do not get the idea that I am
trying to infer that commercial insurance carriers
in the medical-surgical hospital field are not com-
petitive. They are extremely so. They are par-
ticularly so when it comes to group enrolment,
because they have the ability to furnish a con-
tract on experience rating and beat us to death
in some of these areas. One thing they do not
have, but would love to have, is the idea of doc-
tors agreeing to a fee schedule, such as we do in
Blue Shield.
Doctors Should Understand Feasibility of
Expanding Coverage
Even though we are nonprofit, we have the
responsibility of being careful about expansions,
taking on new ideas and areas of coverage, so that
we do not have an adverse experience. Along
this line there are a couple of areas that are to-
tally uninsurable on an unlimited fee for service
basis, these being laboratory and x-ray procedure.
Items to be insurable must fulfil several criteria,
and these three are of major importance: first of
all, the item must occur accidentally or fortuitous-
ly and not at the subscriber’s election, in other
words, per-chance; secondly, the item must be
capable of reasonable, statistical prediction, there-
fore, predictable; and last, the item must be
capable of proof. Thus these controls, plus the
painful experience which is involved in an ap-
pendectomy, or in a multitude of surgical pro-
cedures, are the factors that make these items
per-chance, predictable, and provable.
You might say, “What about the normal ap-
pendixes?” Well, I have taken out a few; I am
sure there are some surgeons here who have done
the same. I think doctors are fundamentally hon-
est, and honest mistakes are being made. The
painful experience in an appendectomy keeps the
individual from seeking the use of his contract
simply because he has a Blue Shield contract.
And last of all, the present status of tissue com-
mittees in the hospitals can raise a question or
two if surgical enthusiasm exceeds surgical judg-
ment at times. While that appendectomy can be
predicted and can be covered, you are stuck with
the problem, for example, of trying to cover un-
limited chest x-rays, or blood cell counts or blood
sugar determinations. It is a difficult problem.
Blue Shield is besieged by numerous demands for
total care, house calls, prosthesis, nursing serv-
ice, you name it. This is an attempt by the public
to relieve themselves of all financial responsibility
as far as illness is concerned. Such is actually
impossible in our type of enterprise, unless you
J. Florida M.A.
April, 1958
BLUE SHIELD
1141
have government intervention and control as some
other countries have. What has happened, of
course, is this idea of developing a major medical
or catastrophic, or as I prefer to call it, prolonged
type of illness coverage, in which the patient
shares the risk along with the plan. Such cover-
age usually follows this sort of pattern: the basic
Blue Cross and Blue Shield are written along
with this prolonged illness rider. After Blue Cross
and Blue Shield are used up, a corridor is develop-
ed, which the patient pays, and after this corridor
is passed, then the rider or the plan usually steps
back in and pays 85 per cent of the total bill, run-
ning it up to five, 10 or 15 thousand dollars or
whatever sort of contract one wishes to write.
Doctors’ Support Is the Deciding Factor
It is up to each and everyone of us to develop
an interest in Blue Shield because, as I told you,
Blue Shield represents two people, the patient and
the doctor. We can ill afford to stand by idly
criticizing without spending some of our time and
our energy and our talent to become intimately
acquainted with Blue Shield.
I am thankful that Blue Shield exists, because
it is slowing down Uncle Sam from the stand-
point of making further inroads in medicine. I do
not think, however, that this is enough to justify
our continued endorsement and participation in
the development of Blue Shield. Even more im-
portant is the fact that here is a profession with a
tremendously important economic tool, which,
when properly used, is of great good and benefit
to the public. I would also remind you that the
day is long gone when Blue Shield is written for
the low income group, or the medical indigent.
Blue Shield can, should, and must provide suitable
coverage to all people. It is up to us to devote the
time and energy that is necessary to maintain the
esteem and dignity that go with our stewardship
of this doctor plan of ours.
Panel
Henry J. Babers Jr., M.D.
GAINESVILLE
The remainder of this program will be a panel
discussion by the 1 7 committee members. The
speakers on the panel are: Dr. James R. Boul-
ware Jr., pediatrician from Lakeland; Dr. Henry
L. Harrell, general practitioner from Ocala, who
is the president of the Florida Academy of Gen-
eral Practice; Dr Donald F. Marion from Miami,
an internist, who is president of the Florida So-
ciety of Internal Medicine; Dr. John S. Stewart,
a radiologist from Ft. Myers; and Dr. Gretchen
V. Squires, pathologist from Pensacola. I do not
think anyone could say this panel was weighted
in favor of the surgeon. Dr. Good is here also
and following the panel, he will discuss any spe-
cific thing you suggest. We are not going to vote
on anything, but you are welcome to make any
remarks you wish following the panel discussion.
Our various committee members represent prac-
tically all specialties and areas of Florida and
they will answer any questions in reference to
their own area. Dr. Whitman C. McConnell and
I will act as coordinators for the panel.
James R. Boulware Jr., M.D.
LAKELAND
My subject is on two of the most important
factors of Blue Shield.
1. Community Rates. — When Blue Shield’s
sister plan, Blue Cross, was originated, it based
its rates on the simple fact that about one out
of 10 persons needed hospital care each year and
the average length of stay was 10 days. Using
this concept, each person in the community paid
for one day of hospital care per year, and there
was enough money to pay for the average stay of
the person who needed the care.
This simple principle still holds true today.
Community rate did not segregate because of age
and sex, and everyone paid the same rate for
the same service.
Following the success of Blue Cross, based on
community rate, doctors created Blue Shield, like-
wise based on one rate for the entire community.
In the beginning, with individual choice and
some underwriting regulations, the persons en-
rolled in Blue Cross and Blue Shield were repre-
sentative of the group. During the war years, in-
dividual choice was encouraged by employers al-
lowing payroll deduction of dues and employer
contribution toward the cost.
The picture changed when the employer or
union entered the field and the insurance com-
panies became interested in the good risks. The
employer with a good risk group asked for a spe-
cial rate, and the commercial insurance com-
panies, which were afraid initially to deal with
the unknown mass, were now prepared to en-
courage this and enroll the good risks. The insur-
ance companies pulled and are pulling away the
1142
BLUE SHIELD
Volume XLIV
Number 10
good risks and leaving the poor risks so that they
cannot support themselves.
Recent studies show that fewer persons in
the lower income groups have health insurance
than do those in the middle and higher brackets,
even though persons in the low income groups
have greater need for medical care. Should these
lower income groups be further segregated, they
would have to drop their insurance and turn to
government or charity for their needed care.
A danger to us is that if we lose Blue Shield,
the voice of the doctor will all but be stilled by
the third party domination of unions and em-
ployers. They are now attempting to tell the
doctor and the employees what care is to be made
available and how this care is to be rendered.
2. Service Benefit. — In the face of these
dangers, there is one evident and optimistic fact
and that is that we beat this before with commu-
nity rate, and in the absence of competition, we
were successful. We must find the means to keep
the people in the community rate and we have the
means in service benefits.
Service benefits protect everyone and crush
segregation. Although developed primarily for the
benefit of the patient, service benefits now have a
real purpose for the doctor. Almost every buyer
of insurance wants service benefits in preference to
only dollar payment since service benefits assure
him that the needed medical care will be paid for.
Service benefits attract to and retain within
the community plan those good risks who would
otherwise seek dollar advantages elsewhere. This
is the reason why it is necessary not only to pro-
vide service benefits in our community plan, but
also necessary to provide service benefits to a
sufficiently representative group of the community
so as to make certain that the good risks in the
middle income group do not leave the community
plan. If service benefits are made available only
to a small group of low income people, the good
risks and the poor risks of the low income group
will be retained within the community plan, but
those good risks of the middle income group who
will not benefit by service benefits will be at-
tracted to competition. Since higher proportions
of good risks are in the middle income group, it
is necessary to make service benefits available to
them also.
We must support one plan, our plan, to assure
that the doctors’ voice will be heard and the per-
sons who most need protection will have it avail-
able at a reasonable community rate-
Henry L. Harrell, M.D.
OCALA
Two weeks ago, in The Journal of the Ameri-
can Medical Association, there were four excel-
lent articles written mostly by people in the com-
mercial insurance fields. One of the articles
brought out the fact that commercial insurance
covers more people in hospital and medical care
insurance than the Blue Plans do. In fact, it
covers around 50 to 60 per cent. We know, how-
ever, that all such plans are indemnity plans, not
service plans. Some commercial companies are
getting into deductible Major Medical Insurance,
and since these plans are gaining headway, it
might be that they will come out with more of
them.
I do not believe the public is quite ready for
deductible insurance plans. At least, they are not
ready around Ocala. These people want every-
thing covered; they do not want to pay the first
$25 themselves. In addition, they would much
rather have an insurance that pays for diagnostic
work, office calls and all that. Some people have
plans that are pretty expensive, but they still buy
them. For example, we will have to get something
to fight this plan of Mr. Reuther’s in Detroit,
because it is true that some people who have
such plans actually like them.
I had a chance to talk with some of the peo-
ple in San Francisco who are under a closed panel
there. You know it has been running for some
years. It surprised me that people on this plan,
including college graduates in research depart-
ments for the oil companies, had to go to closed
panel physicians, and yet nearly all of them liked
it. They thought I was unreasonable to argue
against it. I brought out the idea of not being
able to select their own physician, and they sim-
ply used the same argument we use for partners.
In the fee schedule we sent out recently, most
of the people who received it refused to fill out
anything not in their practice. They would not
fill it out for surgeons if they were internists.
They said, ‘‘We don’t have anything to do with
the surgeon’s schedule.” From looking at some of
the schedules. I think it would have been better
if the medical men had filled out the surgeon’s
schedule and vice versa. All of them seemed to
have such exaggerated opinions of their own fi-
nancial worth that it might have been better if
the general practitioner had filled out all of them.
J. Florida M.A.
April, 1958
BLUE SHIELD
1143
Donald F. Marion, M.D.
MIAMI
The remarks that I make are not to be inter-
preted as a narrow-minded point of view. They
are not so intended. Sincere gratitude is ex-
pressed by everyone in this room to those who
have spoken before. Their general tenor of
thought appears to be just a little too optimistic
to me. It appears to be a little too much of a
eulogy. It seems to imply too much of take this
or else. I am not altogether certain we have to
take it. One point to think about, and possibly
ask questions about, is this situation. The aver-
age man who does not perform surgery, and there
are quite a number in Florida and in every other
state, possibly might well wonder when his pa-
tient says, “Doctor, what’s the best insurance
plan for me to buy?” Is there not something to
think about in the fact that any impersonal
indemnity plan, no matter who runs it, does not
ask whether the individual has a proved appendi-
citis or a proved meningitis. The average person
who is seriously ill with meningitis often feels
that he does not have a minor illness. As the Blue
Plans are now set up, and if we attempt to expand
the income level coverage for complete service
coverage by the Blue Plans, we must be realistic,
gentlemen, or we certainly are not going to sell
them. We cannot tell the people they are going to
have complete coverage on the service basis, and
pay for their meningitis and their asthma at $3 a
day. It cannot be done.
There can be no argument to the idea that
doctors must agree and participate more or less
equally according to their contributions to the
service plans. At the present time, however, al-
though it is politics that usually makes strange
bed fellows, I think Blue Shield has made strange
bed fellows. The medical man and the surgeon
are in the same bed on the service contract; but
the surgical man is getting most of the covers
and the medical man is cold, and he is not happy
about it. If we are to go on, as perhaps we must,
to higher income ceilings for an across-the-board
service contract, I wonder if we should not at-
tempt a little better readjustment of participation.
John S. Stewart, M.D.
FT. MYERS
From 1940 through 1953 we have seen an in-
creased utilization of hospitalization by our in-
sured participants. In 1940, this was approxi-
mately 100 per thousand participants, but we
are now up to around 159 and we are gradually
increasing at the same ratio. The curve is rather
steep, and the cost of hospitalization is going up.
During this past year we had to ask the insur-
ance commissioner for an increase in premium
rates. We have heard many complaints about
overutilization of hospitalization by our partici-
pants. We are constantly besieged locally by a
clamor for more hospital beds. Back in 1940, we
could build a pretty good hospital at $10,000 a
bed; today it is $25,000 per bed. We need hos-
pitalization for the critically ill. It seems to me
that we ought to get it on both ends. We are
going to get it from federal taxes increasing bed
space throughout the states and we will get it
from increased premium rates to our patients.
As to what the answer to that problem is, I heard
just a suggestion of an answer from Mr. Ketch-
urn today. He said that in Michigan they are
appointing regulatory committees; he called them
police committees. I would hate to be on such a
committee, but if that is what it is going to take
to keep everybody honest, the patient and the
doctor, maybe that is the solution to the problem
of these increasing premium rates for our enrolled
participants and our increased overutilization of
the hospitals.
Gretchen V. Squires, M.D.
PENSACOLA
The most prominent complaints that we have
from the physicians of Florida have been regard-
ing the inequities of the Blue Shield fee schedule.
One of the things the Committee of Seventeen
was commissioned to do was to see what could
be done about the fee schedule. The Florida
Medical Association has a fee schedule committee,
but we were supposed to get groundwork laid as
to what were some of the things that could be
done. I do not think anyone will argue the fact
that for any given procedure there must be a
price in relationship to its technical difficulty,
the professional acumen necessary to perform
satisfactorily the task, and the actual cost of
completion of the procedure. That is something
that must be set by a professional, a physician,
and not by someone who is dealing, as an actuary
does, with figures. Since these variables are with-
in the scope of professional knowledge, it would
seem to me that it is the responsibility of the
physicians of the state, either individually or
1144
BLUE SHIELD
Volume X LI V
Number 10
through their representation on the Blue Shield
Boar<j of Directors, to agree on what is the rela-
tive value of procedures and, if possible, what
is the absolute value of any given procedure.
Many of you signed your Blue Shield agree-
ments about 11 years ago, and I would like to
refresh your memory as to what you agreed. “In
consideration of being accepted as a participating
physician of Blue Shield of Florida. Inc., I do
agree, 1. To perform the professional services,
medical and/or surgical, specified in the sub-
scription contracts issued, or that may be issued
by the plan in accordance with accepted practices
in the community, at the time the services are
rendered and at such rates of compensation as
shall be determined by the regulation of the plan,
applicable to the participating physicians, a copy
of which shall at all times be available in the
office of the plan.” You also had the privilege
of cancelling the agreement on 30 day notice, or
having the plan cancel its agreement with you,
on similar notice. We stated back then that the
rates of compensation should be determined by
the plan, and the plan, as you see from this
agenda, is primarily the physicians of the state.
Now, if each practicing physician developed a
schedule of fees that he would accept as full
payment for the services he rendered his patient,
and if the insurance carrier could sell such a con-
tract, I presume the physician would then be
satisfied with the fee he received as a full serv-
ice benefit. That is a normal presumption, be-
cause he himself sets the fee. The transaction
would have no such inflammatory term as “serv-
ice benefits,” which is like waving a red flag to
a group of doctors. It would, for practical pur-
poses, be indemnity insurance in which the pa-
tient pays nothing; everything would be covered
by the plan. The physician would be pleased
with the situation, and you know the patient
would be; that is his idea of medical utopia.
Furthermore, the doctor would be satisfied be-
cause he would be getting a 100 per cent collec-
tion.
Let us compare this optimal situation with the
practical functions of an existing Blue Shield
service benefit or full payment program. There is
only one difference, and again the consideration is
money, the root of all evil. In the first instance,
the physician set his own fee schedule. Under the
Blue Shield Plan, it is arranged and accepted by
himself and a large group of his fellow practicing
physicians, rather than by himself alone. I rather
feel that if you are not willing to accept a fee
schedule that you and your fellow physicians
have worked on, you just do not trust your fellow
physicians.
It seems very definite that the only obstacle
that the nonparticipating or reluctantly participat-
ing physician finds to supporting a full payment
program is that in order to do so, he must relin-
quish his right to construct his own individual fee
schedule for every professional service he renders.
The nonparticipating physician is not willing to
relinquish this right, even to his fellow physicians
and to work with them to construct a schedule,
although he has just as much influence as each
of them has in the determination of dollar
amounts of the Blue Shield full payment sched-
ule.
I should like to digress just for one moment
about the questionnaire sent to you. I have re-
ceived some letters, as have other members of the
Committee of Seventeen. Many replies are,
“We’re not going to let Blue Shield set our fees.”
Again we come back to something that has been
said all day long and I hope we will take home
with us. We are Blue Shield, and I would much
rather have us, as Blue Shield, setting our fees
than a commercial insurance company board. I
do not know how many of you make insurance
examinations, but for how many years have you
been trying to get the physical examination fee
for routine insurance examinations raised to a
reasonable figure? In the 15 years that I can
count in my own life as a practicing physician,
we have received from $3 to $5, and if there were
not competitive standards such as Blue Shield,
we would be in the same fix in regard to the fees
that commercial insurance companies set for us
on their policies. It is an easy tendency to as-
sume that any fixed fee is necessarily incorrect.
This is far from the truth. One of the major
reasons why the cost of physician service has not
kept pace with the rising cost of living is because
most physicians have adhered for many years to
their own particular pattern of fees. These fees,
of course, are fixed, but they are fixed by the
physician himself and, therefore, we may presume
that he feels they are correct.
Once again we return to the view that the
correctness of a fixed fee depends on who does
the fixing. Under the full payment Blue Shield
service benefit plan, practicing physicians are the
ones who fix fees for themselves. This is as it
should be. The practicing physician has nothing
J. Florida M.A.
April, 1958
BLUE SHIELD
1145
to say about the fees provided in commercial
insurance contracts. If we eventually come to a
governmental^ controlled medical program, medi-
cal fees in keeping with familiar bureaucratic
policy probably will be arrived at by the one
person who can be found in the government who
knows least about the practice of medicine, cer-
tainly not by the practicing physicians who will
provide the professional services. Medical costs
must not be all the traffic can bear, and I assure
you as a member of our county screening com-
mittee that there is a vast difference in what a
fee is when a patient is paying for it, and what it
is when an insurance company is paying for it.
We lose sight of the fact that any of us who
have money in the bank are shareholders in an
insurance company. The public already seems to
be aware that, in some instances, indemnity in-
surance may represent a liability rather than an
asset, when their physician comes to make out
his bill.
I have tried to summarize in four axioms the
present situation as far as the practicing physician
is concerned.
1. If in the future the physician expects to be
paid, insurance coverage is going to do it.
2. If insurance is to do it, medical fees must
be stabilized.
3. If medical fees are to be stabilized, practic-
ing physicians are to do it.
4. If practicing physicians are going to do it,
each physician must surrender some of his
individuality on behalf of the profession as
a whole.
Condensation of Questions, Answers and
Discussion
Dr. Herschel G. Cole, of Tampa, stated that
he was the official spokesman for the delegation
from the Hillsborough County Medical Associa-
tion and was instructed to inform the group that
his county society was opposed to an increase
in the income level and further that it wished
psychiatric treatment included. He also stated
that the Florida Orthopedic Society was opposed
to elevation of the income levels.
Dr. W. Dean Steward, of Orlando, asked the
following questions: 1. Is there any provision to
be made for an initial history and physical ex-
amination on patients? 2. Is there any provision
to be made for more than one visit daily when
it is indicated? 3. Will there be any coverage for
the first two days? 4. Is there any provision to
be made for consultation and for follow-up visits
for those patients who are seen in consultation?
5. Will any provision be made toward paying the
attending physician for his care for those patients
who are admitted to the hospital with medical
problems, or what are thought to be medical
problems, and who in the course of their hospital-
ization require surgery?
Dr. Robert E. Zellner, of Orlando, made the
following remarks in reference to Dr. Cole’s state-
ment as well as Dr. Steward’s questions: First of
all, the entire problem is not to increase service
benefits but to increase fees. The problem right
now is that the fee schedule is entirely inequit-
able. There needs to be a complete revision. There
are some fees in there, few though they are, that
are ridiculously high. The problem is to get more
equitable fees. How are we to do it? It may be
that raising the service income limits to some
extent may be part of it, in order to increase the
participation and in order to make it more of a
bargain.
I do not think we are competent to answer
Dr. Steward’s questions. We are a fact-finding
committee. First of all, we are to get facts about
and from Blue Shield to bring to you. Secondly,
we are to get facts from you to take back to Blue
Shield as to what you will accept. I am con-
vinced that the membership of the committee
agrees entirely with Dr. Steward’s thinking and
that this contract must cover medical services and
it must cover them more adequately. It is inter-
esting to point out that this problem in a com-
mercial company would not even come up. Com-
mercial companies do not care whether you
have had a consultation or not. They pay so
much for an operation or for so many days in
the hospital, and if you have three or four doc-
tors, that is your problem. So that again rein-
forces the fact that Blue Shield is the doctors’
plan, and it is something that cares about your
opinion. I am convinced that if we do not do
something to improve the attractiveness of this
contract, we are not going to have the money to
apportion it. These are certainly valid questions,
and as far as I am concerned, this committee is
in sympathy with the solution of them in the
manner indicated by each question itself. All of
this is contingent upon the Blue Shield actuary,
but our sympathy is with the inclusion of ade-
quate payment for medical service.
1146
BLUE SHIELD
Volume XLIV
Number 10
Dr. Steward. — When we say the commercial
company is not interested in consultation or any-
thing else, neither is the commercial company
interested in whether we are paid. That is be-
tween us and our patients. The commercial com-
panies cannot tell a patient that his policy covers
everything, and this brings up something we must
remember when we talk Blue Shield. Blue Shield
says to the buyer, “Here’s a service policy ren-
dered by the doctor, and he shouldn’t charge any
more than is covered,” but the commercial com-
pany cannot do that. Are we forgetting that Blue
Shield deals with us and, therefore, should con-
sider us, instead of the patient alone or the
amount of finances in the company alone?
Dr. Donald F. Marion, Miami. — In regard to
Dr. Steward’s questions, I wish I knew the an-
swers. I feel that there is a great deal implied by
any service contract. Such contracts imply that
all the patient has to do is select a good doctor
and have a diagnosis made automatically. All
he has to do is say, “I’m now your patient,” and
all the doctor has to say is. “Okay, I’m now your
doctor, and I know what’s wrong with you.”
That is exactly how ridiculous it is. People say
they would like to have diagnostic care. Everyone
says we cannot afford diagnostic care. We can
afford to operate on you, but we cannot afford to
find out what is wrong with you.
There is no incentive at the present time to
take advantage of the better diagnostic means
that are available because of this penny-pinching
economic mess that everybody is in. Now that is
something we must do something about.
Dr. Cole. — We want to maintain the form for
the indigent, the present status quo in so far as
income limits are concerned. We do not want to
go into the higher income levels, because we feel
that when we do, we are socializing ourselves.
Dr. Henry J. Babers Jr., Gainesville.— I think
it is clear that in all medical work we define our
terms. When you say we are socializing ourselves,
you have to know what socialization is. Social-
ism is an economic system in which the produc-
tion of capital goods is controlled by the govern-
ment, not by Blue Shield. I believe you mean
trade unionism instead of socialism, any union or
group, a syndicalism you might call it. This is en-
tirely different from socialism.
Dr. Edward R. Annis, Miami. — Two years
ago, we had 16 million people in this country
over 65 years of age; today, we have 18.5 million.
There is no provision in the commercial com-
panies to take care of these people, the retirees
and the indigent. If we do not provide for them
and the commercial companies will not do it,
there is no one else to do it but the government,
which certainly will do it. If we were right in the
first place to support Blue Shield as a defense
against the onward march of socialism, then we
must still be right in supporting the principle.
If it cannot stand on its own two feet by selling
only to the indigent, then the only way we can
finance it actuarily is to invade the general com-
munity. As one from a larger community, how-
ever, I agree with those speakers who have said
that if we maintain the status quo, we are going
out of business. I know of various corporations
in Miami at the present time that are negotiating
new health contracts, and Blue Shield is being
pushed out of the picture because we cannot com-
pete with what is being offered by some of these
plans, major medical plans and others. What do
you think the answer is? Are we going to satisfy
the demands of the various branches of the pro-
fession who should be justly treated by equally
distributing the funds? By the same token, if we
are going to continue to sell Blue Shield, we are
going to have to increase our coverage over a
wider area, in order to compete with commercial
companies which are offering these major medical
and other benefits. What do you propose? I
know the Dade County Public Schools and a few
other major users and subscribers to Blue Shield
are going to fall by the wayside in the next year
or two if we do not do something about it. What
is your idea as to where we should go and what
we should be thinking about when we go back
home and try to carry this wealth of information
to others who have been equally muddled in their
thinking concerning Blue Shield and its problems?
Dr. H. Phillip Hampton, Tampa. — I should
like to ask if we have any information or experi-
ence to go on to consider the advisability of issu-
ing an additional Blue Shield major medical de-
ductible policy to go along with the basic plan
that is now available, in preference to increasing
service benefits on an income level basis.
Dr. Gretchen V. Squires, Pensacola. — Instead
of answering that question, I am going to give you
a question of my own. The income level of $3,600
ten years ago is now approximately $4,900, or
very close to $5,000. Let us go back to the
T. Florida M.A.
April, 1958
OTHERS ARE SAYING
114?
Hillsborough question of status quo. To maintain
the status quo, we have to start out at approxi-
mately the $5,000 level instead of the $3,600
level. That is the first point. How many of you
would be any worse off financially if you received
100 per cent collection on all your patients whose
income was $5,000 or less, than you are at the
present time not collecting from the patients who
are uninsured because they would not buy in-
demnity benefits and are not eligible for service
benefits? I was interested in checking over some
of the answers of the questionnaire as to how few
doctors put down a different fee for a person in
the $5,000 income bracket as against the $7,500
income bracket. I think most of us work on a
standard fee. Is not 100 per cent collection of a
fixed fee from 85 per cent of the population, when
that fee has been fixed by you and is adequate,
better than a large segment of the population not
paying its bills, or you reducing them voluntarily
because you know this group cannot afford to
pay them?
Dr. Babers. — As far as unity and organization
are concerned, I will follow what anybody says,
as long as it is a majority. The main trouble,
however, is that the way this is set up, Blue
Shield cannot move in any way whatever. Blue
Shield cannot change a thing because it has to
have our permission before it can do it. So when
you say major medical and all what not, the first
premise is that until someone tells Blue Shield
it can at least start working on it nothing hap-
pens. As for what our committee would recom-
mend, we plan to get together perhaps in Feb-
ruary and come up with our own recommenda-
tions.
Dr. Marion. — I should like to discuss Dr.
Hampton’s question about a separate medical
policy. This committee talked about a major
medical rider to be attached to the regular plan.
Every place it has been tried, it has been virtual-
ly unsalable. If we are to survive, we are obliged
to sell something the people want.
Dr. Frederick H. Good, Denver. — We, in
Colorado, have a major medical coverage set up
that started out originally in district nine. We
have sold it to several groups and are now watch-
ing it. We also sold to these groups a home and
office call rider, by demand, and we are watching
that with considerable interest. The interesting
thing is, if you have an adequate service income
limit, and if you have a realistic fee schedule that
the doctors can live with, you are not going to
have much demand for this so-called prolonged
illness coverage, except in the areas where pres-
sure is on. You will sell that to the executive
class. Labor is now demanding the employer
put money in the kitty to provide this coverage,
but is not particularly interested in this so-called
prolonged illness coverage, although it is cheap.
In regard to the old people in Colorado, we
just signed a contract with the State Welfare De-
partment to take over the old age pensioners
and we are doing that on a cost plus basis on a
six months’ trial. We are doing it on our old
standard contract, which is our $2,400 service in-
come limit contract. The old age pensioners get
between $80 and $100 per month; starting in Feb-
ruary, there will be enough money available in the
state to start this plan. These old age pensioners
✓ re a problem. We are going to try this for them
because it was either that, or, as we were frankly
told, closed panel. We were simply told that the
money was available and the Department was
going to buy the care and were asked whether or
not we were interested.
Dr. Babers then thanked the members for
their attendance and participation and closed the
meeting with the thought that each person in at-
tendance should carry back to his society as much
information as possible.
OTHERS ARE SAYING
Editorial
The Public Wants to Know
The lay public has shown an increasing inter-
est and demand for medical information. Most
large circulation magazines carry a medical col-
umn that apparently is widely read. The local
response to the recent telecast of a heart operation
shows how the public is interested in their own
health.
Many times the average individual becomes
confused by what he or she reads and is the source
of poor advice to their friends. The readers are
frequently misled by sensational articles written
to improve the author’s financial state rather than
t) provide useful information. Frequently experi-
mental medicines or methods are reported as pro-
ven and accepted facts. These are all drawbacks to
the dissemination of information to the lay public.
The public is no longer satisfied with the
simple admonition “take these pills and every-
1148
Volume XLIV
Number 10
thing will be O.K.” or “you need an operation.”
They demand explanations and this frequently
takes more time than the actual treatment of the
patient. Even the most painstaking explanations
are twisted and confused by apparently intelligent
persons.
One way to improve the education of the lay
public and to satisfy their demand is in the use of
Medical Forums. Here is a place where we can
meet the public, create goodwill for our medical
association and profession, and expose quack
methods and beliefs. The first such Forum was
held recently and was quite successful. Over 700
persons attended and if the pattern is followed
here as in other cities the audience should increase
in size with subsequent programs. The partici-
pants are to be congratulated for their efforts and
preparation.
Eventually all members of our Association
who desire to participate will be called upon to
serve upon the panel. Tentative plans are to hold
two or three more Forums this winter with the
next one scheduled for January 16th. The Fort
Lauderdale Recreation Department and the Fort
Lauderdale Daily News are giving us their full
cooperation in these Forums and it behooves us
to give our fullest measure of help as we are all
directly benefited. The lay public wants to know
and will find out — let’s make it correct infor-
mation and not misconception.
Richard L. Foster, M.D.
The Record, Broward County
Medical Association
December, 1957
STATE NEWS ITEMS
Dr. Theodore F. Hahn Jr. of Deland attended
the recent six day course in cardiology held at the
Grady Hospital in Atlanta.
Dr. C'has. J. Collins of Orlando attended the
meeting of the South Atlantic Association of
Obstetricians and Gynecologists held at Holly-
wood.
Dr. J. Harold Newman of Jacksonville pre-
sented a paper entitled “Nephro-Ureterectomy” at
the meeting of the Southeastern Section of the
American Urological Association held recently at
Hollywood.
Dr. Thomas J. Bixler of Tallahassee has ac-
cepted appointment to the Committee for the em-
ployment of the Handicapped recently organized
by Governor Leroy Collins.
Dr. David Sloane of Lakeland recently ad-
dressed the Woman’s Club there on the subject
“My Aching Back.” The more usual types of
backaches were explained and the treatment des-
cribed. Considerable attention was given to pro-
lotherapy injections for chronic relaxation of the
ligaments of the lower back. The address was
sponsored by the Education Department of the
Woman’s Club.
Dr. Alfred G. Levin of Miami has been elect-
ed president of the Greater Miami Radiological
Society. Serving with Dr. Levin are Dr. Andre S.
Capi of Hollywood as vice president and Dr.
George P. Daurelle of Miami as secretary-treas-
urer.
Dr. Frank W. Putnam of Gainesville, Profes-
sor of Biochemistry at the College of Medicine,
University of Florida, has been appointed to the
Divisional Committee for Biological and Medical
Sciences of the National Science Foundation.
The Second Annual Seminar on Cardiovascular
Disease sponsored by the Hillsborough County
Heart Association was held March 29 in Tampa.
Dr. Richard G. Conner of Tampa served as pro-
gram chairman. Speakers included Dr. Jack
Myers, Chairman, Department of Medicine, Uni-
versity of Pittsburgh School of Medicine, Dr.
Denton A. Cooley, Associate Professor of Surgery,
Baylor University College of Medicine, Dr.
Samuel Kaplin, Children’s Hospital, Cincinnati,
and Dr. Herman K. Hellerstein, Assistant Profes-
sor of Medicine, Western Reserve University
School of Medicine.
The Eleventh Annual Convention of the Flor-
ida Society of Medical Technologists has been
scheduled for May 23-25 in Clearwater at the Ft.
Harrison Hotel.
The Florida Trudeau Society will hold its an-
nual meeting April 25-26 at the Ft. Harrison
Hotel in Clearwater, according to announcement
by Dr. Howard M. DuBose of Lakeland, presi-
dent. Dr. William R. Barclay, Associate Professor
J. Florida M.A.
April, 1958
1149
CHEMOTHERAPY PLUS FLORA CONTROL
Floraquin
Destroys Vaginal Parasites
Protects Vaginal Mucosa
Vaginal discharge is one of the most com-
mon and most troublesome complaints met
in practice. Trichomoniasis and monilial
vaginitis, by far the most common causes
of leukorrhea, are often the most difficult to
control. Unless the normal acid secretions
are restored and the protective Doderlein
bacilli return, the infection usually persists.
Through the direct chemotherapeutic ac-
tion of its Diodoquin® (diiodohydroxyquin,
U.S.P.) content, Floraquin effectively elimi-
nates both trichomonal and monilial infec-
tions. Floraquin also contains boric acid and
dextrose to restore the physiologic acid pH
and provide nutriment which favor-s re-
growth of the normal flora.
Method of Use
The following therapeutic procedure is
suggested: One or two tablets are inserted
by the patient each night and each morning;
treatment is continued for four to eight
weeks.
Intravaginal Applicator for Improved
Treatment of Vaginitis
This smooth, unbreakable, plastic device is
designed for simplified vaginal insertion of
Floraquin tablets by the patient. It places
tablets in the fornices and thus assures coat-
ing of the entire vaginal mucosa as the tab-
lets disintegrate.
A Floraquin applicator is supplied with
each box of 50 tablets. G. D. Searle & Co.,
Chicago 80, Illinois. Research in the Service
of Medicine.
1150
Volume XLIV
Number 10
of Medicine, School of Medicine, University of
Chicago, will be keynote speaker. Dr. Kip G.
Kelso of Vero Beach is chairman of the program
committee.
Dr. Albert V. Hardy of Jacksonville is serv-
ing on the committee appointed by the Nuclear
Development Commission to draft a program to
encourage maximum development and utilization
of atomic energy in Florida consistent with pro-
tection of the public against possible radiological
hazard.
Drs. Joseph J. Ruskin of Tampa and Lucien
Y. Dyrenforth of Jacksonville served on the Com-
mittee on Arrangements for the annual meeting of
the Atlantic Coast Line Railroad Surgeons’ As-
sociation held March 21-24 at Nassau with head-
quarters on the S. S. Florida. Dr. Richard A.
Worsham of Jacksonville discussed “Knee In-
juries” at the scientific session on March 22, and
Dr. Dyrenforth presided during the business ses-
sion held the following day.
Dr. Paul S. Jarrett of Miami has been ap-
pointed by Governor LeRoy Collins to the Ad-
visory Council, Alcoholic Rehabilitation Program.
INSTRUMENT REPAIR
SERVICE
Microscopes, pHmeters, balances,
colorimeters, microtomes, etc.
Factory authorized repairs for
B.&L., A.O., Zeiss, Becker, etc.
PRECISION INSTRUMENTS
30 KINGS COURT, SARASOTA, FLA.
Phone: RIngling 7-2687
Write for shipping instructions
and containers.
The Fifth International Congress of Internal
Medicine has been scheduled for April 24-26 in
Philadelphia with headquarters in the Sheraton
Hotel. Following the Congress, the Annual Ses-
sion of the American College of Physicians is be-
ing held at Atlantic City April 28-May 2.
Dr. W. Lawson Shackelford of West Palm
Beach, president of the Palm Beach County Medi-
cal Society, has received a letter from the County
Commission in which official appreciation was
expressed to members of the Society for their
time and effort expended in providing medical
treatment for indigent sick persons within the
county.
Dr. Leonard G. Rowntree of Miami Beach has
been awarded the honorary Doctor of Letters de-
gree by the University of Miami for “his great
contributions to the progress of medicine and his
significant role In the founding of the University
of Miami School of Medicine.”
Dr. Photis J. Nichols of Apalachicola was prin-
cipal speaker at a recent meeting of the Philaco
Club of that city. His subject was cancer.
Dr. Karl R. Rolls of Sarasota was the initial
speaker for the Vocational Guidance Clinic held
in that city for the benefit of high school students.
Dr. Rolls is president of the Sarasota County
Medical Society.
Dr. Eunice M. Lache of Tampa is serving as
instructor for the class in medical terminology be-
ing sponsored at the University of Tampa by the
Medical Secretaries and Assistants Association.
Dr. James H. Ferguson of Miami, Chairman
of Obstetrics-Gynecology Department at the Uni-
Your one-stop direct source for the
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3045 Sumter Ave. • AMherst 4-7616
J. Florida M.A.
April, 1958
1151
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■ ARTHRITIC DISORDERS ■ DERMATOSES
Squibb Triamcinolone
BHCQin
Initial dosage: 8 to 20 mg. daily. After 2 to 7 days
gradually reduce to maintenance levels.
See package insert for specific dosages and precautions.
1 mg. tablets, bottles of 50 and 500.
4 mg. tablets, bottles of 30 and 100.
— sss— H Squibb Quality— the Priceless Ingredient
'KCNACORT' IS A SQUI08 TRADEMARK
1152
Volume XLIV
Number 10
versity of Miami School of Medicine, presented
a paper at the Twentieth Annual Meeting of the
South Atlantic Association of Obstetricians and
Gynecologists held recently at Hollywood.
Dr. S. Carnes Harvard of Brooksville is serv-
ing as medical chairman for the 1958 Heart Fund
Drive in Hernando County.
Dr. Richard A. Henry of Brooksville has been
designated “Outstanding Young Man of the Year'’
by the Junior Chamber of Commerce of that city.
He is a former president of the Rotary Club, a
member of the Junior Chamber of Commerce,
and is active in Boy Scout activities.
Dr. William C. Roberts of Panama City, Pres-
ident of the Florida Medical Association, and
Drs. Walter C. Payne Sr. and Herbert L. Bryans
of Pensacola, both Past Presidents of the Associa-
tion, will serve as fraternal delegates to the an-
nual meeting of the Medical Association of the
State of Alabama being held April 17-19 at Mont-
gomery.
A Symposium on the Management of Cardio-
vascular Problems of the Aged is being held Sa-
turday, April 12, in the Eden Roc Hotel at Miami
Beach. It is sponsored by the Dade County Medi-
cal Association. Co-sponsor is the J. B. Roerig
Company.
Dr. C'has. J. Collins of Orlando has been re-
elected president of the Florida State Board of
Health.
A Medico-Legal Institute sponsored by the
Florida Medical Association and the Florida Bar
is being held in Tampa April 11-12. Physicians
from Florida appearing on the program include
Drs. John E. Gottsch. and Frank H. Lindeman
Jr. of Tampa, and Drs. Ben J. Sheppard, W.
Tracy Haverfield and Herbert Eichert of Miami.
Dr. William C. Roberts of Panama City,
President of the Florida Medical Association,
will be in Gatlinburg, Tenn., April 21-23, for the
annual meeting of the Tennessee State Medical
Association being held there.
The First Annual Postgraduate Seminar in
Pediatrics will be conducted by the combined
faculties of the Georgetown and George Wash-
ington Departments of Pediatrics at the Children’s
Hospital of Washington, D. C., May 22-24. Ap-
lication blanks may be obtained from the Direct-
or of Medical Education, Children’s Hospital of
Washington. D. C., 2125 Thirteenth Street. X.W.,
Washington 9, D. C.
VMB-200
'Premarin" with Meprobamate new potency
Each tablet contains 0.4 mg. "Premarin," 200 mg. meprobamate
For undue emotional stress
in the menopause
WRITE SIMPLY...
vS^
Also available as
PMB-400 (0.4 mg. "Premarin," 400 mg. meprobamate
in each tablet).
Supply:
No. 880, PMB-200
bottles of 60 and 500.
No. 881, PMB-400
bottles of 60 and 500.
AYERST LABORATORIES
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1r£
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Premarin®" conjugated estrogens (equine)
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J. Florida M.A.
April, 1958
1153
Provides therapeutic quantities
Potent ‘Trinsicon’ offers complete and
convenient anemia therapy plus max-
imum absorption and tolerance. Just two
Pulvules ‘Trinsicon’ daily produce a
standard response in the average uncom-
plicated case of pernicious anemia (and
related megaloblastic anemias) and pro-
ot all known hematinic factors
vide at least an average dose of iron for
hypochromic anemias, including nutri-
tional deficiency types. The intrinsic fac-
tor in the ‘Trinsicon’ formula enhances
(never inhibits) vitamin B,. absorption.
Available in bottles of 60 and 500.
*'Trinsicon' (Hematinic Concentrate with Intrinsic Factor, Lilly)
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A
819034
1154
Volume XLIV
Number 10
Q^£akecC
ODeuevfc
Q^Leat ^attCeA
Your patient has a wide choice of
unseasoned, strained or chopped foods
The Low
Residue Diet
— and may we
remind you that
a glass of beer
can make low-
residue diets more
palatable?
Consomme can be served jellied or hot. Pureed
vegetables folded into well-beaten egg can be
baked to a puff. Chopped beef moistened with
broth and mixed with bread crumbs shapes into
patties. Eggs can be soft or hard-cooked by
simmering. Flaked fish in lemon gelatin looks
true to nature when your patient uses a mold.
For banana-split salad he can try cottage
cheese on banana and top with pureed apricots.
Rice cooked in pineapple juice, water and sugar
makes a golden dessert. For a parfait, try layers
of farina pudding and pureed plums.
Of course, you’ll tell your patient just which
foods you want him to have — and whether he
can enjoy a glass of beer* with his meals.
•pH — 4.3, 104 Calories/8 oz. glass (Average of American Beers)
United States Brewers Foundation
Beer — America’s Beverage of Moderation
If you'd like reprints of this and 1 I other diets, please write United States Brewers Foundation, 535 Fifth Avenue, New York 17, N. Y.
J. Florida M.A.
April, 1958
1155
• those who developed moniliasis on previous
broad-spectrum therapy
• those on prolonged and/or
high antibiotic dosage
• women— especially if pregnant or diabetic
the best broad-spectrum antibiotic to use is
• debilitated
• elderly
• diabetics
• infants, especially prematures
• those on corticoids
MYSTECL1N-V
Squibb Tetracycline Phosphate Complex (Sumycin) and Nystatin (Mycostatin) Sumycin plus Mycostatin
for practical purposes, Mysteclin-V is sodium-free
for “built-in" safety, Mysteclin-V combines:
1. Tetracycline phosphate complex (Sumycin) for superior
initial tetracycline blood levels, assuring fast transport of
adequate tetracycline to the infection site.
2. Mycostatin— the first safe antifungal antibiotic— for its
specific antimonilial activity. Mycostatin protects
many patients (see above) who are particularly prone to monilial
complications when on broad-spectrum therapy.
MYSTECLIN-V PREVENTS MONILIAL OVERGROWTH
Capaulea (260 mg./250,000 u.). bottles
of 16 and 100. Half -Strength Capsules
(125 mgr./125,000 u.), bottles of 16
and 100. Suspension (125 mfj./125,000
u.), 2 oz. bottles. Pediatric Drops (100
mg./lOO.OOO u.), 10 cc. dropper bottles.
Squibb
Squibb Quality—
the Priceless Ingredient
•MX5TeCCIN, « •MYCOSTATIN AhO 'SUMYCIN- ARC SQUIBB TRaOCMARKJ
25 PATIENTS ON
TETRACYCLINE ALONE
25 PATIENTS ON r
TETRACYCLINE PLUS MYCOSTATIN
Before therapy
After seven days
of therapy
Before therapy
After seven days
of therapy
$ • # • ©
• • • • o
© ® ® ®
• • • • •
• • • e o
• •• 0 •
• • • • o
• •
<
• # • • 3
Monilial overgrowth (rectal swab)
None $ Scanty 0 Heavy
Childs, A. J.: British M. J. 1:660 1956.
1156
Volume XLIV
Number 10
COMPONENT SOCIETY NOTES
Alachua
Dr. William C. Roberts, of Panama City,
President of the Florida Medical Association,
was principal speaker for the March meeting of
the Alachua County Medical Society.
Brevard
Dr. John M. Langstaff, of Melbourne, and Dr.
Robert G. Rosser, of Cocoa, were scientific speak-
ers for the February meeting of the Brevard
County Medical Society. Dr. Langstaff presented
a comprehensive address on renal calculi and the
theories of formation, and Dr. Rosser discussed
methods of removal, emphasizing the multiple
ureteral catheter technic. Films and specimens
from several interesting cases were shown.
Collier
The Collier County Medical Society has paid
100 per cent of its state dues for 1958.
Dade
‘ Can We Have a Safe Social Security?” was
the topic for discussion at the March meeting of
the Dade County Medical Association. Film
slides were shown by Mr. W. W. Edwards, ex-
ecutive secretary of the Miami Association of Life
Underwriters.
Duval
The March meeting of the Duval County
Medical Society was held at the U. S. Naval Air
Station Hospital. Speakers included Cmdr. D. A.
Doohen, MC, USN, who discussed “Superior
Arterio-Mesenteric Obstruction of the Duode-
num;” Lt. Cmdr. Mason Romaine III, MC,
USNR, “Dissecting Aneurysm in Youth,” and Lt.
E. G. Sheehan, MC, USNR. “Postpartum Hem-
on hage, A Case Report.”
The Society has paid 100 per cent of its state
dues for 1958.
Indian River
The Indian River County Medical Society has
paid 100 per cent of its state dues for 1958.
Jackson-Calhoun
The Jackson-Calhoun County Medical Society
has paid 100 per cent of its state dues for 1958.
(Continued on page 1160)
GREATER PERMANENCE
IN THE MANAGEMENT
OF DERMATOSES...
(Regardless of Previous Refractoriness)
Confirmed by
an impressive and
growing body of published
clinical investigations
jv iv av M. Ill cream
Hydrocortisone 0.5% and Special Coal Tar Extract 5%
(TARBONIS®) in a greaseless, stainless vanishing cream base.
^ JL OINTMENT
Hydrocortisone 0.5%, Neomycin 0.35% (as Sulfate) and Special
Coal Tar Extract 5% (TARBONIS) in an ointment base.
*
REED
J.A.M.A. toe: 158. 1958; Welsh, A.L. and Ede.M.
. . . prompt remissions of . . . acute phases.”
with TARCORTIN
A CARNRICK j Jersey City 6, New Jersey
1. Clyman, S. G. : Postgrad. Med. 21: 309, 1957.
2. Bleiberg, J.: J. M. Soc. New Jersey 53: 37, 1956. *
• 3. Abrams, B. P, and Shaw, C. : Clin. Med. 3 : 839, 1956.
4. Welsh, A. L.. and Ede, M. : Ohio State M. J. 50: 837, 1954.
5. Bleiberg, J.: Am. Practitioner 5:1404, 1957.
J. Florida M.A.
April, 1958
1157
IN ALL DIARRHEAS . . . REGARDLESS OF ETIOLOGY
CREMOMYCIN
comprehensive control
with
SULFASUX1DINE * PECT I N- K AOL I N - N EOM YC I N SUSPENSION
SOOTHING ACTION . . . Kaolin and pectin coat and soothe the inflamed mucosa, ad-
sorb toxins and help reduce intestinal hypermotility.
BROAD THERAPY . . . The combined antibacterial effectiveness of neomycin and
Sulfasuxidine is concentrated in the bowel since the absorption of both agents
is negligible.
LOCAL IRRITATION IS REDUCED and control is instituted against spread of infective
organisms and loss of body fluid.
PALATABLE creamy pink, fruit-flavored CREMOMYCIN is pleasant tasting, readily
accepted by patients of all ages.
* Sulfasuxidine is a trade-mark of Merck & Co., Inc.
^3^
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., |NC., PHILADELPHIA 1, PA.
••••. /''£s AX:jT-
\ •••
to®
o *****
make a note to send for your
polio reminder cards today.
Remember— every unvaccinated person under
40 should receive one of these reminder cards
from his doctor.
Just fill in
the coupon
and mail it to
Public Relations Department
American Medical Association
535 N. Dearborn Street
Chicago 10, Illinois
J. Florida M.A.
April, 1958
1159
IT DOESN'T STOP THE PATIENT
BONADOXIN brings relief to 88.1%
of patients ... often within a few hours.1-2
But it does not produce drowsiness, or
side effects associated with over-potent
antinauseants. With safe BONADOXIN,
"toxicity and intolerance... (is] zero.”2
BUT
BONADOXIN ®
STOPS MORNING SICKNESS.
...and for a nutritional buildup
plus freedom from leg cramps*
STORCAVITE
Is she blue at breakfast? Prescribe
BONADOXIN. Usually just one tablet at
bedtime stops nausea and vomiting
of pregnancy . . .
phosphate-free calcium, 10 essential
vitamins, 8 important minerals.
Bottles of 100.
*due to calcium-phosphorus Imbalance
NEW YORK 17, NEW YORK
Division, Chas. Pfizer & Co., Inc.
and just one supplies the a
full 50 mg. of pyridoxine. N|
EACH TABLET CONTAINS:
MECLIZINE HCI 25 mg.
PYRIDOXINE HCI SO mg.
Bottles of 25 and 100.
References: 1. Groskloss, H. H., et al: Clin.
Med. 2:885 (Sept.) 1955. 2. Goldsmith, J. W.t
Minnesota Med. 40:99 (Feb.) 1957.
1160
Voj.ume XT. IV
Number 10
(Continued from page 1156)
Lake
Dr. Leroy H. Oetjen. of Leesburg, presented
the program for the February meeting of the Lake
County Medical Society which was held at Lees-
burg. Dr. Oetjen discussed his recent trip to
Washington, D. C., where he met with Congress-
ional representatives and members of the A.M.A.
staff to discuss impending legislation, particularly
the Forand bill and the Herlong-Keough bill.
The Society has paid 100 per cent of its state
dues for 1958.
Madison
The Madison County Medical Society has paid
100 per cent of its state dues for 1958.
Manatee
The Manatee County Medical Society has
paid 100 per cent of its state dues for 1958.
Marion
The Marion County Medical Society has paid
100 per cent of its state dues for 1958.
Monroe
The Monroe County Medical Society has paid
100 per cent of its state dues for 1958.
Pinellas
Dr. Irwin S. Leinbach, of St Petersburg, was
principal speaker for the March meeting of the
Pinellas County Medical Society. The title of his
address was “Doctor Defendant; His influence
on Patient Relationship.”
Taylor
The Taylor County Medical Society has paid
100 per cent of its state dues for 1958.
Medical Officers Returned
Dr. Mason Romaine III, who entered military
service on March 31, 1956, was released from ac-
tive duty on December 31, 1957, with the rank
of lieutenant commander, U. S. Navy. His address
is 1661 Riverside Ave., Jacksonville, Fla.
Dr. William Stromberg, who entered military
service on July 8, 1955, was released from active
duty on July 4, 1957, with the rank of captain,
U. S. Coast Guard. His address is 432 Marshall
Taylor Doctors Bldg., Jacksonville, Fla.
TAKE A LOOK AT
NEW DIMETANE
THE UNEXCELLED
ANTIHISTAMINE
J. Florida M.A.
April, 1958
1161
NEW MEMBERS ,
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Ayres, Thomas W., Daytona Beach
Barrineau, Charles E., Palatka
Beychok, Irving A., Sarasota
Boyd, Eugene J., Sarasota
Cook, Thomas D., New Smyrna Beach
Cooper, Leonard S., Sarasota
Crews, Frederick F., Fort Walton Beach
Crotzer, Malcolm C., Fort Walton Beach
Damsey, Lloyd, Marathon Shores
Dickerson, Edzell P., Bradenton
Ezzo, Joseph A., St. Petersburg
Foxworthy, Donald L., Tampa
Fritz, George S., Boca Grande
Graf, George P., Winter Haven
Greenwood, Robert W., Sarasota
Hodnett, James D., Pensacola
Howard, Woods A., Lakeland
Lambert, Walter R., Key West
Lawrence, Joseph W., Fort Myers
Lehman, John D., Sarasota
Liberman, Milton J., Sarasota
Lindsey, Edwin L., Sanford
Logan, John B., Sarasota
Marrero, Emilio J., Jay
Miles, George G., Orlando
Nichols, Thomas H., Clermont
Nickau, Robert H., Lakeland
Palmer, David B., Venice
Pfaff, Robert J., Lakeland
Ratchford, Lawrence A., Tampa
Robinson, James L. Jr., Naples
Robinson, Melvin S., St. Petersburg
Rye, William A., Brewster
Schanze, John K., Sarasota
Shively, John A., Bradenton
Smith, Ernest C. Jr., Englewood
Uthlaut, William W., Winter Garden
Watkins, Lee C. Jr., Clearwater
Williams, Thomas C. Jr., Crestview
Zeller, Frank Jr.. Winter Haven
(RARABROMDYLAMINE MALEATE)
riERAPEUTIC
ND RELATIVE SAFETY. MINIMUM
DROWSINESS AND OTHER SIDE EFFECTS.
H. ROBINS CO., INC., RICHMOND, VIR-
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HOCH
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QUININE
ATABRINE
ARALEN
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\J
J. Florida M.A.
April. 1958
1163
versatile dermatotherapy
for JUNIOR and SENIOR citizens
in pediatrics
Desitin Ointment is
unequalled in preventing
and clearing up diaper rash,
excoriation, irritation,
chafing.
in geriatrics
an incomparable protectant
and healing agent against
excoriation due to incon-
tinence; senile pruritus,
excessive skin dryness.
Write for samples and literature
DESITIN CHEMICAL COMPANY
812 Branch Ave., Providence 4, R. I.
1164
Volume XLIV
Number 10
I. Florida M.A.
April, 1958
Gastric distress accompanying "predni-steroid”
therapy is a definite clinical problem — well
documented in a growing body of literature.
lew of the beneficial re-
observed ■when antacids
i diets were used concom-
th prednisone and predni-
e feel that these measures
« employed prophylacli-
offset any gastrointestinal
Is.” — Dordick, J. R. et al.:
te J. Med. 57:2049 (June
sjc“lt is our growing convic-
tion that all patients receiving
oral steroids should take each
•lose after food or with ade-
quate buffering with aluminum
or magnesium hydroxide prep-
arations.”— Sigler, J. W. and
Ensign, D. C.: J. Kentucky
State M.A. 54:771 (Sept.) 1956.
sfc“Tlie apparent high inci-
dence of this serious (gastric)
side effect in patients receiving
prednisone or prednisolone
suggests the advisability of
routine co-administration of an
aluminum hydroxide gel.” —
Hollet, A. J. and Bunim, J. J.:
J. A. M. A. 158:459 (June 11)
1955.
One way to make sure that patients receive
full benefits of ‘'predni-steroid” therapy plus
positive protection against gastric distress is
by prescribing CO-DELTRA or CO-HYDELTRA.
PREDNISONE BUFFERED
>le compressed tablets
provide all the benefits
of “Predni-steroid” therapy-
plus positive antacid protection
against gastric distress
2.5 mg. or 5.0 mg. of prednisone
or prednisolone, plus 300 mg. of
dried aluminum hydroxide gel
and 50 mg. magnesium trisili-
cate, in bottles of 30, 100. 500.
j MERCK SHARP & D0HME Division of MERCK & CO.. Inc., Philadelphia 1, Pa.
1165
1166
Volume XLIV
Number 10
-MJjjjjg
IT'S NOT AN ACCIDENT
our claims and suits
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CLASSIFIED
Advertising rates for (tils column are S5.0U |>er
insertion for ads of 25 words or less. Add 20c for
each additional word
HOSPITAL FOR SALE: 30 bed ultra modern
hospital and clinic in booming Titusville, Florida
next to Guided Missile Base. Suitable for three or
more doctors. Easy terms. Write 69-242, P. O. Box
2411, Jacksonville, Fla.
WANTED: General Practitioner qualified to do
surgery or surgeon willing to do general practice in
small town with excellent hospital. Salary or percent-
age to start; partnership after six months. Write
69-2S4, P.O. Box 2411, Jacksonville, Fla.
BRAND NEW AIR CONDITIONED AND
HEATED MEDICAL BUILDING in fast growing
North Miami has three openings. Prefer Board-certi-
fied (or eligible) internist, ophthalmologist, otolaryn-
gologist, dermatologist, or laboratory to complement
present occupants: pediatrician, surgeon, orthopedist,
obstetrician. All independent. See it at 1545 N.E.
123rd Street and phone PL 4-2744.
SUITE AVAILABLE: St. Nicholas Medical Cen-
ter, 3127 Atlantic Blvd., Jacksonville. 700 square
feet, conveniently located to all Jacksonville by pub-
lic and private transportation, in a balanced clinic,
lanitor and maid service. Air cond'tioned. All utili-
ties furnished except telephone. W. G. Allen Jr.,
Mgr., Colonial Properties, Inc., 3116 Atlantic Blvd.
Phone EX 8-5500.
PEDIATRICIAN: Completing training in July
1958. University trained. Board eligible in Pediatrics.
Florida license. Desires group practice or association
with one or more pediatricians. Write 69-261, P.O.
Box 2411, Jacksonville, FTa.
LOCATION: General Practitioner wanted to es-
tablish practice in Keystone Heights, Fla. Completely
modern building, center of city. Flexible rental terms
available first six months. Contact, Mr. Joe Werner,
Box 283, Keystone Heights, Fla.
F’OR RENT: Doctor’s office, 2000 square feet,
available immediately. Carpeting, partially furnished.
Air conditioning and heat. On the waterfront. Contact
Ballard F. Smith, M.D., 3206 N. E. 19th St., Fort
Lauderdale, Fla.
RADIOLOGIST : Exceptional qualifications. Pri-
vate office, hospital, group or partnership. Write 69-
264, P. O. Box 2411, Jacksonville, Fla.
RADIOLOGIST: Aged 32. Finishing residency
June 30, 1958. Will take specialty board exam May
1958 for certification in Radiology, including isotopes.
Would like to become associated with established radi-
ologist in private practice. Florida licensed. Contact
C. R. Merrill Jr., M.D., 8956 Rutherford, Detroit 28,
Mich.
INTERNIST WANTED Florida group specialists
desire Internist trained GI fluorosccpy and x-ray in-
terpretation. Academic, financial, personal satisfaction.
Beautiful area. Florida license essential. Modern clin-
ic building with all facilities. Write 69-265, P. O. Box
2411, Jacksonville, Fla.
J. Florida M.A.
April, 1958
1167
OBITUARIES
Texas Alexander Adams
Dr. Texas Alexander Adams of Daytona Beach
died at Halifax District Hospital on Oct. 3, 1957.
He was 81 years of age.
Dr. Adams, prominent Negro physician and
civic leader, had practiced medicine in Daytona
Beach for 51 years and had previously practiced
for a short time in Key West. A native Floridian,
he was born in Lake City on Sept. 10, 1876. He
was a graduate of Cookman College in Jackson-
ville, which was later merged with Daytona Nor-
mal School to form Bethune-Cookman College in
Daytona Beach. His medical training was received
at Meharry Medical College in Nashville, Tenn.,
where he was awarded the degree of Doctor of
Medicine in 1905.
For more than 40 years Dr. Adams was a
member of the Board of Trustees of Bethune-
Cookman College and in 1955 was selected a
Father of the College in recognition of his work.
He was medical director for the college and in
charge of the college hospital for more than 15
years. The infirmary at the college is named for
him.
In 1954 Dr. Adams became the second Negro
to be appointed to the City Planning Board and
recently he received a key to the city and a
citation for his work with the board. He was an
honorary member of the Medical Staff of Halifax
District Hospital, and a member of the Elks
Club, Knights of Pythias and Alpha Phi Alpha
fraternity. For many years he was a trustee and a
member of the official board of Stewart Memorial
Methodist Church, and served as a delegate to
many Methodist conferences.
Dr. Adams was a member of the Volusia
County Medical Society. Since 1951 he had held
membership in the Florida Medical Association
and was also a member of the American Medical
Association, the National Medical Association
and the Dental and Pharmaceutical Association.
Survivors include three daughters, Mrs. John
L. Slack, of Daytona Beach, Mrs. Preston S.
Peterson, of Jacksonville, and Mrs. Sebron Willis,
of Miami; a brother, Millard Adams, of Daytona
Beach; a sister, Mrs. Darnell Watson, of Daytona
Beach; a granddaughter, Mrs. Carrell Horton
and a great grandson, Richard Horton, both of
Nashville; and three nieces, Mrs. Ernestine Butler
(Continued on page 1172)
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St. New York 3.
now...
unprecedented
Sulfa
therapy
New authoritative studies show that Kynex
dosage can be reduced even further than that
recommended earlier.1 Now, clinical evidence
has established that a single (0.5 Gm.) tablet
maintains therapeutic blood levels extending
beyond 24 hours. Still more proof that Kynex
stands alone in sulfa performance —
• Lowest Oral Dose In Sulfa History— 0.5 Gm.
(1 tablet) daily in the usual patient for main-
tenance of therapeutic blood levels
• Higher Solubility— effective blood concentra-
tions within an hour or two
• Effective Antibacterial Range— exceptional
effectiveness in urinary tract infections
• Convenience— the low dose of 0.5 Gm. (1 tab-
let) per day offers optimum convenience and
acceptance to patients
NEW DOSAGE
The recommended adult dose is 1 Gm. (2 tab-
lets or 4 teaspoonfu-ls of syrup) the first day,
followed by 0.5 Gm. ( 1 tablet or 2 teaspoonfuls
of syrup) every day thereafter, or 1 Gm. every
other day for mild to moderate infections. In
severe infections where prompt, high blood
levels are indicated, the initial dose should be
2 Gm. followed by 0.5 Gm. every 24 hours.
Dosage in children, according to weight ; i.e.,
a 40 lb. child should receive 14 of the adult
dosage. It is recommended that these dosages
not be exceeded.
Tablets :
Each tablet contains 0.5 Gm. (IV2 grains) of sulfamethoxy-
pyridazine. Bottles of 24 and 100 tablets.
Syrup:
Each teaspoonful (5 cc.) of caramel-flavored syrup contains
250 mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
•Nichols, R. L. and Finland, M.: J. Clin. Med. 49:410, 1957.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER. NEW YORK
*Ra9. U.S. Pot. Off.
1170
Voi
Nu
From
CONFUSION
NICOZOL relieves mental
confusion and deterioration,
mild memory defects and
abnormal behavior patterns
in the aged.
NICOZOL therapy will en-
able your senile patients to
live fuller, more useful lives.
Rehabilitation from public
and private institutions may
be accomplished for your
mildly confused patients by
treatment with the Nicozol
formula. 1 2
NICOZOL is supplied in cap-
sule and elixir forms. Each
capsule or Vz teaspoonful
contains:
Pentylenetetrazol .. 100 mg.
Nicotinic Acid 50 mg.
1. Levy, S., JAMA., 153:1260, 1953
2. Thompson, L., Procter R.,
North Carolina M. J., 15:596, 1954
to a
NORMAL
BEHAVIOR
PATTERN
WRITE for FREE NICOZOL
DRUG SPECIALTIES, INC.
WINSTON-SALEM 1, N. C.
for professional samples of
NICOZOL capsules and literature on
NICOZOL for senile psychoses.
S C
CORRECTS
IRON DEFICIENCY
AS IT
STIMULATES
APPETITE
DELICIOUS CHERRY FLAVOR
DESIGNED TO APPEAL TO
BOTH CHILDREN AND ADULTS
FOR CHILDREN
Supplies essential Iron as ferric pyrophos-
phate, highly stable, well-tolerated, readily
absorbed ; essential vitamins Bi, B6 and B12,
established as appetite stimulants; essential
1-Lysine for greater protein economy in the
pediatric diet.
INCREMIN Syrup
Each teaspoonful (5 cc.) contains
1-Lysine HCI
ferric Pyrophosphate (Soluble) .
Iron (as Ferric Pyrophosphate) .
Vitamin B12 Crystalline . . . .
Thiamine Mononitrate (Bi) . . .
Pyridoxine HCI (B6)
Alcohol
300 mg.
250 mg.
30 mg.
25 mcgm.
10 mg.
5 mg.
0.75%
1172
Volume XLIV
Number 10
(Continued from page 1167)
and Mrs. Thelma Young, both of Daytona Beach,
and Mrs. Gwendolyn Watson, of New York.
Robert Gleve Neill
Dr. Robert Gleve Neill of Orlando died at
Orange Memorial Hospital in that city on Oct.
19, 1957. He was 45 years of age. Interment took
place in Greenwood Cemetery in Eustis.
A native of McKittrick, Calif., where he was
born on July 2, 1912, Dr. Neill received his aca-
demic training at the University of California.
He was awarded both the Bachelor of Arts and
the Master of Science degrees by that institution.
For his medical training he turned to Duke
University School of Medicine and was graduated
with the degree of Doctor of Medicine in 1940.
His special training in neurosurgery and neuro-
pathology was also received there.
Entering the Medical Corps of the United
States Army in 1945 with the rank of captain, he
was appointed Chief of an Army Mobile Neuro-
surgical Unit. He saw much action both in Okin-
nawa and in Korea and was discharged with the
rank of major.
Upon his release from military service, Dr.
Neill entered the private practice of neurological
surgery in Orlando on July 1, 1949. At that time
he was the fourth neurosurgeon in the entire state.
He was on the staffs of Orange Memorial Hospi-
tal, Florida Sanitarium & Hospital, Winter Park
Memorial Hospital, Holiday House and Central
Florida Tuberculosis Hospital, and was a consult-
ant to Orlando Air Force Base Hospital. He was
associated in practice with Dr. J. Cornall Ho-
warth.
A member of the Orange County Medical
Society, Dr. Neill was also a member of the Flor-
ida Medical Association, the American Medical
Association and the World Medical Association.
In addition, he held membership in the Southern
Neurosurgical Society and the Congress of Neuro-
logical Surgeons.
Dr. Neill is survived by his widow, Mrs. Lois
Neill, a son, Darryl Neill, and two daughters,
Diantha and Debra Neill, of Orlando.
Frank Oliver Nichols
Dr. Frank Oliver Nichols of Miami died of a
heart attack in his home on Dec. 5, 1957. He was
TO SERVE YOU BEST
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J. BEATTY WILLIAMS
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April, 1958
1173
SR is a cardiac patient. His doctor
put him on atarax because (4.)
it is an anti-arrhythmic and non-
hypotensive tranquilizer.
Other tranquilizers added to PN’s
g. i. discomfort (he has ulcers).
But now his doctor has him on
atarax because (4) it lowers gas-
tric secretion while it tranquilizes.
Asthmatic JL used to have fre-
quent tantrums followed by acute
bronchospasm. Her family doctor
tranquilized her with ATARAX be-
cause (4) it is safe, even for chil-
dren.
Senile anxiety and persecution
complex dogged Mrs. K. until her
doctor prescribed atarax Syrup.
(4) It tastes good, and it’s a per-
fect vehicle for Mrs. K’s tonic.
Dosage: Children, 1-2 10 mg. tablets or
1-2 tap. Syrup t.i.d. Adults, one 25 mg.
tablet or 1 tbsp. Syrup q.i.d.
Supplied : 10, 25 and 100 mg. tablets, bottles
of 100. Syrup, pint bottles. Parenteral Solu-
tion, 10 cc. multiple-dose vials.
1174
Volume XLIV
Number 10
59 years of age. Interment was in Etowah, Tenn.
Born in Warne, N. C., on Feb. 13, 1898, Dr.
Nichols was educated in Tennessee. After receiv-
ing his academic education at the University of
Tennessee in Knoxville, he entered Vanderbilt
University School of Medicine in Nashville and
was awarded the degree of Doctor of Medicine in
1920. He served in the Navy Medical Corps in
World War I and was a major in the Army Medi-
cal Corps in World War II.
In 1945, Dr. Nichols came to Miami from
Knoxville and had since that time engaged in the
general practice of medicine there. He was a mem-
ber of the Baptist Church.
Dr. Nichols was a member of the Dade Coun-
ty Medical Association, the Florida Medical Asso-
ciation and the American Medical Association.
He was also affiliated with the American Academy
of General Practice.
His widow, Mrs. Mabeth D. Nichols, survives
him. Other survivors are a son, 1st Lt. Frank O.
Nichols Jr., of Pine Castle Air Force Base; his
mother, Mrs. Flossie Nichols, and a sister, Mrs.
D. H. Meredith, both of Pulaski, Va.
John Turner McDermid
Dr. John Turner McDermid of Fort Pierce
died on Nov. 22, 1957, after an illness of several
months. He was 46 years of age.
A native of Sparks, Ga., Dr. McDermid moved
to Florida with his family in 1929, residing in
Okeechobee. He was graduated from the high
school there. Before studying medicine, he was
superintendent of a wholesale grocery chain in
Georgia for 12 years. He received his medical
training at the University of Georgia and was
awarded the degree of Doctor of Medicine by the
Medical College of Georgia at Augusta in 1948.
Following graduation, he served an internship at
the Baroness Erlanger Hospital in Chattanooga,
Tenn.
In 1949, he entered the private practice of
medicine in Fort Pierce and continued to practice
there for eight years. Locally, he was on the staff
of the Fort Pierce Memorial Hospital and was a
member of the First Baptist Church.
Dr. McDermid was a member of the St. Lucie-
Okeechobee-Martin County Medical Society.
Since 1950, he had held membership in the Flor-
ida Medical Association and he was also a mem-
ber of the American Medical Association.
(Continued on page 1175)
She's Been
SONATED
She’s just one of more than a million patients who have been treated with
Ultrasound by the more than 20,000 physicians using Ultrasonics in their
practices. If you are thinking of buying an Ultrasonic examine the
mechanical features • look at the transducer. Is it adaptable (adjustable)
to all five of the recommended treatment positions ? Is the crystal small
enough (5CM2 is the experts’ choice) to treat the concave areas ? Is the
electronic circuit stable so that output remains constant throughout
treatment ? Is the dosage always what reads on the meter ? Is the
manufacturer experienced in producing equipment for the medical
profession ? Does he have dealers everywhere to give you service when
you need it? You owe it to yourself to know the answers to these questions.
In all sincerity we believe that every Birtcher MEGASON Ultrasonic
(there are four models, you know) will meet your every qualification.
64 page booklet
“Medical Ultrason-
ics in a Nutshell’’
answers 25 com-
monly asked ques-
tions about ultra-
sound and contains
abstracts of several
medical journal
articles.
THE BIRTCHER CORPORATION
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Zone State
J. Florida M.A.
April, 1958
1175
(Continued from page 1174)
Surviving are the widow, Mrs. Mariam Mc-
Dermid, a son, John Jr., and a daughter, Marcia
Sue, all of Fort Pierce. Other survivors include his
mother, Mrs. H. C. McDermid of Vidalia, Ga.;
a brother, Dr. Howard C. McDermid of Fort
Pierce; and two sisters, Mrs. Burnett Bartlett of
Okeechobee, and Mrs. H. S. Musgrove of Horner-
ville, Ga.
Warren Ainsworth Brooks
Dr. Warren Ainsworth Brooks of Winter Park
died in a local hospital on Nov. 9, 1957. He was
42 years of age.
The son of a Methodist minister, Dr. Brooks
was born on Feb. 23, 1915 in Adel, Ga., and dur-
ing his childhood lived chiefly in South Georgia.
He received his academic training at Emory
University, where he was awarded the degree of
Bachelor of Science in 1934. He pursued his med-
ical training at his alma mater, receiving the Doc-
tor of Medicine degree from the School of Medi-
cine in 1938. He then interned at Orange Memo-
rial Hospital, known at that time as Orange Gen-
eral Hospital, in Orlando. His medical fraternity
was Alpha Kappa Kappa and his social fraternity
Alpha Tau Omega.
In July 1939, Dr. Brooks entered the general
practice of medicine in Orlando, but both his
further postgraduate study and his practice were
interrupted by repeated bouts of tuberculosis.
His devotion to his profession placed him again in
private practice in 1954 when he became associ-
ated with Dr. Ruth Jewett in Winter Park.
Locally, he was on the staffs of Orange Memorial
Hospital, Winter Park Memorial Hospital and
Florida Sanitarium and Hospital. He also served
on the staff of the Central Florida Tuberculosis
Hospital for five years. He was a member of
Masonic Lodge 69 and of the Winter Park Lions
Club.
Dr. Brooks was a member of the Orange
County Medical Society, the Florida Medical
Association and the American Medical Associa-
tion. He also held membership in the Trudeau
Society and was a fellow of the American College
of Chest Physicians.
Surviving are the widow, Mrs. Julia A. Brooks,
and his parents, the Rev. and Mrs. J. C. G.
Brooks, of Winter Park; two brothers, Julian W.
Brooks, of Panama City, and William G. Brooks,
of Savannah, Ga.; and a sister, Mrs. R. D. Pull-
iam, of Decatur, Ga.
and inflammation
withBUFFERir
IN ARTHRITIS
salicylate benefits with
minimal salicylate drawbacks
Rapid and prolonged relief — with less intoler-
ance. The analgesic and specific anti-
inflammatory action of Bufferin helps re-
duce pain and joint edema— comfortably.
Bufferin caused no gastric distress in 70
per cent of hospitalized arthritics with
proved intolerance to aspirin. (Arthritics
are at least 3 to 10 times as intolerant to
straight aspirin as the general population.1)
No sodium accumulation. Because Bufferin is
sodium free, massive dosage for prolonged
periods will not cause sodium accumula-
tion or edema, even in cardiovascular cases.
Each sodium-free Bufferin tablet contains acetyl-
salicylic acid, 5 grains, and the antacids magnesium
carbonate and aluminum glycinate.
Reference: 1. J.A.M.A. 158:386 (June4) 1955.
ANOTHER FINE PRODUCT OF BRISTOL-MYERS
Bristol-Myers Company
19 West 50 St., New York 20, N. Y
1176
Volume XI. IV
Number 10
for “This Wormy World
Pleasant tasting
‘ANTEPAR!
brand
PIPERAZINE
SYRUP - TABLETS - WAFERS
Eliminate PINWORMS IN ONE WEEK
ROUNDWORMS IN ONE OR TWO DAYS
PALATABLE • DEPENDABLE • ECONOMICAL
‘ANTEPAR’ SYRUP “ Piperazine Citrate, 100 mg. per cc.
‘ANTEPAR’ TABLETS “Piperazine Citrate, 250 or 500 mg., scored
‘ANTEPAR’ WAFERS - Piperazine Phosphate, 500 mg.
Literature available on request
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y.
J. Klorida M.A.
April, 1958
1177
ACH ROCI Dl N
TETRACYCLINE-ANTIHISTAMINE-ANALGESIC COMPOUND LEDERLE
A versatile, well-balanced formula capable of modifying
the course of common upper respiratory infections . . .
particularly valuable during respiratory epidemics; when
bacterial complications are likely; when patient’s history
is positive for recurrent otitis, pulmonary , nephritic, or
rheumatic involvement.
Adult dosage for Achrocidin Tablets and new caffeine-
free Achrocidin Syrup is two tablets or teaspoonfuls of
syrup three or four times daily. Dosage for children ac-
cording to weight and age.
Available on prescription only.
TABLETS (sugar coated) Each Tablet contains:
Achromycin® Tetracycline 125 mg.
Phenacetin 120 mg.
Caffeine 30 mg.
Salicylamide 150 mg.
Chlorothen Citrate 25 mg.
Bottles of 24 and 100.
SYRUP (lemon -lime flavored) Each teaspoonful (5 cc.)
contains:
Achromycin® Tetracycline
equivalent to tetracycline HC1 125 mg.
Phenacetin 120 mg.
Salicylamide 150 mg.
Ascorbic Acid (C) 25 mg.
Pyrilamine Maleate 15 mg.
Methylparaben 4 mg.
Propylparaben 1 mg.
Bottle of 4 oz.
rapidly relieves the
debilitating symptoms
LEDERLE LABORATORIES
*T rademark
DIVISION.
AMERICAN CYANAMID COMPANY.
1178
Volume XL1V
Number 10
BOOKS RECEIVED
Clinical Toxicology of Commercial Products.
Acute Poisoning (Home & Farm). By Marion N.
Gleason, Robert E. Gosselin, M.D., Ph.D., and Harold
C. Hodge, Ph.D., D.Sc. Pp. 1160. Price, $16.00. Balti-
more, The Williams & Wilkins Co., 1957.
This unique and invaluable book contains a startling
amount of toxocologic information never before in print
or under one cover. It is intensely practical and is ar-
ranged for speedy, emergency use. As stated in the
Foreword, this reference volume, designed to make
urgently needed information immediately available,
should be most helpful to any physician faced with a
patient who has swallowed some possibly toxic trade-
marked product. Pediatricians and general practitioners
will find it especially useful. Medical libraries, pharma-
cies, industrial medical departments, public health nurs-
ing centers, and any agency frequently called upon for
emergency help should also find it helpful as a quick
source of information on first aid, treatment procedures,
and other questions. Widespread and immediate use of
such a reference can help to prevent deaths from chemical
poisoning.
The book provides (a) a list of trade name products
together with their ingredients when these have been
available, (b) sample formulas of many types of prod-
ucts with an estimate of the toxicity of each formula,
(c) toxocologic information including an estimate of the
toxicity of individual ingredients, (d) recommendations
for treatment, and (e) names and addresses of manu-
facturers. The price includes a free supplement to be
issued next year.
Modern Perinatal Care. By Leslie V. Dill, M.D.,
F.A.C.S. Pp. 309. Price, $6.50. New York, Appleton-
Century-Crofts, Inc., 1957.
The purpose of this text is to present, briefly and
concisely, a digest of informed current thought and of-
fer modern technics for the total care of women from
earliest pregnancy through labor and the postpartum
period. All available source material has been utilized
and tempered by the experience of the author and 16
valued consultants to define the physiologic limits for
normal pregnancy, clarify present trends in prophylaxis
and therapy for the normal gravida and present effective
methods and therapies for treating the various pathologic
conditions which may occur during pregnancy and com-
plicate it. Many of the methods included are designed
for use by physicians without access to elaborate hos-
pital facilities and which can be safely depended upon
in emergencies or until specialty consultation sendee is
available.
Among the obstetric problems discussed are abortion,
pelvic mensuration, toxemias and anemias of pregnancy,
the fourth stage of labor, and the complications to
pregnancy arising from such conditions as heart disease,
diabetes mellitus, thyroid disorders, tuberculosis, and
venereal diseases. Attention is given to nutrition in preg-
nancy and to the psychologic aspects of pregnancy.
Various problems relative to the infant are also con-
sidered: fetal mortality, birth injuries, congenital mal-
formations, and infant feeding. The two concluding
chapters cover the medicolegal, and religious problems
encountered in obstetric practice.
Manual of Nutrition. Pp. 70. Price, $3.50. New
Ycrk, Philosophical Library, 1957.
This book presents concisely and simply the principles
of nutrition, not only to teachers and students of home
(Continued on page 1186)
in
PREVENTIVE GERIATRICS
a FIRST from TUTAG !
Now — 20 to 1 Androgen-Estrogen
(activity) ratio* !
Each Magenta Soft Gelatin Capsule contains:
Methyltestosterone . 2 mg.
Ethinyl Estradiol 0.01 mg.
Ferrous Sulfate 50 mg.
Rutin 10 mg.
Ascorbic Acid 30 mg.
B- 12 I meg.
Molybdenum 0.5 mg.
Cobalt O.l mg
Copper 0.2 mg.
Vitamin A 5,000 I.U.
Vitamin D 400 I.U.
Vitamin E I I.U.
Cal. Pantothenate .3 mg.
Thiamine Hcl. 2 mg
Riboflavin 2 mg
Pyridoxine Hcl. . 0.3 mg
Niacinamide 20 mg
Manganese I mg
Magnesium 5 mg
Iodine 0.15 mg
Potassium 2 mg
Zinc .... I mg
Choline Bitartrate . 40 mg
Methionine 20 mg
Inositol 20 mg
Write for Latest Technical Bulletins.
‘REFERENCE: J.A.M.A. 163: 359, 1957 (February 2)
S. J. IUTA6 & COMPANY
DETROIT 34, MICHIGAN
Lederle announces a major drug with great new promise
a new corticosteroid created to minimize
major deterrents to all previous steroid therapy
9 alpha-fluoro-16 alpha-hydroxyprednisolone
* t
Q a new high in anti-inflammatory effects with lower dosage
(averages 1 L less than prednisone)
Q a new low in the collateral hormonal effects associated
with all previous corticosteroids
0 No sodium or water retention
Q No potassium loss
0 No interference with psychic equilibrium
0 Low incidence of peptic ulcer and osteoporosis
Biological Effects of
with
particular emphasis
on:
Kidney function
Animal studies on aristocort1 have not dem-
onstrated any interference with creatinine or
urea clearance. Autopsy surveys of organs of
animals on prolonged study of this medication
have shown no renal damage.
Sodium and water
aristocort produced an increase of 230 per
cent of water diuresis and 145 per cent sodium
excretion when compared to control animals.1
Metabolic balance studies in man revealed
an average negative sodium balance of 0.8
Gm. per day throughout a 12-day period on a
dosage of 30 mg. per day.2 Additional balance
studies showed actual sodium loss when
aristocort was given in doses of 12 mg.
daily.3 Other investigators observed significant
losses of sodium and water during balance
studies and that those patients with edema
from some older corticosteroids lost it when
transferred to aristocort.4’5 In two studies of
various rheumatic disorders (194 cases) on
prolonged treatment, sodium and water reten-
tion was not observed in a single case.6- 7
Potassium and chlorides
There was no active excretion of potassium
or chloride ions in animals given mainte-
nance doses of aristocort 25 times that
found to be clinically effective.1 Potassium
balance studies in humans2,3 revealed that
negative balance did not occur even with
doses somewhat higher than those employed
for prolonged therapy in rheumatoid arthri-
tis. Hypokalemia, hyperkalemia or hypochlo-
remia did not occur, when tested, in 194
patients with rheumatoid arthritis treated for
up to ten and one-half months.6,7
Calcium and phosphorus
Phosphate excretion in animals1 was not
changed from normal even with amounts 25
times greater (by body weight) than those
known to be clinically effective. Human met-
abolic balance studies3 demonstrated that no
change in calcium excretion occurred on dos-
ages usually employed clinically when the
compound is administered for its anti-inflam-
matory effect. Even at a dosage level twice
this, slight negative balance appeared only
during a short period.
Protein and nitrogen balance
Positive nitrogen balance was maintained dur-
ing a human metabolic study on mainte-
nance dosage of 12 mg. per day.3 At dosages
two to three times normal levels, positive bal-
ance was maintained except for occasional
short periods in metabolic studies of several
weeks’ duration.2,3
There was always a tendency for normali-
zation of the A/G ratio and elevation of blood
albumin when aristocort was used in treat-
ing the nephrotic syndrome.8
t
c
Liver glycogen deposition and
inflammatory processes
An intimate correlation exists between the
ability of a corticosteroid to cause deposition
of glycogen in the liver and its capacity to
ameliorate inflammatory processes.
In animal liver glycogen studies, relative
potencies of aristocort over cortisone of up
to 40 to 1 have been observed. Compared to
aristocort, five to 12 times the amount of
prednisone is required to produce varying but
equal amounts of glycogen deposition in the
liver.1
Most patients show normal fasting blood
sugars on aristocort. Diabetic patients on
aristocort may require increased insulin
dosage, and occasional latent diabetics may
develop the overt disease.
Anti-inflammatory potency of aristocort
was determined by both the asbestos pellet1
and cottonball9 tests. It was found to be nine
to 10 times more effective than hydrocortisone
in this respect.
Gastric acidity and pepsin
The precise mode of ulcerogenesis during
treatment with corticosteroids is not known.
There is much experimental evidence for be-
lieving this may be related to the tendency of
these agents to increase gastric pepsin and
acidity— and this cannot be abolished by vagot-
omy, anticholinergic drugs or gastric antral
resection.10 Clinical studies11 of patients on
aristocort revealed that uropepsin excretion
is not elevated. Further, their basal acidity
and gastric response to histamine stimulation
were within normal limits.
Central nervous system
The tendency of corticosteroids to produce
euphoria, nervousness, mental instability, oc-
casional convulsions and psychosis is well
known.12 The mechanism underlying these
disturbances is not well understood.
aristocort, on the contrary, does not pro-
duce a false sense of well being, insomnia or
tension except in rare instances. In the treat-
ment of 824 patients, for up to one year, not
a single case of psychosis has been produced.
In general, it appears to maintain psychic
equilibrium without producing cerebral stim-
ulation or depression.
Bibliography
1. Experimental Therapeutics Section, Lederle Laboratories.
To be published. 2. Bunim, J. J., Whedon, G., and Black,
R. L. : Personal Communication. 3. Heilman, L., Zumoff,
B., Schwartz, M. K., Gallagher, T. F., Berntsen, C. A., and
Freyberg, R. H.: Antirheumatic and Metabolic Effects of
a New Synthetic Steroid, paper quoted in Bull. Rheumat.
Dis. 7: 130, 1957. 4. Spies, T. D.: South. M. J. 50: 216,
(Feb.) 1957. 5. Freyberg, R. H.: Personal Communication.
6. Freyberg, R. H., Berntsen, C. A., and Heilman, L. : Pa-
per presented at the International Congress on Rheumatic
Diseases, Toronto, June 25, 1957. 7. Hartung, E. F.: To be
published. 8. Heilman, L., Zumoff, B., Kretschmer, N. and
Kramer, B.: Personal Communication. 9. Dorfman, R. I.,
and Dorfman, A. S.: Personal Communication. 10. Gray,
S. J., Ramsey, C. G., Villarreal, R., and Krakauer, L. J.: Ed-
ited by H. Selye and G. Heuser in: Fifth Annual Report on
Stress, 1955-56. M.D. Publications, Inc., New York, 1956,
p. 138. 11. Dubois, E. L.: Personal Communication. 12.
Good, R. A., Vernier, R. L., and Smith, R. T.: Pediatrics
19:95, 1957.
The Promise of
in Reduction of Side Effects
0 It is axiomatic to affirm that the undesirable
collateral hormone effects of corticosteroids
increase in frequency and severity the higher
the dosage and the longer used.
It has also become well recognized that the
most serious of the major side effects from
long-term corticosteroid treatment are peptic
ulcers, osteoporosis with fracture, drug psy-
chosis and euphoria, and sodium and water
retention leading often to general tissue
edema and hypertension.
It is significant that of the close to 400 pa-
tients on the lower dosage schedules found
effective in bronchial asthma and dermato-
logic conditions, only 1 case of peptic ulcera-
tion has developed. No other of the above
side effects have been observed even though
aristocort was administered continuously
to them for periods as long as one year.
The treatment of rheumatoid arthritis with
steroids appears to result in the highest inci-
dence of side effects. For this reason, the side
effects associated with aristocort therapy in
292 patients with rheumatoid arthritis are
reported below.
Peptic Ulcer
The occurrence of peptic ulcer in 292 pa-
tients with rheumatoid arthritis treated con-
tinuously for up to one year with aristocort
is approximately 1 per cent (2 of the 3
occurred in patients transferred from predni-
sone). In the remaining 532 cases recently
analyzed, only one ulcer has been discovered
in a patient who apparently had no ulcer
when he was changed from another steroid.
Osteoporosis and
Compression Fractures
The occurrence of osteoporosis with com-
pression fracture in 292 patients with rheu-
matoid arthritis treated continuously for up to
one year with aristocort is 0.33 per cent
(1 case1). Although these results are encour-
aging, determination of the true incidence
of osteoporosis will have to await the passage
of more time.
Euphoria and Psychosis
The euphoria so commonly produced by all
previous corticosteroids has seemed a most
desirable attribute to patients. In penalty,
however, they have often later to pay for this
by mental disturbances, varying from mild
and transitory to severe depression and psy-
chosis,2 and toxic syndromes producing even
convulsions and death.3
Since the onset of these complications is not
directly related to duration of steroid admin-
istration,4 the fact that not one case of psy-
chosis occurred in 824 patients treated with
aristocort, is most encouraging.
Sodium Retention— Hypertension-
Potassium Depletion
When 17 patients were changed from predni-
sone to aristocort, 1 1 rapidly lost weight al-
though only one had had visible edema.5
Sodium and water retention, hypokalemia
or hyperkalemia and steroid hypertension did
not appear in 194 rheumatoid arthritis pa-
tients treated with aristocort.1'6
The interrelation between blood and body
sodium, and steroid hypertension has long
been generally appreciated.7-8 Except in
rare instances, or when unusually high doses
are used (e.g., leukemia), the problem of
edema and hypertension caused by sodium
and water retention, has been eliminated
With ARISTOCORT.
Minor Side Effects
Collateral hormonal effects of less serious con-
sequence occurred with approximately the
same frequency as with the older corticoster-
oids.1 These include erythema, easy bruising,
acne, hypertrichosis, hot flashes and vertigo.
Several investigators have reported symptoms
not previously described as occurring with
corticosteroid therapy, e.g., headaches, light-
headedness, tiredness, sleepiness and occa-
sional weakness.
Moon facies and buffalo humping have
been seen in some patients on aristocort.
However, aristocort therapy, in many in-
stances, resulted in diminution of “Cushin-
goid” signs induced by prior therapy. Where
this occurs, it may be related to reduced
dosage on which patients can be maintained.
Reduction of dosage
by one-third to one-half
In a double-blind study of comparative dos-
age in patients with rheumatoid arthritis,9
70 per cent of the cases were as well controlled
on a dose of aristocort one-half that of pred-
nisone. A general recommendation can be
made that aristocort be used in doses two-
thirds that of prednisone or prednisolone in
the treatment of rheumatoid arthritis. There
are individual variations, however, and each
patient should be carefully titrated to produce
the desired amount of disease suppression.
Comparative studies, of patients changed
from prednisone, indicate reduced dosage of
aristocort in bronchial asthma and allergic
rhinitis (33 per cent),5 and in inflammatory
and allergic skin diseases (33-50 per cent).1011
General Precautions and
Contraindications
Administration of aristocort has resulted
in lower incidence of major serious side
effects, and in fewer of the troublesome minor
side effects known to occur with all previously
available corticosteroids. However, since it is
a highly potent glucocorticoid, with profound
metabolic effects, all traditional contraindica-
tions to corticosteroid therapy should be ob-
served.
No precautions are necessary in regard to
dietary restriction of sodium or supplementa-
tion with potassium.
Since aristocort has less of the traditional
side effects, the appearance of sodium and
water retention, potassium depletion, or
steroid hypertension cannot be used as signs
of overdosage. As a rule patients will lose
some weight during the first few days of
treatment as a result of urinary output, but
then the weight levels off.
Patients do not develop the abnormally
voracious appetite common to previous corti-
costeroid administration. In fact, some patients
experienced anorexia, and it is advisable to
inform patients of this and to recommend
they maintain a normal intake of food, with
emphasis on liberal protein intake.
While precipitation of diabetes, peptic
ulcer, osteoporosis, and psychosis can be ex-
pected to appear rarely from aristocort,
they must be searched for periodically in
patients on long-term steroid therapy.
Traditional precautions should be observed
in gradually discontinuing therapy, in meet-
ing the increased stress of operation, injury
and shock, and in the development of inter-
current infection.
There is one overriding principle to be ob-
served in the treatment of any disease with
aristocort. The amount of the drug used
should he carefully titrated to find the smallest
possible dose which will suppress symptoms.
Bibliography
1. Freyberg, R. H., Bemtsen, C. A., and Heilman, L.:
Paper presented at International Congress on Rheumatic
Diseases, Toronto, June 25, 1957. 2. Bunim, J. J.: Bull.
New York Acad. Med. 33:461, 1957. 3. Good, R. A.,
Vernier, R. L., and Smith, R. T.: Pediatrics 19:95, 1957.
4. Goolker, P., and Schein, J.: Psychosom. Med. 15:589,
1953. 5. Sherwood, H., and Cooke, R. A.: J. Allergy
28:97, 1957. 6. Hartung, E. F.: Personal Communication.
7. Schroeder, H. A.: J.A.M.A. 162:1362, 1956. 8. Thorn,
G. W., Laidlaw, J. C., and Goldfein, A.: Ciba Found. Coll,
on Endocrinology, J. & A. Churchill, Ltd., London, 8:343,
1955. 9. Freeman, H., Bachrach, S., McGilpin, H. H., and
Dorfman, R. L: Personal Communication. 10. Rein, C. R.,
Fleischmajer, R., and Rosenthal, A.: J.A.M.A. 165:1821,
1957. 1 1. Shelley, W. B., and Pillsbury, D. M.: Personal
Communication.
The Promise of
in Rheumatoid Arthritis
Q aristocort therapy has been intensely and
extensively studied for periods up to one year
on 292 patients with rheumatoid arthritis.
Significant is the fact that most patients were
severe arthritics, transferred to aristocort
from other corticosteroids because satisfactory
remission had not been attained, or because
the seriousness of collateral hormonal effects
had made discontinuance desirable.
Results of treatment
Freyberg and associates1 treated 89 patients
with rheumatoid arthritis (A. R. A. Class II
or III and Stage II or III). Of these, 51 were
on aristocort therapy from three to over 10
months. In all but a few patients, satisfactory
suppression of rheumatoid activity was ob-
tained with 10 mg. per day. Thirteen were
controlled on 6 mg. or less a day, and for
periods to 180 days. The investigators reported
therapeutic effect in most cases to be A. R. A.
Grade II (impressive) and that marked re-
duction in sedimentation rates occurred.
Another interesting observation in this
study: Of the 89 patients treated, 12 had ac-
tive ulcers, developed from prior steroid ther-
apy. In six patients, the idcers healed while
on doses of aristocort sufficient to control
arthritic symptoms.
Hartung2 treated 67 cases of rheumatoid
arthritis for up to 10 months. He found the
optimum maintenance dose to be 11 mg. per
day. Nineteen of these patients were treated
for six to 10 months with an “excellent” thera-
peutic response.
Dosage and course of therapy
The initial dosage range recommended is 14
to 20 mg. per day— depending on the severity
and acuteness of signs and symptoms. Dosage
is divided into four parts and given with
meals and at bedtime. Anti-rheumatic effect
may be evident as early as eight hours, and
full response often obtained within 24 hours.
This dosage schedule should be continued
for two or three days, or until all acute mani-
festations of the disease have subsided,
whichever is later.
The maintenance level is arrived at by re-
duction of the total daily dosage in decre-
ments of 2 mg. every three days. The range
of maintenance therapy has been found to
be from 2 mg. to 1 5 mg. per day— with only
a very occasional patient requiring as much
as 20 mg. per day. Patients requiring more
than this should not be long continued on
steroid therapy.
The aim of corticosteroid therapy in rheu-
matoid arthritis is to suppress the disease only
to the stage which will enable the patient to
carry out the required activities of normal
living or to obtain reasonable comfort. The
maintenance dose of aristocort to achieve
this end is arrived at while making full use of
all other established methods of controlling
the disease.
aristocort is available in 2 mg. scored tablets
(pink); 4 mg. scored tablets (white). Bottles
of 30.
Bibliography
1. Freyberg, R. H., Berntsen, C. A., and Heilman, L.: Paper
presented at International Congress on Rheumatic Diseases,
Toronto, June 25, 1957. 2. Hartung, E. F.: Paper presented
at Florida Academy of General Practice, St. Petersburg,
Florida, Nov. 2, 1957.
The Promise of J^sto®©®^
in Respiratory Allergies
Q About 200 patients with respiratory allergies
have been treated with aristocort for con-
tinuous periods up to eight months.
Results of treatment
Sherwood and Cooke1,2 gave aristocort to
42 patients with bronchial asthma and allergic
rhinitis. Average dose needed to control the
asthmatic group was approximately 6 mg. per
day (range, 2 to 14 mg.). Results, which were
called “good to excellent’’ in all but four, were
achieved on one-third less than similarly ef-
fective doses of prednisone or prednisolone.
The investigators noted other major im-
provements in aristocort therapy over the
older steroids. There was no increase in blood
pressure in any patient: on the contrary, in
12 patients, there was reduction of pressure
when they were transferred to aristocort.
One patient had required auxiliary antihyper-
tensive drug therapy; over a nine-week period
on aristocort, the pressure gradually fell
from 206/100 to 136/79. In another case, the
pressure slowly dropped from 205/105 to
154/86.
The number of cases in which these inves-
tigators tried aristocort in allergic rhinitis
was not large enough to provide significant
averages. However, the range of effective ther-
apy was from 2 to 6 mg. per day. These strik-
ingly low daily doses resulted in control of all
signs and symptoms.
Schwartz3 treated 30 patients with chronic,
intractable bronchial asthma. At an average
daily dose of 7 mg., he reported “good to ex-
cellent” results in all but one. Spies,4 Barach5
and Segal,6 reported similar results at aver-
age daily maintenance doses of 4 to 10 mg.
of ARISTOCORT.
Dosage and course of therapy
The initial dosage range recommended is 8 to
14 mg. of aristocort daily. Although a rare,
very severe case may require more than this on
the first day of therapy, these dosages will
usually result in prompt alleviation of dyspnea,
wheezing and cyanosis. Patients are soon able
to carry out a normal span of daily activity.
The maintenance level is arrived at by re-
duction of the total daily dose every three
days in decrements of 2 mg.; in the over-all
series, the average daily dose for bronchial
asthma is approximately 8 to 10 mg. and for
allergic rhinitis, 2 to 6 mg. per day. All total
daily doses should be divided into four parts
and given with meals and at bedtime. As in
every condition where corticosteroids are em-
ployed, each patient’s treatment should be
individualized and the maintenance arrived
at by careful titration against signs and symp-
toms of disease.
Patients with chronic bronchial asthma may
require steroid therapy for several months.
And since asthma may be associated with
cardiac disease, especially in the older age
groups, aristocort is particularly useful be-
cause of its ability to cause excretion of
sodium and water.
aristocort is available in 2 mg. scored tab-
lets (pink); 4 mg. scored tablets (white).
Bottles of 30.
Bibliography
I. Sherwood, H., and Cooke, R. A.: J. Allergy 28:97,
1957. 2. Sherwood, H., and Cooke, R. A.: Personal Com-
munication. 3. Schwartz, E.: Personal Communication. 4.
Spies, T. D.: Personal Communication. 5. Barach, A. L.:
Personal Communication. 6. Segal, M. S.: Personal Com-
munication.
The Promise
in Nephrotic Syndrome
Q Fourteen -patients with the nephrotic syn-
drome have been treated with aristocort for
continuous periods of up to six weeks.
Results of treatment
Heilman and associates1-2 noted that
aristocort, because of its favorable electro-
lyte effects, may well be the most desirable
steroid to date in treatment of the nephrotic
syndrome. However, thus far its use has been
reported in only 14 children, of whom 8 had
a complete diuresis and disappearance of all
abnormal chemical findings. Four of the pa-
tients had diuresis, but continued to show
some abnormal chemical findings, while two
patients with signs of chronic renal disease
failed to respond.
Dosage and course of therapy
In order to produce maximal response, 20 mg.
should be given daily until diuresis occurs.
The dose should then be decreased gradually
and maintained around 10 mg. a day. After
the patient has been in remission for some
time, it may be advisable to diminish the dose
gradually and discontinue aristocort.
in Pulmonary Emphysema
and Fibrosis
0 Eleven patients with pulmonary emphysema
and/or fibrosis were treated with aristocort
for continuous periods of over two months.
Results of treatment
Only small series of cases observed by Barach,3
Segal,4 and Cooke,5 are available. Barach
treated patients who were not adequately con-
trolled by prednisone, with the same dose of
aristocort with significant improvement.
Dosage and course of therapy
The initial suppressive dose range recom-
mended is 10-14 mg. daily. Frequently, there
is a prompt decrease in cyanosis and dyspnea,
with increase in vital capacity.
The average maintenance dose level was
8 mg. a day. If it is desired to maintain a pa-
tient on continuous therapy for some months,
dosages as low as 2 mg. a day have been suc-
cessful. All decreases in dosage should be
gradual and at a rate of 2 mg. decrements in
total daily amount, every two to four days.
The daily dosage is divided into four parts and
given with meals and at bedtime.
in Neoplastic Diseases
0 Fortyf our children and adults have been
given aristocort for palliative treatment of
acute leukemia, chronic lymphatic leukemia,
lymphosarcoma, lympholeukosarcoma and
Hodgkin’s disease.
Results of treatment
Farber6 has treated 22 children with acute
leukemia for an average of three weeks. Of
the 17 observed long enough to judge the
efficacy of the medication, he rated five as
excellent, three as good, two as fair and seven
as poor responses.
Heilman and associates7 gave aristocort
to a group of patients with the various lym-
phomas in doses of 40 to 50 mg. a day— occa-
sionally up to 100 milligrams. Treatment was
continued in some cases for 17 weeks. Re-
sponse was classified as good for the palliative
purposes for which the drug was given.
Dosage and course of therapy
Massive initial suppressive doses of 40 to 50
mg. per day in children (1 mg./kg./day) and
up to 100 mg. a day in adults have been
administered.
Responses to any specific dosage in these
conditions vary so widely that only a general
dosage range can be indicated. Treatment
must be individualized; rate of reduction in
dosage and determination of maintenance
levels cannot be categorized.
Miscellaneous
Patients with various other diseases have been
treated by several clinical investigators. These
include patients with osteoarthritis, acute bur-
sitis, rheumatic fever, spondylitis, other
“collagen-vascular” diseases (dermatomyositis,
etc.), thrombocytopenic purpura, chronic eosi-
nophilia, hemolytic anemia, diuretic-resistant
congestive heart failures, and adrenogenital
syndrome.
There have not been sufficient patients in
any of the above categories to permit defini-
tive treatment schedules to be finally estab-
lished for aristocort. Additional studies are
now in progress and physicians desiring in-
formation on any of these diseases are re-
quested to write to Lederle Laboratories, Pearl
River, New York for available data.
aristocort is available in 2 mg. scored tab-
lets (pink); 4 mg. scored tablets (white).
Bottles of 30.
Bibliography
1. llellman, L., ZumofT, B., Krctshmer, N., and Kramer, B.:
Presented at Nephrosis Conf., Bethesda, Md.,Oct. 26, 1957.
2. Ibid: Personal Communication. 3. Barach, A. L: Personal
Communication. 4. Segal, M. S.: Personal Communication.
5. Cooke, R. A.: Personal Communication. 6. Farber, S.:
Personal Communication. 7. Heilman, L., Diamond, H. D.,
Ellison, R., Jaslowitz, B., Murphy, M. L.,Tan,C. and Zumoff,
B.: Personal Communication.
The Promise of
in Inflammatory and
Allergic Skin Diseases
Q Over 2 00 patients with allergic and inflamma-
tory skin diseases ( including psoriasis, atopic
dermatitis, exfoliative dermatitis, pemphigus,
dermatitis herpetiformis, eczematoid derma-
titis, contact dermatitis and angioneurotic
edema) have been treated continuously with
aristocort for periods of up to eight months.
Results of treatment
Rein and associates1 treated 26 patients with
severe dermatitis. Twenty-four had been on
prednisone when changed to aristocort.
While some had found satisfactory sympto-
matic relief, others had also developed side
effects— moon face, buffalo hump, increased
appetite with excessive weight increases and
gastro-intestinal disturbances.
These investigators determined the equiva-.
lent dosage of aristocort to be approximately
two-thirds that required to control symptoms
on the previous corticosteroid. Thirteen of the
26, who had developed moon face, noted
either an actual decrease or no further in-
crease when transferred to aristocort. In
addition: Voracious appetites disappeared,
with loss of weight in 11 patients ; there was
no elevation in blood pressure, and no neces-
sity to restrict sodium or administer supple-
mental potassium. Sherwood and Cooke,2 and
Shelley and Pillsbury3 obtained similar results
in allied disorders.
Hollander4 first observed that aristocort
appears to have striking affinity for the skin
and great activity in controlling such diseases
as psoriasis, for which other corticosteroids
have been indifferently effective. Shelley and
Pillsbury,3 in 50 cases of acute extending
psoriasis found that over 60 per cent were
markedly improved.
Dosage and course of therapy
The recommended initial suppressive dose
range is 14 to 20 mg. per day. In very severe
cases, temporary dosages up to 32 mg. a day
have been successfully employed. Once le-
sions are suppressed, gradually reduce dose
to the maintenance level— which may be as
low as 2 mg. per day.
Bibliography
1 . Rein, C. R., Fleischmajer, R., and Rosenthal, A. : J.A.M.A.,
165:1821, 1957. 2. Sherwood, H., and Cooke, R. A.: Per-
sonal Communication. 3. Shelley, W. B., and Pillsbury,
D. M.: Personal Communication. 4. Hollander, J. L. : Dis-
cussion of Paper by Black, R. L., presented at International
Congress on Rheumatic Diseases, Toronto, June 28, 1957.
in Disseminated Lupus
Erythematosus
0 Forty patients with disseminated lupus ery-
thematosus were treated with aristocort for
continuous periods of up to nine months.
Results of treatment
Patients have responded very promisingly to
therapy. Dubois1 has had the largest single
experience (28 cases) with aristocort in the
treatment of this disease. He reported 25 of
the 28 responded favorably.
Freyberg,2 Hartung,3 Hollander,4 Spies,5
and Segal,6 each in smaller series of cases,
reported similarly good therapeutic responses.
Dosage and course of therapy
The initial suppressive dose recommended is
20-30 mg. daily. Once the desired effect is
achieved, the dose should be reduced gradu-
ally to maintenance levels (3 to 18 mg. per
day).
In severely ill patients large doses may be
required for several days in order to preserve
life. Even on these large doses, edema and
sodium retention have not occurred.
aristocort is available in 2 mg. scored tab-
lets (pink); 4 mg. scored tablets (white).
Bottles of 30.
Bibliography
1. Dubois, E. L.: Personal Communication. 2. Freyberg,
R. H.: Personal Communication. 3. Hartung, E. F.: Per-
sonal Communication. 4. Hollander, J. L. : Personal Com-
munication. 5. Spies, T. D.: Personal Communication. 6.
Segal, M. S.: Personal Communication.
Results with fr. . . antacid therapy with DAA are essentially the same as . . . with
potent anticholinergic drugs. ”
Dihydroxy aluminum aminoacetate, N.N.R.
In recent years, a number of new synthetic anticholiner-
gic drugs with numerous and varying side effects have
been investigated for treatment of peptic ulcer. However,
a double-blind study conducted recently by Cayer et al
suggests that the use of such anticholinergic drugs is
seldom necessary. The authors concluded that "The
percentage of 'good to excellent’ results obtained in
patients on continuous long-term antacid therapy with
DAA (74%) is essentially the same as that previously
noted in ulcer patients treated under similar conditions
with potent anticholinergic drugs alone.”
The authors’ choice of dihydroxy aluminum amino-
acetate (DAA) was based on the fact that "the tablet
form of DAA (is) more active than a variety of straight
aluminum hydroxide magmas.” They further commented
that "Because of the convenience of tablet medication
as compared with the liquid gel — a convenience which
in the use of other tablets is gained at the expense of
therapeutic effectiveness — dihydroxy aluminum amino-
acetate was used exclusively.”
Alglyn (dihydroxy aluminum aminoacetate) Tablets
are supplied in bottles of 100 tablets (0.5 Gm. per tablet).
□
BRAYTEN PHARMACEUTICAL COMPANY • Chattanooga 9, Tennessee
WALLACE LABORATORIES. New Brunswick, N. J.
Milpath
Miltown® O anticholinergic
two-level control of
gastrointestinal dysfunction
the man
han merely
his stomach”'
at the central level The tranquilizer Miltown® reduces anxiety and tension.13
Unlike the barbiturates, it does not impair mental or physical efficiency.5-7
at the peripheral level The anticholinergic tridihexethyl iodide reduces
hypermotility and hypersecretion.
Unlike the belladonna alkaloids, it rarely produces dry mouth or blurred vision.2-4
indications: peptic ulcer, spastic and irritable colon, esophageal
spasm, G. I. symptoms of anxiety states.
each Milpath tablet contains:
Miltown.® (meprobamate WALLACE) 400 mg.
(2-methyl-2-«-propy 1-1, 3-propanediol dicarbamate)
Tridihexethyl iodide 25 mg.
(3-diethylamino-l-cyclohexyl-l-phenyl-l-propanol-ethiodide)
references: 1 Altschul. A. and Billow. B : The clinical use of meprobamate. (Miltown*) New York J Med. 57: 2361.
July 15, 1957. 2. At water. J. S. : The use of anticholinergic agents in peptic ulcer therapy. J. M. A. Georgia 45:421. Oct. 1956.
3. Borrus, J (\: Study of effect of Miltown (2-met hy!-2-/i-propy 1-1. 3-propanediol dicarbamate) on psychiatric states.
J. A. M. A. 757:1596, April 30, 1955. 4 Cayer, 1).: Prolonged anticholinergic therapy of duodenal ulcer. Am. J. Digest. Dis.
7:301, July 1956. 5. Marquis, D. CL, Kelly. E. L . Miller. J. (l.. Gerard, R. \V. and Rapoport. A.: Experimental studies of
behavioral effects of. meprobamate on normal subjects. Ann. New York Acad. Sc. 6*7:701. May 9. 1957. 6. Phillips. R. E.:
Use of meprobamate (Miltown®) for the treatment of emotional disorders. Am. Pract. & Digest Treat. 7:1573. Oct 1956.
7. Selling. I. S : A clinical study of Miltown*. a new tranquilizing agent. J. Clin. & Exper. Psychopath. 77:7, March 1956.
8. Wolf, S. and Wolff, H. G.: Human Gastric Function, Oxford University Press, New York, 1947.
dosage: 1 tablet t.i.d. at mealtime
and 2 tablets at bedtime.
available : bottles of 50 scored tablets
r-
J. Florida M.A.
April, 1958
1183
VU v
why wine
in Urology?
The essence of recent research on the effects
of wine in renal disease indicates (1) that wine
in moderate quantities is non-irritative to the
kidneys; (2) that wine increases glomerular blood
flow and diuresis; (3) that it is useful in
minimizing acidosis, and (4) that properly
used in selected patients, wine can brighten an
otherwise monotonous and unappealing diet.
The Superior Diuretic Action of White Wine—
The diuretic properties of wine have been the
subject of intensive study. Interestingly, the
diuretic action of white wine, and particularly
sweet white wine, has been found to be superior
to that of red wine.
White wine, therefore, is prescribed with
benefit in nephritis, especially that associated
with hypertension and arteriosclerosis. Wine is
not suggested in cases of renal insufficiency.
The Buffers in Wine — Such buffering agents
as natural tartrates and phosphates in wine
prevent the acidosis which normally tends to follow
the ingestion of alcohol. Used in renal disease,
therefore, wine tends to minimize acidosis
and maintain the alkaline reserve.
An extensive bibliography is now available showing the important role of wine in
various phases of medical practice. A digest of current findings with specific
references to published .medical literature is yours for the asking. Just write for
your copy of “Uses of Wine in Medical Practice" to Wine Advisory Board, 717
Market Street, San Francisco 3, California.
1184
Volume XLIV
Number 10
(CHLOROTHIAZIDE)
in
EDEMA
Start therapy with one or two 500 mg.
tablets of ' diuril' once or twice a day .
BENEFITS:
• The only orally effective nonmercurial agent
with diuretic activity equivalent to that of the
parenteral mercurials.
• Excellent for initiating diuresis and maintaining
the edema-free state for prolonged periods.
• Promotes balanced excretion of sodium and
chloride— without acidosis.
Any indication for diuresis is an in
dication for 'DIURIL':
Congestive heart failure of all degrees of severity;
premenstrual syndrome (edema) ; edema and toxe-
mia of pregnancy; renal edema— nephrosis; ne-
phritis; cirrhosis with ascites; drug-induced edema.
May be of value to relieve fluid retention compli-
cating obesity.
SUPPLIED: 250 mg. and 500 mg. scored tablets 'DIURIL*
(chlorothiazide): bottles of 100 and 1,000.
'diuril' and 'inversine' are trade-marks of Merck & Co.. Inc.
MERCK SHARP & DOHME
Division of MERCK & CO., Inc., Philadelphia ltPa.
J. Florida M.A.
April, 1958
1185
as simple
as 1-2-3
in
HYPERTENSION
1
2
INITIATE 'DIURIL' THERAPY
'DIURIL' is given in a dosage range of from 250
mg. twice a day to 500 mg. three times a day.
ADJUST DOSAGE OF OTHER AGENTS
The dosage of other antihypertensive medication
(reserpine, hydralazine, etc.) is adjusted as indi-
cated by patient response. If the patient is estab-
lished on a ganglionic blocking agent (e.g., 'IN-
VERSINE') this should be continued, but the total
daily dose should be immediately reduced by 25
to 50 per cent. This will reduce the serious side
effects often observed with ganglionic blockade.
ADJUST DOSAGE OF ALL MEDICATION
The patient must be frequently observed and care-
ful adjustment of all agents should be made to
determine optimal maintenance dosage.
BENEFITS:
• improves and simplifies the management of hypertension
• markedly enhances the effects of antihypertensive agents
• reduces dosage requirements for other antihypertensive
agents— often below the level of distressing side effects
• smooths out blood pressure fluctuations
INDICATIONS: management of hypertension
Smooth , more trouble-free manage-
ment of hypertension with ' DIURIL '
1188
Volume XLXV
Number 10
(Continued from page 1178)
economics, but to anyone who wants to understand
good, healthy feeding. The science of nutrition is complex,
and a working knowledge of the subject demands care-
ful study. The purpose of the Manual is to supply in-
formation sufficient for this purpose. Originally written
by Dr. Magnus Pyke, Ph D., F.R.I.C., and first published
in Great Britain in 1945, it grew out of a need arising
during World War II for a program of nutrition educa-
tion which would direct attention to the natural, healthy
foods and the best way of serving them. The present
fourth edition differs substantially from former editions,
owing to the rapid advance in nutritional knowledge,
and has been prepared by present members of the Scienti-
fic Adviser’s Division (Food) of the Ministry of Agricul-
ture, Fisheries and Food of Great Britain.
Ciba Foundation Symposium on the Chemis-
try and Biology of Purines. Editors for the Ciba
Foundation, G. E. W. Wolstenholme, O.B.E., M.A., M.B.,
B.Ch., and Cecilia M. O’Connor, B.Sc. Pp. 327. Ulus.
124. Price, $9.00. Boston, Little, Brown and Company,
1957.
The study of purines has proceeded, until recently,
along two lines: from the approach of the synthetic
chemist and the point of view of the biochemist. Now,
with an exchange of views a collaborative reorientation
is producing valuable results. This symposium, therefore,
is an important record of current thought on purines
voiced by workers in both disciplines. This cooperative
approach of biochemists and synthetic chemists points to
the possible development of new chemotherapeutic agents
whose activity depends upon their purine structure.
Recent, striking advances have been made in the
biosynthesis of nucleic acid ; and the knowledge gained
in elucidating this problem opens the prospect of funda-
mental research into chemotherapy. Considerable prog-
ress has also been made in the enzymology of purines and
their complex derivatives. One or two drugs of some
clinical value have already been discovered as a by-
product of a particular line of research. To the dis-
covery of vitamin BJ2 and its purine-containing analogues
can be added the trypanocidal and antitumor activity of
puromycin and the possible use of adenine and its esters
in vascular disorders.
Biologists generally will be interested in this volume
because of its broad applicability. Those in cancer re-
search and genetics will find it especially timely.
Vital Statistics of the United States 1954.
Volume I. Pp. 358. Price, §3.75. Volume II.
Pp. 505. Price, $4.00. Washington, D. C., United
States Government Printing Office, 1956.
These volumes, prepared under the supervision of Hal-
bert L. Dunn, M.D., Chief of the National Office of Vital
Statistics, present final vital statistics for the United
States, its Territories, and two possessions for the year
1954. Their subject matter consists of vital events that
occurred in these areas during the year — marriages, di-
vorces, births, fetal deaths, infant deaths, and deaths
among the general population.
This annual report is organized as follows: Volume
I. Introduction and Summary Tables. Tables contain-
ing data for Alaska, Hawaii, the Commonwealth of
Puerto Rico, and the Virgin Islands (U.S.). Marriage,
Divorce, Natality, Fetal Mortality, and Infant Mortality
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
CALL THE MEDICAL SUPPLY MAN!
429 W. Monroe St. 329 N. Orange Ave.
Telephone EL 4-6661 Telephone 5-3537
f. Florida M.A.
April, 1958
1187
1 , Recurrent joint pain followed by
long periods of complete remis-
sion. (Percentages refer to inci-
dence.)
SERUM URIC ACID
CONCENTRATION
3. Elevated serum uric acid levels.
2 . Enlargement of bursae such as in
this case involving the olecranon
bursa.
4. Colchicine test: full dose (0.5
mg.) every 1 to 2 hours until pain
is relieved or nausea, vomiting or
diarrhea occur. The test requires
usually 8 to 16 doses. Pain relief
is highly indicative of gout.
FROM THESE FINDINGS... SUSPECT GOUT:
^BENEMID
PROBENECID
A SPECIFIC FOR GOUT
Once findings point to gout, long-term management can be started
with Benemid. This effective uricosuric agent has these unique
benefits:
Urinary excretion of uric acid is approximately doubled.
Serum uric acid levels are reduced.
Uric acid deposits (tophi) in tissues are mobilized.
Formation of new tophi can often be prevented.
Fewer attacks and severity is reduced.
RECOMMENDED DOSAGE: 0.25 Gm. (% tablet) twice daily for
one week followed by 1 Gm. (2 tablets) daily in divided doses.
BENEMID is a trade-mark of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
1188
Volume XLIV
Number 10
The purity, the
V
wholesomeness,
1
the quality of
1
Coca-Cola as
:j*t:
refreshment has helped
make Coke the
HI
SIGN OF GOOD TASTE
Data for the United States and each State. Volume II.
Mortality Data for the United States and each State.
In using statistics from either volume, it is recom-
mended that reference be made to the explanatory text
in Volume I, which describes the sources and limitations
of the data.
Primera Conferencia Inter-Americana de
Medicina del Trabajo Patrocinada por la Escuela
de Medicina de la Universidad de Miami, Coral
Gables, Florida, E. U. de Norte America y por la
Facultad de Medicina de la Universidad de la
Habana, Cuba, 3-6 Septiembre, 1956. Pp. 251. Coral
Gables, University of Miami, 1957.
The organization and presentation of the Primera Con-
ierencia Inter-Americana de Medicina del Trabajo was
jndertaken as a joint enterprise of the University of
Miami School of Medicine and the University of Havana
Faculty of Medicine and Pharmacy. The proceedings of
ihis Conference are here presented.
This Conference represents one of many efforts of the
University of Miami through the years to encourage co-
uperative educational and cultural programs with coun-
ties of the Caribbean, and South and Central America,
tn the Foreword of the proceedings, Dean Homer F.
Marsh of the University of Miami School of Medicine
romments: '“As the School of Medicine came into be-
ng in this natural gateway to the Latin-Americas, it be-
:ame the medical education facility of continental United
States most proximal to the medical centers of the south-
ern hemisphere, long influenced by European thinking
n Medicine. Personal contacts with medical personnel
n the Caribbean and South America led to the thought
:hat our School and that of the University of Havana
rould become terminal anchors of a bridge linking the
wo hemispheres. Across such a bridge could flow a
:wo-way traffic of benefits to be derived from informal
liscussion of mutual medical problems, continuing post-
graduate education efforts, and development of inter-
related research programs. The Conference reported
herein is the first joint effort to bring into reality, this
thought. In keeping with the philosophy of creating an
atmosphere of friendship, the official language of the
Conference was designated as Spanish. This decision
probably was instrumental in attracting attendees from
such widely separated countries as Puerto Rico and Spain
in the East, Mexico in the West, and Peru and Chile in
the South.”
The program of the Thirty-First Annual
Meeting of the Woman’s Auxiliary to the Florida
Medical Association is published in this issue of
The Journal on page 1118.
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
Gnderson Surgical Supply Co.
Established 19 1 <5
A GOOD REPUTATION
1 1 lakes years lo build, but can be
<| u ickly destroyed.
It must be carefully guarded.
"A good name is rather lo be chosen
I han great riches.”
Distributors of Known Brands of Proven Quality
tWLAWFM
TELEPHONE 2-850-4
MORGAN AT PLATT
P. O. BOX 1228
TAMPA 1. FLORIDA
TELEPHONE 5-4362
9th ST. & 6th AVE.. SO.
ST. PETERSBURG. FLORIDA
1190
Volume X I. IV
Number 10
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1901
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against lire — by Auto
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy
five by eighty five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
<228 Nichol St. DON SAVAGE P. O. Box 10368
Telephone 61-4191 Owner and Manager Tampa 9. Florida
i
J. Florida M.A.
April, 1958
1191
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond. Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
1192
Volume XI. IV
Number 10
mim
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
© Modern Treatment Facilities
© Psychotherapy Emphasiied
© Large Trained Staff
© Individual Attention
• Capacity Limited
© Occupational and Hobby Therapy
© Healthful Outdoor Recreation
© Supervised Sports
© Religious Services
© Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants in Psychiatry
SAMUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
BRAWNER’S SANITARIUM
ESTABLISHED 1910
SMYRNA, GEORGIA
N. Brawner, Jr., M.D. Albert F. Brawner, M.D.
Medical Director Associate Director
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Member
Georgia Hospital Association, American Hospital Association
National Association of Private Psychiatric Hospitals
P.O. Box 218
HEmlock 5-4486
[. Florida M.A.
April, 1958
INDEX TO ADVERTISERS
1193
Allen’s Invalid Home ..
1193
Ames Co., Inc
1086
Anclote Manor
1192
Anderson Surgical Supply Co.
1189
Appalachian Hall
1191
Ayerst Laboratories
1152
Ballast Point Manor
1190
Birtcher Corp
1174
Brawner’s Sanitarium
1192
Brayten Pharmaceutical
Co
1179
Bristol - Mvers Co
1175
Burroughs Wellcome &
Co
1084,
1166a,
1176
Carlton Corp
1167
Coca-Cola Co
1188
Convention Press
1193
Desitin Chemical Co.
1163
Drug Specialties, Inc.
1170
Duvall Home
1189
General Electric Corp. .
1150
Highland Hospital, Inc.
1190
Hill Crest Sanitarium
1194
Lakeside Laboratories ...
1073
Lederle Laboratories ....
1078a, 1168,
1169,
1171
1177,
1180,
1181
Eli Lilly & Co
1088.
1153
Medical Protective Co.
1166
• Medical Supply Co 1186
• Merck Sharp & Dohme 1074, 1075, 1157, 1164
1165, 1184, 1185, 1187
• Miami Medical Center 1195
• Parke-Davis & Co. 2nd Cover, 1071
• Piedmont Auto & Truck Rental, Inc 1078
• Precision Instruments 1150
• Reed & Carnrick 1156
• Riker Laboratories, Inc. . Third Cover
• A. H. Robins & Co 1160, 1161
• Roerig & Co 1076, 1083, 1159, 1173
• Sanborn Company 1079
• Schieffelin & Co 1166
• Schering Corp. 1080, 1081, 1087
• G. D. Searle Company 1077, 1149
• Smith, Kline & French Labs. Back Cover
• E. R. Squibb & Sons 1082, 1151, 1155
• Surgical Supply Co. . 1172
• Tucker Hospital, Inc 1191
• S. J. Tutag & Co 1178
• Upjohn Co 1174a
• U. S. Brewers Foundation 1154
• Wallace Laboratories 1085, 1182, 1182a
• Westbrook Sanatorium 1194
• Wine Advisory 1183
• Winthrop Laboratories, Inc. 1162
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY LOOK PRINTING
PUBLICATIONS -ft BROCHURES
Convention
PRESS ^ *
2 18 West Church St.
) AC k s o n v i i, i. is , F i. o it II) A
Allens Invalid Home
MILLEDGEVILLE, GA.
Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 6()0 Acres
Buildings Brick Fireproof
Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
1194
Volume X I.I V
Number 10
Westbroo\ Sanatorium
Rl CHMO N D
CstabUsIwd b)ll
VIRGINIA
A. private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy— for nervous
and mental disorders and problems of
addiction.
atujj
PAUL V. ANDERSON, M.D., President
REX BLANKINSHIP. M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
A / edi cal Di rector
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CH \RLES A. PEACH EE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and Views Sent On Request - l\ O. Box 1514 • Phone 5-3245
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1151
LORI OA M.A.
il, 1958
SCHEDULE OF MEETINGS
1195
OR GANIZATION
rida Medical Association
rida Medical Districts
i-Xorthwest
[-Northeast
'-Southwest
)-Southeast
rida Specialty Societies
idemy of General Practice
■rgy Society
.'sthcsiologists, Soc. of
?st Phys., Am. Coll., Fla. Chap,
matology, Soc. of
ilth Officers’ Society
lustrial and Railway Surgeons
ernal Medicine
and Gynec. Society
lithal. & Otol., Soc. of
Itopedic Society
hologists, Society of
liatric Society
Stic & Reconstructive Surgery
ictologic Society
chiatric Society
liological Society
geons, Am. Coll., Fla. Chapter
logical Society
rida—
lasic Science Exam. Board
Hood Banks, Association
Hue Cross of Florida, Inc
Hue Shield of Florida, Inc
iancer Council
Diabetes Assn
Dental Society, State
lea it Association
lospilal Association
dedical Examining Board
dedical Postgraduate Course
'lurse Anesthetists, Fla. Assn.
'Jurses Association, State
’harmaceutical Assoc., State
’ublic Health Association
'udeaii Society
I uliemilosis & Health Assn.
Voman’s Auxiliary
lerican Medical Association
k.M.A. Clinical Session
it hern Medical Association
hama Medical Association
argia. Medical Assn, of
F,. Hospital Conference
ithcastern Allergy Assn,
itheastern, Am. Urological Assn,
itheastern Surgical Congress
If Coast Clinical Society
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Donald F. Marion, Miami
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax
Mr. C. DeWitt Miller, Orlando
Russell B. Carson. Ft. Lauderdale
Ashbcl C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax.
Howard M. DuBose, Lakeland
DeWitt C. Daughtry, Miami
Mrs. Perry D. Melvin, Miami
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City .
John A. Martin, Montgomery
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
T. O. Morgan. Gadsden, Ala.
Lee Sharp, Pensacola
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota ...
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Nathan J. Schneider, Jax.
Frank Cline Jr., Tampa
Mrs. R. H. McIntosh, Port St. Joe
Mrs. Wendell J. Newcomb, Pensa.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon. Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
J. J. Baehr Jr., Pensacola
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Miami Beach, May 1958
77 77 77 77
77 77 77 77
»* 77 J > 77
Miami Beach, April 19-20, ’58
Miami Beach, May 1958
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
77 77 77 77
Miami Beach, May 11, ’58
Miami, June 7, 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
77 77 77 77
Miami Beach, May 18-21, ’58
Miami, Apr. 25-26, ’58
June 29, 1958
Jacksonville, May 18-21, ’58
Clearwater, April 25-26, ’58
Miami Beach, May 10-14, ’58
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Montgomery, Apr. 17-19, ’58
Macon, April 27-30, ’58
Miami Beach, May 14-16, ’58
Pensacola, Oct. 23-24, ’58
MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 — 9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin, Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
Information on request
Memoer American Hospital Association
1196
Volume XLIV
Number 10
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
WILLIAM C. ROBERTS, M.D., President ..Panama Cily
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy.-Treas. . . .Jacksonville
SHALER RICHARDSON, M.D., Editor . .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama Cily
EUGENE G. PEEK JR., M.D. ..AL-58 Ocala
GEORGE S. PALMER, M.D.. A-58 Tallahassee
CLYDE O. ANDERSON, M.D.. .C-59 Si. Petersburg
REUBEN B. CHRISM AN JR., M.D.. D-60. .Coral Gables
MEREDITH MALLORY, M.D.. .B-61 Orlando
JOHN D. MILTON, M.D...PP-58 Miami
FRANCIS H. LANGLEY, M.D...PP-59 Si. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) . .Jacksonville
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm AL-58
HENRY L. SMITH JR., M.D. A 58
Gainesville
JOHN J. CHELEDEN, M.D. B-58
tOHN M. BUTCHER, M.D. C-58
PAUL G. SHELL, M.D. D-58
Fort Lauderdale
GRETCHEN V. SQUIRES, M.D. A 59
HENRY L. HARRELL, M.D. B-59
JAMES R. BOULWARF. JR., M.D. C 59
RALPH M. OVERSTREET JR., M.D. D 59
MERRITT R. CLEMENTS, M.D. A-60
ROBERT F.. ZELLNER, M.D. B 60
W. Palm Beach
Tallahassee
Orlando
whitman c. McConnell, m.d. C 6o
St. Petersburg
RALPH S. SAPPENFIELD, M.D. 1) 60
HAROLD F.. WAGER, M.D. A 61
CHARLES F. McCRORY, M.D. B 61
JOHN S. STEWART, M.D. G-61
Jacksonville
Fort Myers
DONALD F. MARION, M.D. D 61
Miami
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm AL-58 ...Jacksonville
1 It AZIER J. PAYTON, M.D D-58 Miami
BARCLEY D. RHEA, M.D A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D B 61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm D 58 Coral Gables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D A 60 Tallahassee
J. K. DAVID JR., M.D B 61 Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm AL-58 Orlando
WILLIAM W. TRICE JR„ M.D C-58 _ Tampa
JOHN V. HANDWERKER JR., M.D D-59 Miami
WALTER C. PAYNE JR., M.D A-60 Pensacola
W. DEAN STEWARD, M.D B 61 Orlando
CONSERVATION OF VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orlando
HUGH E. PARSONS, M.D C-58 Tampa
CHARLES C. GRACE, M.D B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D D 61 W. Palm Beach
S. CARNES HARVARD, M.D., Chm AL-58 ...Brooksville
First — ALPHEUS T. KENNEDY, M.D 1-58 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2-59 Tallahassee
Third— LEO M. WACHTEL, M.D. 5 58 Jacksonville
Fourth — DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D. 5-59 Sarasota
Sixth— GORDON II. McSWAIN, M.D 6-58 Arcadia
Seventh — RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
EOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D., Chm Orlando
THOMAS H. BATES, M.D “A” Lake Citv
FRANK L. FORT, M.D “B” Jacksonville
ALVIN L. MILLS, M.D “C” St. Petersburg
JOHN D. MILTON, M.D '•D" Miami
BLOOD
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm W. Palm Beach
FRANCIS H. LANGLEY, M.D St. Petersburg
JOHN I). MILTON, M.D. Miami
DUNCAN T. McEWAN, M.D Orlando
ROBERT B. McIVER, M.D Jacksonville
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 W. Palm Beach
GEORGE H. GARMANY, M.D. A 61 Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY, M.D. (Ex Officio) Jacksonville
MATERNAL WELFARE
JAMES N. PATTERSON, M.D., Chm C 61
LEO E. REILLY, M.D. AL-58
Rt >B1 i: I B. McIVER, M.D B-58
GRETCHEN V. SQUIRES, M.D. A 59
DONALD W. SMITH, M.D. D 60
Tampa
Panama C.its
Jacksonville
Pensacola
Miami
E. FRANK McCAI.L, M.D., Chm B-60 Jacksonville
WILLIAM C. FONTAINE, M.D AL 58 Panama City
J. LLOYD MASSEY M.D A-58 Quincy
RICHARD F. STOVER, M.D. D-59 Miami
S. L. WATSON, M.D C.61 ..Lakeland
J. Florida M.A.
April, 1958
1197
MEDICAL ECONOMICS
ROBERT E. ZELLNF.R, M.D., Clint AL.58 Orlando
DEWITT C. DAUGHTRY, M l) D-58... Miami
S. CARNES HARVARD, M.D. C-59 Brooksville
MERRITT R. CLEMENTS, M.D. A 60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm B 60 Gainesville
FRANZ H. STEWART, M.D AL-58 Miami
DONALD F. MARION, M.D D-58 Miami
RICHARD REESER JR., M.D C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D A-61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
FALL I. COUGHLIN, M.D. AL 58 Tallahassee
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. 15 60 Gainesville
RAYMOND B. SQUIRES, M.D. A 61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassge
HENRY H. GRAHAM, M.D. B-58 Gainesville
JAMES N. PATTERSON, M.D C-61 Tampa
EDWARD W. CULLIPHER, M.D D-59 Miami
HOMER F. MARSH, Ph.D Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD., Chm. A-60 Chattahoochee
NELSON H. KRAEFT, M.D AL-58 Tallahassee
WILLIAM L. MUSSER, M.D B-58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D D-61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. B-61 Jacksonville
HENRY I. LANGSTON, M.D AL-58 Apalachicola
JOHN G. CHESNEY, M.D D 58 Miami
HAWLEY H. SEILER, M.D C-59 Tampa
HAROLD B. CANNING, M.D. A 60 Wewahitchha
Special Assignment
1. Diabetes Control
VENEREAL DISEASE CONTROL
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm B-59 Jacksonville
LEO M. WACIITEL, M.D AI.-58 Jacksonville
C. FRANK CHUNN, M.D. C-58 Tampa
WILLIAM I). CAWTHON, M.D. A-60 DcFuniak Springs
V. MARKLIN JOHNSON, M.D D 61 W. Palm Beach
MENTAL HEALTH
SULLIVAN G. REDELL, M.D., Chm B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D AL-58 Pensacola
J. LLOYD MASSEY, M.D A- 5 8 Quincy
W. TRACY HAVERFIELD, M.D D-59 Miami
MASON TRUPP, M.D C 60 Tampa
NECROLOGY
J. BASIL HALL, M.D., Chm AL-58 Tavares
WALTER W. SACKETT JR., M.D D-58 Miami
LEO M. WACIITEL, M.D B-59 Jacksonville
ALVIN I.. STEBBINS, M.D A 60 Pensacola
RAYMOND II. CENTER, M.D C-61 Clearwater
NURSING
THOMAS C. KENASTON, M.D., Chm B-59 Cocoa
CARL M. HERBERT, M.D. AL-58 Gainesville
HERBERT L. BRYANS, M.D. A-58 Pensacola
NOI1VAL M. MAR11 SR., M.D. C-60 St. Petersburg
JAMES R. SORY. M.D D 61 VV. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B-59 Jacksonville
JOHN J. BENTON, M.D AL-58 Panama City
GEORGE S. PALMER, M.D A-58 Tallahassee
EDWARD W. CULLIPHER, M.D D 60 Miami
FRANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
PASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
WILLIAM 1. HUTCHISON, M.D. AL-58 Tallahassee
CHAS. L. FARRINGTON, M.D C-58 St. Petersburg
THOMAS N. RYON, M.D. D-59 Miami
RAYMOND R. KILLINGER, M.l). B-61 Jacksonville
Special Assignment
1. Industrial Health
C. W. SHACKELFORD, M.D., Chm A 61 Panama City
FRANK V. CHAPPELL, M.D AL 58 Tampa
A. BUIST LITTERER, M.D. D-58 Miami
LINUS W. HEWIT, M.D C-59 Tampa
LORENZO L. PARKS, M.D B 60 Jacksonville
WOMAN’S AUXILIARY ADVISORY
MERRITT R. CLEMENTS, M.D., Chm A 60 Tallahassee
JOHN H. TERRY, M.D. AL-58 Jacksonville
WILEY M. SAMS, M.D D-58 Miami
G. DEKLE TAYLOR, M.D. B-59 Jacksonville
CHARLES McC. GRAY, M.D. C-61 Tampa
A.M.A. HOUSE OF DELEGATES
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Tort Lauderdale
(Terms expire Dee. 31, 1959)
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 - Jacksonville
JULIUS C. DAVIS, M.D., 1930.™ Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT B. McIVER, M.l)., 1952 Jacksonville
FREDERICK K. HERPEL, M.D., 1953 IV. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
JOHN 1). MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
r
1198
Volume XI. IV
Number 10
I
and more
for Rauwiloid IS better tolerated...
"alseroxylon [Rauwiloid] is an anti-
hypertensive agent of equal therapeutic
efficacy to reserpine in the treatment
of hypertension, but with significantly
less toxicity.”
Ford, R. V., and Moyer, J. H.: Rauwollia
Toxicity in the Treatment of Hypertension,
Postgrad. Med. 23:41 (Jan.) 1958.
for three years
Many such hypertensives
have been on
No Tolerance Development
Lower Incidence of Depression
Rauwiloid
ALSEROXYLON, 2 MG
just two tablets
at bedtime
After full effect
one tablet suffices
For gratifying Rauwolfia response
virtually free from side actions
When more potent drugs are needed, prescribe
Rauwiloid® + Veriloid®
alseroxylon 1 mg. and alkavervir 3 mg.
for moderate to severe hypertension.
Initial dose 1 tablet t.i.d., p.c.
Rauwiloid® + Hexamethonium
alseroxylon 1 mg. and hexamethoniom chloride dlhydrate 250 mg.
in severe, otherwise intractable hypertension.
Initial dose '/•> tablet q.i.d.
Both combinations in convenient single-tablet form.
2
iCW YORK A C /* D C V» V OF
WGD !C S ME
> E 503RD ST
MFW YORK N V 29
in G.l. disorders
‘Compazine’ controls tension
—often brings complete relief
In such conditions as gastritis, pylor-
ospasm, peptic ulcer and spastic
colitis, ‘Compazine’ not only re-
lieves anxiety and tension, but also
controls the nausea and vomiting
which often complicate these
disorders.
Physicians who have used ‘Com-
pazine’ in gastrointestinal disorders
— often in chronic, unresponsive
cases — have had gratifying results
(87% favorable).
Smiih 1 line & rend' Laboratories , Philadelphia
Compazine
the tranquilizer and antiemetic
remarkable for its freedom from
drowsiness and depressing effect
Available: Tablets, Ampuls, Multi-
ple dose vials, Spansule* susu ned
release capsules, Syrup and Sup-
positories.
*T.M. Reg. U.s. Pat. Off. for prochlorperazine, S.K.F.
</<
OF THE FLORIDA MEDICAL ASSOCIATION
Vol. XLIV
OFFICIAL PUBLICATION OF THE
FLORIDA MEDICAL ASSOCIATION
THIS 5-YEAR STUDY SHOWS...
CONTINUED EFFICACY
m n maj hi h ^*21
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
Recent reports comparing the effectiveness of various antibiotics against
commonly encountered pathogens indicate that CHLOROMYCETIN (chlor-
amphenicol, Parke-Davis) has maintained its high degree of effective-
ness.1-5 It is still highly active against many strains of staphylococci,1-8
streptococci,2,7 pneumococci,2 and gram-negative1,2,7,9,10 organisms.
CHLOROMYCETIN is a potent therapeutic agent, and because certain blood dyscrasias
have been associated with its administration, it should not be used indiscriminately or
for minor infections. Furthermore, as with certain other drugs, adequate blood studies
should be made when the patient requires prolonged or intermittent therapy.
REFERENCES: (1) Roy, T. E.; Collins, A. M.; Craig, G., & Duncan, I. B. R.: Canad. M.AJ.
77:844 (Nov. 1) 1957. (2) Schneierson, S. S. J. Mount Sinai Hosp. 25:52 (Jan. -Feb ) 1958. (3) Koch, R.,
& Donnell, G.: California Med. 87:313, 1957. (4) Waisbren, B. A., & Strelitzer, C. L.: A Five-Year
Study of the Antibiotic Sensitivities and Cross Resistances of Staphylococci in a General Hospital, paper
presented at Fifth Ann. Symp. on Antibiotics, Washington, D. C., Oct. 2-4, 1957. (5) Doniger, D. E., &
Parenteau, Sr. C. M.: J. Maine M. A. 48:120, 1957. (6) Royer, A.: Changes in Resistance to Various
Antibiotics of Staphylococci and Other Microbes, paper presented at Fifth Ann. Symp. on Antibiotics,
Washington, D. C., Oct. 2-4, 1957. (7) Hasenclever, H. E: J. Iowa M. Soc. 47:136, 1957. (8) Josephson,
J. E., & Butler, R. W.: Canad. M.A.J. 77:567 (Sept. 15) 1957. (9) Rhoads, E S.: Postgrad. Med. 21:563,
1957. (10) Holloway, W. J., & Scott, E. G.: Delaware M. J. 29:159, 1957.
PARKE, DAVIS & COMPANY - DETROIT 32, MICHIGAN
IN VITRO SENSITIVITY OF FOUR COMMON PATHOGENS
TO CHLOROMYCETIN FROM 1952 TO 1956*
(sis strains)
strains)
(749 STRAINS)
(455 STRAINS)
<296 strains)
(91 STRAINS)
(128 STRAINS)
(106 strains)
<87 strains) i oo%
(66 strains)
(46 STRAINS)
(72 STRAINS)
(36 STRAINS) ^■i[^^^^^■■|^■||^■■■■li^■^■■■■■■^■i^^■
(39 STRAINS)
(i4 strains) 64%
(55 STRAINS)
1955 (113 STRAINS) 25%
1954 (102 STRAINS) ■■^■H 15%
1953 (78 STRAINS) 17%
1952 (51 STRAINS) 29%
0 10 20 30 40 50 60 70 80 90 100
•Adapted from Roy and others.1 loaso-*
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
CONTENT S
Scientific Articles
Guiding Principles for Continuing Pediatric
Supervision of Children, Harold C. Stuart, M. D. 1219
The Pulmonary Manifestations of Hodgkin’s Disease,
Robert H. Nickau, M. D., and Robert J. Reeves, M. D. 1224
Puerperal Breast Abscess. Major Thomas D. Cook (MC) 1229
Asthma and Hay Fever Versus Spells of Asthma
and Hay Fever, Frank C. Metzger, M. D. 1231
Neuromuscular Reflex Therapy for Spastic Disorders,
Temple Fay, M. D. 1234
The Hospital Program in Florida, Alvin D. James 1241
Abstracts
Drs. Benedict R. Harrow, John M. Schultz, and William D. Futch 1244
Editorials and Commentaries
What Price Radiation? 1245
Annual Graduate Short Course Discontinued 1247
American Medical Association Annual Meeting San Francisco,
June 23-27 1248
Mount Sinai Hospital Postgraduate Seminar, Miami Beach,
May 22-25 1249
Florida Association of Blood Banks Annual Meeting,
Ponte Vedra Beach, June 7-9, 1958 1249
Mountaintop Medical Assembly, Waynesville, N. C., June 19-21 1249
An Impressive Record 1250
Another County Medical Society Employs Lay Executive Secretary 1250
General Features
Others Are Saying 1252
State News Items 1256
Component Society Notes 1270
New Members 1282
. Classified 1284
Obituaries 1290
Schedule of Meetings 1303
Florida Medical Association Officers and Committees 1304
County Medical Societies of Florida 1306
T his Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida. Price So. 00 a year: single numbers. 50 cenis. Address Journal of Florida
Medical Association, P.O. Box 2411, 735 Riverside Ave.. Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail-
ing a i special rate of postage provided for in Section 1103. Act of Congress of October 3, 1917: authorized October 16.
1918. Entered as second-class matter under Act of Congress of March 3, 1879. at the Dost office at Jacksonville.
Florida, October 23, 1924
J. Florida M.A.
May, 1 95S
1205
“Nocturia and orthopnea have disappeared since he’s
on NEOHYDRIN— and he’s edema-free when he
wakes in the morning.”
oral
organomercurial
NEOHYDRIN
BRAND OF CHLORMERODRIN
2491$
"Rheumatoid arthritis is a constitutional disease with symptoms affecting chiefly joints and muscles."1 "Pain
in the affected joint is accompanied by splinting of the adjacent muscles, with resultant ‘muscle spasm.' "*
Florida M.A.
Hay, 1958
1207
MEPR0L0NE is the only anti-
rheumatic-antiarthritic designed to
relieve simultaneously (a) muscle
spasm (b) joint-muscle inflammation
(c) physical distress ... and may
thereby help prevent deformity and
disability in more arthritic patients
to a greater degree than ever before.
SUPPLIED: Multiple Compressed
Tablets in bottles of 100, in three
formulas:
MEPROLONE-5— 5.0 mg. prednisolone,
400 mg. meprobamate and 200 mg.
dried aluminum hydroxide gel.
MEPROLONE-2— 2.0 mg. prednisolone,
200 mg. meprobamate and 200 mg.
dried aluminum hydroxide gel.
MEPROLONE-1— supplies 1.0 mg.
prednisolone in the same formula as
MEPROLONE-2.
1. Comroe’s Arthritis: Hollander, J. L., p. 149 (Fifth
Edition, Lea & Febiger, Philadelphia, Pa. 1953).
2. Merck Manual: Lyght, C. E„ p. 1102 (Ninth
Edition, Merck & Co., Inc., Rahway, N. J. 1956)
THE FIRST MEPROBAMATE PREDNISO LONETHERAPY
meprobamate to relieve muscle spasm
prednisolone to suppress inflammation
relieves both
muscle spasm
and joint inflammation
MERCK SHARP & D0HME Philadelphia 1, Pa.
Division of MERCK & CO., Inc.
rheumatoid arthritis
involves both
joints and
muscles
only
1208
Voi.UME XI. IV
Number II
SR is a cardiac patient. His doctor
put him on atarax because
it is an anti-arrhythmic and non-
hypotensive tranquilizer.
Other tranquilizers added to PN’s
g. i. discomfort (he has ulcers).
But now his doctor has him on
atarax because (4.) it lowers gas-
tric secretion while it tranquilizes.
Asthmatic JL used to have fre-
quent tantrums followed by acute
bronchospasm. Her family doctor
tranquilized her with atarax be-
cause it is safe, even for chil-
dren.
Senile anxiety and persecution
complex dogged Mrs. K. until her
doctor prescribed atarax Syrup.
/+« It tastes good, and it’s a per-
fect vehicle for Mrs. K’s tonic.
Dosage: Children, 1-2 10 mg. tablets or
1-2 tsp. Syrup t.i. d. Adults, one 25 mg.
tablet or 1 tbsp. Syrup q.i.d.
Supplied : 10, 25 and 100 mg. tablets, bottles
of 100. Syrup, pint bottles. Parenteral Solu-
tion, 10 cc. multiple-dose vials.
J. Florida M.A.
May, 1958
1209
COMPREHENSIVE VAGINITIS REGIMEN
Powder Insufflation
Tablet Insertion
Floraquin Rebuilds the Defense
Mechanism in Vaginitis
Combined, office and home treatment with Floraquin
provides a comprehensive regimen which encourages restoration
of the normal “acid barrier” to pathogenic infection.
Vaginal secretions normally show a high
degree of protective acidity (pH 3.8 to 4.4).
When this “acid barrier” is disturbed, growth
of benign Doderlein bacilli is inhibited and
that of pathogens encouraged. Floraquin not
only provides an effective protozoacide and
fungicide (Diodoquin®) destructive to path-
ogenic trichomonads and yeast, but also
furnishes sugar and boric acid for reestab-
lishment of the normal vaginal acidity and
regrowth of the normal protective flora.
Suggested Office Floraquin Insufflation
. . the vagina is treated daily by swab-
bing with green soap and water, drying and
insufflation of Floraquin powder.”*
Suggested Home Floraquin Treatment
“The patient is also issued a prescription
for Floraquin vaginal suppositories which
she is instructed to insert high into the vagina
each evening. On the morning following each
application of these suppositories, the patient
should take a vinegar water douche. . . .”*
A Floraquin applicator is supplied with
each box of 50 Floraquin tablets. G. D. Searle
& Co., Chicago 80, Illinois, Research in the
Service of Medicine.
♦Williamson, P.: Trichomonad Infestation, M. Times 84: 929
(Sept.) 1956.
1210
Volume XLIV
Number 11
New...
meprobamate
prolonged
release
capsules
Evenly sustain relaxation of mind and muscle
TWO MEPROSPAN CAPSULES IN THE MORNING
BELIEVE ANXIETY. TENSION ANO SKELETAL MU^
CLE SPASM THROUGHOUT THE DAY.
TWO MEPROSPAN CAPSULES AT BEOTIME
PROVIDE UNINTERRUPTED SLEEP THROUGH>
OUT THE NIGHT.
MEPROBAMATE IN PROLONGED RELEASE CAPSULES
maintains constant level of relaxation
minimizes the possibility of side effects
simplifies patient’s dosage schedule
Dosage: Two Meprospan capsules q. 12 h.
Supplied : Bottles of 30 capsules.
Each capsule contains :
Meprobamate (Wallace) 200 mg.
2-methyl -2-n-propyl- 1.3-propanediol dicarbamate
Literature and samples on request .
0 WALLACE LABORATORIES, New Brunswick, N. J.
*** TRAOE-MAfiH CME-6598-40
J. Florida M.A.
May, 1958
1211
r
And it is, oh, such fun!
And 1 am sure that we shall rue
The time when we are both
too old to play
The game of u Booh ”!
—EUGENE FIELD
r*
■■
© 1958, MEAD JOHNSON ft CO
You can specify
with confidence
Pablum Oatmeal is rich in Vitamin B
that reduces irritability while further-
ing growth and repair. Natural vitamin
and mineral content of oats is fortified
in Pablum Oatmeal. Babies love the
taste and smooth texture, too. For vari-
ety, baby can find his favorites among
all five Pablum Cereals . . .
the baby cereals made to pharma-
ceutical standards of quality — espe-
cially processed for extra smoothness
and lasting freshness.
PABLUM MIXED CEREAL • BARLEY CEREAL • RICE CEREAL • OATMEAL • HIGH PROTEIN CEREAL AND ASSORTED PAK
Division of mead Johnson & co., Evansville. Indiana •
manufacturers of nutritional and pharmaceutical products
1212
Volume XI. IV
Number II
Avoid “BOTTOM OF THE VIAL’’ reactions
Of the intermediate-acting insulins,
only Globin Insulin is a clear solution.
24-hour control for the majority
of diabetics
GLOBIN INSULIN
‘B. W. & CO.’’
Each cc. of Globin Insulin
— including the last one—
provides the same
unvarying potency.
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
J. Florida M.A.
May, 1958
1213
See anybody here you know, Doctor?
I’m just too much
AMPLUS
*
for sound obesity management
dextro-amphetamine plus vitamins
and minerals
I’m too little
STIMAVITE
stimulates appetite and growth
vitamins Bi, B6, B12, C and L-lysine
I’m simply two
OBRON
a nutritional buildup for the OB patient
OBRON@
HEMATINIC
when anemia complicates pregnancy
And I’m getting brittle
NEOBON
5-factor geriatric formula
hormonal, hematinic and
nutritional support
With my anemia,
I’ll never make it up
that high
ROETINIC
one capsule a day, for all treatable anemias
HEPTUNA® PLUS
when more than a hematinic is indicated
solve their problems with a nutrition product from
(Prescription information on request)
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
1214
Volume XI
Number 11
“the G-I tract
is the
barometer
of the mind...’’
Belbarb
soothes the agitated mind
and calms the G-I spasm
through the central effect
of phenobarbital and the
synergistic action of
fixed proportions
of natural belladonna
alkaloids on the
gastrointestinal tract.
20 years of clinical satisfaction
Belbarb No. 1; Belbarb No. 2; Belbarb Elixir; Belbarb-B; Belbarb Trisules
CHARLES C.<
& COMPANY, Richmond, Virginia
a new specific moniliacide micofur™ is combined with
— — — — 1 brand of nifuroxime
the established specific trichomonacide furoxone® in
■ ■ ' brand of furazolidone
T R I C O F u tfWw
VAGINAL SUPPOSITORIES AND POWDER
85% CLINICAL CURES* In 219 patients with either trichomonal vaginitis,
monilial vaginitis, or both, clinical cures were secured in 187.
71% CULTURAL CURES* 157 patients showed negative culture tests at 3
months’ follow-up examinations.
Simple two-step treatment swiftly brings relief and
control of vaginal moniliasis and trichomoniasis.
step 1 Office administration of Tricofuron vaginal powder
Applied by the physician at least once a week, except during menstruation.
(Micofur 0.5% [ anti 5-nitro-2-furaldoxime], the new nitrofuran fungicide, and Furoxone
0.1% in an acidic, water-soluble powder base). Plastic insufflator of 15 Gm., with 3
sanitary disposable tips. Also glass bottle of 30 Gm.
STEP 2 Continued home use to maintain moniliacidal-trichomonacidal
action : Tricofuron vaginal suppositories Employed by the
patient each morning and night the first week and each night thereafter —
through one cycle, especially during the important menstrual days.
(Micofur 0.375% and Furoxone 0.25% in a water-soluble base) [JQQJ Box of 24 bullet-
shaped suppositories, each hermetically sealed in green foil; with applicator. Box of 12
wedge-shaped suppositories without applicator.
•Combined results of 12 clinical investigators. Data available on request.
o2n
R
NITROFURANS— a new class of antimicrobials— neither antibiotics nor sulfonamides
EATON LABORATORIES, NORWICH, NEW YORK
Each double-layered Entozyme
tablet contains:
Pepsin, N.E 250 mg.
— released in the stomach from
gastric-soluble outer coating
of tablet.
Pancreatin, U.S.P 300 mg.
Bile Salts 150 mg.
—released in the small intestine
from enteric-coated inner
core.
A. H. ROBINS CO., INC.
Richmond 20, Virginia
Ethical Pharmaceuticals of Merit since 1878
As a comprehensive supplement to deficient natural
secretion of digestive enzymes, particularly in older
patients, ENTOZYME effectively improves nutrition by
bridging the gap between adequate ingestion and proper
digestion. Among patients of all ages, it has proved help-
ful in chronic cholecystitis, post-cholecystectomy syn-
drome, subtotal gastrectomy, pancreatitis, dyspepsia,
food intolerance, flatulence, nausea and chronic nutri-
tional disturbances.
For comprehensive digestive enzyme replacement-
need not rely on "wishing”
ENTOZYME
pp^
ms
. Robinson, H. M„ Jr.; Robinson, R. C.
Cohen, M. M.: U.S. Armed Forces M. Ji
. Oanizurcs, ().; Shatin, II., and Koscnb}
Med. 55:35K3. 1955.
.Sternberjr, T. II., and Newcomer, V.J
Treat, tf : 1 102, 1955.
.Baer, R. L.: J. M. Soc. New Jersey SJ
. Lane, C. W.: Postgrad. Med. IS: 218, 1*
.Goldman, L., and Preston, R.: “Meti*;
son Ivy Dermatitis, to be published. <
l. Mathewson, J. B.: New York J. Med. Si
. Noojin, R. O.; South. M. J. 49:149, 19
:. Goldman. L.; Flatt, R.. ami Baskets
. Frank, J
. Mullini
H. M.
. Weidmai
71: 58, IS
METI-DERM Cream 0.5G
Neomycin, 10 Cm. tubes.
and
(1) Noojin, R. O.: South. M. J. 49:149,1
ifiS :1379, 1956. (3) Goldman, L.; Flatt, J
-*••>: 75, 1955. (4) Frank. L., and Stritzier,-
(5) Robinson, R. C. V., and Robinson, if
(6) Canizares, 0.; Shatin, H., and Rosenj
1955.
I
*
of alk
-with I
:mic abs
javy del
indetini
der
e to
Dei
WANTED
BY ALL DERMATOLOGISTS
A TOPICAL “MET!" STEROID PREPARATION FREE
FROM UNWANTED SENSITIZATION POTENTIAL
approximat
potency of t
no edema a
provides Me
form, .report
to be the mo
steroid thera
'active local r
ivy dermatd
ih gram
Eg. of |
Mti-Der
is^j*-brand o!
f&iONe/* br J
NAME
METI-DERM CREAM 0.5%
DESCRIPTION
5 mg. prednisolone, free alcohol, in each
gram — nonstaining, water-washable base —
exerts a therapeutic effect in presence of an
exudate without being occlusive.
supplied: 10 Gm. tube.
Meti-T.M. -brand of corticosteroids.
SCHERING CORPORATION • BLOOMFIELD, NEW JERSEY
N l>
STRONGEST
PACKAGING: Meti-Derm Cream 0.5%, 10 Gm. tube.
“METI”STEROID— PLUs|i
WHEN SCRATCHING <
Meti-Derm
N TOPICAL CREAM Meti-Derm Cream
allergic action in the affected area. No system!
lema and weight gain, have been reported wit)
IN SKIN RASHE
OR ALLERGY P
MET I -STEROID
NEW
Meti
1218
Volume XLIV
Number 11
E?
At the last accounting,1 physicians throughout the coun-
try had administered at least one dose of poliomyelitis
vaccine to 64 million Americans — all three doses to an
estimated 34 million. Undoubtedly, these inoculations
have played a major part in the dramatic reduction of
paralytic poliomyelitis in this country.
APR. MAY JUNE JULY AUG. SEPT. OCT. MOV. OEC
Incidence of polio in the United States, 1952-1957
(data compiled from U.S.P.H.S. reports)
vaccine is plentiful for the job remaining
There are still more than 45 million Americans under
forty who have received no vaccine at all and many
more who have taken only one gji*fWo\£loses.
As it was phrased in a
ment of Health, Edu;
“It will
apathyfvaccine
deat
the Depart-
of public
' alysis or even
lared to assist you and
*socieJ#To reach those individuals who
i. For information see your Lilly
Eli Lilly am
your local
still lack full p:
representative.
1. J. A. M. A.. 165:2/ (.November 23), 1957.
2. Department of Health, Education, and Welfare: News Release, October 10,
1957.
ELI LILLY AND COMPANY
849008
INDIANAPOLIS 6, INDIANA, U. S. A.
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIV Jacksonville, Florida, May, 1958 No. 11
Guiding Principles for Continuing Pediatric
Supervision of Children
Harold C. Stuart, M.D.
BOSTON
Pediatricians have an enviable record among
modern medical specialists for retaining the out-
standing assets of the old time family physician
while advancing in the forefront of modern scien-
tific medicine. These specialists are like general
practitioners in being personal physicians to chil-
dren and in having a strong interest in each
child’s family. They differ, first, in not providing
medical care for older members of the family,
and secondly, in utilizing more specialists’ serv-
ices for their patients in order to assure them
full advantage of the advances and skills of mod-
ern scientific medicine. In doing this they do not
or should not relinquish personal concern for the
total well-being of the child during these episodes.
At best, the pediatrician’s focus of interest is on
the child — the child in process of becoming a
man — in health and in illness and not merely on
the diseases which occur in childhood.
The pediatrician must be an expert in his
understanding of children and of what constitutes
health, age by age, in childhood, as well as in
disease as it manifests itself at each stage or age
period. Furthermore, since a child does not grow
and develop in isolation or in a vacuum, as Dr.
Wolf put it, the pediatrician must have knowl-
edge of and be sensitive to the impacts of the
family, the home, and the physical, social and
psychologic components of the community upon
the child, with particular reference to his health
and development. This is a large order but a
challenging and fascinating one. It disturbs me
sometimes to have former students in pediatrics
return and talk about their practice in a rather
gloomy way, saying they never see any of the
very interesting, rare or difficult diseases they
used to see in the hospital. Their practice gets to
be too routine, just seeing many children every
day and answering questions about common prob-
lems. To me, the opportunity of being a guide
Professor of Maternal and Child Health, Harvard Univer-
sity, School of Public Health.
Head before the Florida Pediatric Society, Fall Meeting,
C learwater, Nov. 1, 1956.
and counselor to those who are helping children
to grow and develop without unnecessary hin-
drances to a full and adequate maturity in the best
possible physical, mental and emotional health
should be interesting and satisfying to all who
like children. The opportunity to follow the same
child over long periods of time should create new
interests, and later on becoming the physician to
an adolescent can be extremely challenging.
At this hour I propose to discuss what I be-
lieve the pediatrician should be attempting to do
when he is following children periodically in his
practice and rendering what we call health serv-
ices, in addition to caring for them in illness. I
will not consider the goals in the care of the sick
child, but will simply point out that health serv-
ices are importantly related to the illnesses of
childhood and that the pediatrician is fortunate in
being able to provide both types of care and thus
to consider their interrelationships.
In discussing health services, I will state some
general principles which I believe should be kept
constantly in mind in dealing with well children.
Also, I will state some of the common character-
istics or principles which seem to govern the prog-
ress of growth and development in childhood.
Broad View of Child Health
My first principle is that we should take a
broad view of child health, that is, be concerned
with total health— physical, physiologic, mental,
and emotional. All of these aspects of health and
development have important interrelationships.
One cannot deal effectively with a feeding prob-
lem without considering many factors which have
led to its development. This broad view should
not only consider all aspects of the child himself
but should take into account as far as possible
the characteristics and attributes of the parents
and others in the family constellation, and many
aspects of the environment and care of the child
concerned. It requires considerable interest, un-
derstanding and experience to assure adequate
1220
STUART: PRINCIPLES FOR CONTINUING PEDIATRIC SUPERVISION
Volume XLIV
Number 11
knowledge of these related subjects, but this un-
dertaking is greatly facilitated by periodic con-
tacts and is contributed to greatly by adequate
interval histories and observant examinations.
Long Range View
My second principle is to take the long range
view and not to consider solely the immediate im-
plications of present problems or occurrences.
Oftentimes these are viewed as isolated events
which in reality are part of a galaxy of continu-
ous events with a common denominator. Poor
habits, constitutional weaknesses, and many other
factors which explain a child’s recurrent problems
are the things that one wants to recognize and
deal with and not just periodically provide pallia-
tive treatment or advice for momentary manage-
ment. As an example, consider accidents. The
treatment of the damage resulting from the acci-
dent is, of course, the first objective. It is often
important, however, to consider the cause, particu-
larly when a child has frequent accidents. Is it
because of carelessness, either on the part of the
parents or of the child himself? Is it due to some
physical disability or individual attribute, such as
lack of coordination, or is it lack of information
or awareness of what leads to accidents? Fur-
thermore, the fact that the child needs medical
treatment because of an accident makes this an
ideal time to raise these questions with mother
and child and to help them understand how to
avoid future accidents and what to do in case
they occur.
This long range type of thinking requires
cultivation on the part of the physician. The
young pediatrician has particular difficulty in
taking this view because of lack of experience
with individuals over long periods of time. Be-
cause of lack of facts we all have difficulty tak-
ing a position about the future significance of
many present findings. This is essentially why I
undertook 26 years ago to set up what we have
called longitudinal studies of child health and
development. The importance we attach to many
findings on physical examination or occurrences
reported in history taking depends upon whether
they are transient and will be outgrown or wheth-
er they are permanent attributes which will in-
fluence physical well-being throughout the individ-
ual’s life. Certainly this applies to obesity in
childhood and other subjects which we hope to
talk more about later.
Balanced View
The third principle I want to enunciate is
that each of us must maintain a balanced view of
all areas of health. This principle should be ap-
plied in respect to the relative importance of vari-
ous factors and to their present and future sig-
nificance. It involves avoiding riding our own
hobbies. It applies to every one of us, for we all
have our special interests and tend to forget the
importance of other things that have failed to
arouse our interest. It also involves avoiding
waves of popular interest and often requires con-
certed effort to broaden the mother’s interests,
helping her to avoid riding her hobbies. The
physician must frequently wean the mother away
from concentration on or obsession with some-
thing she thinks is important to the neglect of
other matters which may be of greater importance.
Educate Parents and Child
My fourth principle is that a continuing
objective should be to educate parents in matters
of child health and, later on, to educate the child
himself. This does not mean didactic instruction
but rather broadening of their understanding and
encouragement of their thinking for themselves
on the basis of accurate information. I believe
pediatricians can do a great deal to help parents,
most of whom want to give their children good
care. They want to understand their children and
meet their needs, and usually are so hungry for
this knowledge that they read all sorts of litera-
ture about children and their care. What they
read may be good, bad, or indifferent, but it must
be presented to them on the basis of children in
general, and not in any sense, of course, related
to their own child and his individual needs. It
seems to me that this service on the part of the
pediatrician involves chiefly explanation and
guidance, particularly as one takes the history
and carries out the examination.
The understanding of a child and his personal
characteristics and needs can only be conveyed
after the physician has acquired such an under-
standing for himself. Otherwise, it is the blind
leading the blind. This means that we should
try as a matter of habit to get to recognize the
child’s aptitudes, significant characteristics, and
so forth, through our history, examination, and
continuing record of events. Only then can we
undertake to convey to the parents such knowl-
edge of the characteristics of their own child
which will help them to do the best possible job
for him. This knowledge must be kept abreast of
J. Florida M.A.
May. 1958
STUART: PRINCIPLES FOR CONTINUING PEDIATRIC SUPERVISION
1221
the child’s changes with each stage of develop-
ment.
I have become tremendously impressed with
the serious attention which the adolescent will
give to the physician when he talks — and if he
talks to him at his level — as he takes the history
and conducts the examination. Dr. Wolf pointed
out that the adolescent is naturally interested in
himself. He will worry about the most minor
things, and he is eager to have someone whom he
respects and can talk with and ask questions
which he would not dream of asking his parents,
his peers, or his teachers. My own personal feel-
ing is that pediatricians make a great mistake
when they drop children whom they have been
following since birth, and know intimately, just
at the time when the child is going through the
rapid and confusing changes of pubescence and is
trying to become independent and yearning for
information about himself. If the break in this
relationship occurs at this time, it is not likely
that another doctor will be turned to for this pur-
pose for a long time.
Recognizing Intrinsic Assets and Liabilities
My fifth principle to some extent is an ex-
tension and implementation of those already dis-
cussed. It is that the physician, in taking histories
and carrying out examinations, should be alert to
recognize evidences of particular assets and liabili-
ties which appear to be intrinsic characteristics
with which the child will have to learn to live.
The former deserve cultivation whereas the latter
need to be dealt with in the most satisfactory way
to minimize handicaps. Body build, particularly
when extreme, has a great deal to do with a child’s
physical problems and physical requirements.
Size, pattern of growth, and particularly early or
late maturation have tremendous impact on the
older child. Constitutional weaknesses, which are
particularly troublesome in adolescence, should be
brought into the open and discussed at an ap-
propriate time. Many children enjoy far less phy-
sical fitness or general good health than their
potentialities would permit. This may be due to
a variety of faulty habits, such as physical in-
activity, excess of various sorts, or inappropriate
diet. Part of good health service includes recogni-
tion and differentiation of these, followed by ex-
planation and an attempt to motivate change.
Total Health Service for Handicapped Child
The sixth and final principle I want to mention
in this series may be stated thus: provide total
health service for the child with a specific defect
or disability, that is, for the crippled or otherwise
handicapped child. Obviously, for such a child
physical fitness and good general health are more
important than for the normal child. The trouble
is that the handicap often becomes a fixation for
mother, father, pediatrician, and other specialists
alike. A specific defect or crippling condition
usually leads to a variety of handicaps or related
special problems, all of which need attention as
well as the defect itself. In addition, such a child
may have any of the health problems of other
children which may be unrelated to his defect.
Not uncommonly a mother who has been secur-
ing periodic health supervision for a normal child
will discontinue this when a chronic disease or
other problem requires repeated visits to a spe-
cialist. The excuse that the care of the specific
problem required too much time and attention is
understandable but unfortunate if it leads to
neglect of other aspects of total health as, for ex-
ample, neglect of dental care. The pediatrician
can be most helpful in coordinating the long range
treatment of a disease or defect with the long
range consideration of the needs and best interests
of the child concerned from the broad standpoint
of health.
Growth and Development Principles
General Human Pattern. — Now I propose
to discuss a few principles derived from studies
of growth and development, which I believe de-
serve consideration in providing care for children.
First, there is a general human pattern for all
aspects of growth and development, many of
which are easily recognized and the manifestations
of which can be followed in individual children.
Childhood is characterized by constant changes
in a great variety of ways, and the changes which
will occur in any one period are broadly predict-
able. For the pediatrician, these changes are en-
compassed by the words growth, development and
adaptation. These processes progress according
to general expectancies at each stage of develop-
ment, and the pediatrician must know, in general,
what to expect of children at each stage. We
know that diseases manifest themselves in differ-
ent ways with different mortality and morbidity
rates at different ages, but the processes of adap-
tation apply to many other aspects of a child’s
health than the characteristics of illnesses. These
differences with age stem from several basic fea-
tures of childhood. The child is small, but con-
stantly is growing, though at different rates at
1222
STUART: PRINCIPLES FOR CONTINUING PEDIATRIC SUPERVISION
Volume XLIV
Number 11
successive periods, until in each aspect he has
reached mature size. Of course, these differences
in growth rates affect nutritional needs and other
health problems. The child is immature, but is
continually progressing toward greater maturity
in different ways and to different extents at suc-
cessive ages, so that at any one age, the liabilities
of his immaturity are different from those of
others.
Some age problems stem from the fact that
the child is ignorant and inexperienced, but he
is constantly learning and getting experience.
He actually learns through the normal everyday
experiences of life. As Dr. Wolfe pointed out,
if he does not get the satisfactions required from
these experiences, whether it be for love or phy-
sical activity or anything else, he will not progress
satisfactorily in this learning or become more
competent to deal with himself. Of course, as
he gets older he learns both through natural
experiences and through more formal education.
The stages of learning which he has passed
through and the opportunities for experiences
which he has had affect the likelihood of accidents
and many other aspects of his well-being.
We can say definitely that there is law and
order and predictability in the progress of the
child toward maturity; that natural laws deter-
mine in the main the changes which occur in the
child with time, and that these occur in expected
sequences. Certainly, before undertaking to pro-
vide care or give guidance for children, the pedia-
trician must know these general expectancies.
Physical growth is characterized by constant for-
ward progress, coming to an end in different parts
at different ages. In this respect few latent peri-
ods or retrogressive changes occur. In contrast,
mental, emotional and social development seem
to manifest periods of latency and retrogressive
change, and appear to be less ordered in progress.
Individual Differences in Normal Chil-
dren.— The second principle of growth and de-
velopment which we all recognize is that within
the broad frame of progress made by all normal
children, there are wide individual differences in
each and every aspect. The pediatrician particu-
larly must be familiar with the ways in which,
and the extent to which, normal individuals differ
between themselves, age by age. If it were not for
these individual differences, we could give all
mothers specific instructions and otherwise follow
standard practices for children of any given age.
Unfortunately, something like this approach is
being attempted by some today through the vari-
ous channels of mass communication. It is im-
portant to accept not only the principle that there
is a wide range of individual differences between
children at every age, but that these differences
have an important bearing upon nutritional and
other health needs — in fact, upon every aspect
of child care. This concept stresses the impor-
tance of recognition of a child’s individuality in
respect to growth, development and adaptation
in order to give advice and counsel appropriate
for him.
The characteristics of the distributions for
many attributes have been described for each age
and sex, based upon population studies. So-called
“norms” are available to serve as standards of
reference for evaluating individual children.
Such norms are useful in following the progress
of a child and in helping to recognize when he is
failing to maintain expected progress. Norms
are unfortunately thought of as means of distin-
guishing normality from abnormality. This mis-
conception, I think, comes from the use of a sta-
tistical word which has no such connotation.
Norms only point to abnormality in the extreme
when it usually is recognizable otherwise. Norms
used as standards of reference make it possible
to recognize some of the basic characteristics of
a child and help to define how unusual he is in
various attributes. For example, if a child’s
weight is at the third percentile, we can say that
he is exceptionally light for his age because not
more than three children in 100 would be expected
to weigh so little. If his height is also at the third
percentile, we can say that he is an exceptionally
small child but with an appropriate weight for
height. If his weight is at the third percentile but
his height at the fiftieth percentile, we would rec-
ognize that the weight was unusually light for a
child of average height and would seek for an
explanation in build, small muscles, lack of fat,
or other factors. This search might lead to the
conclusion that the child is quite normal with an
appropriate height-weight relationship for him on
the basis of his genetic characteristics. On the
other hand, it might suggest that there probably
are some dietary or environmental factors which
have been operative and account in some measure
for his light weight, and these would be sought.
The physician is tremendously aided in his at-
tempt to evaluate individual differences when he
has repeated contacts and suitable records at ap-
propriate intervals, for these permit him to rec-
J. Florida M.A.
May, 1958
STUART: PRINCIPLES FOR CONTINUING PEDIATRIC SUPERVISION
1223
ognize whether or not the child has been making
expected or consistent progress. In general, con-
sistent progress is more likely to result from con-
stitutional factors whereas abrupt or pronounced
changes in the course of progress suggest careful
search for environmental causes which may de-
serve attention.
Self Likeness at Successive Ages. — A third
principle in respect to growth and development
is that a child tends to be like himself at suc-
cessive ages. This characteristic is obviously be-
cause what he is like is so largely determined by
his genes. The child who has inherited a weak
potential for growth and a linear build will tend
to have small gains in height and weight year
after year, and will always, in health or illness,
appear thin and small in comparison with an-
other child endowed with a vigorous growth pat-
tern and with potential for stocky bones and
heavy muscles. Under conditions of chronic ill
health or consistently inadequate nutrition, the
latter may resemble the former in size and build.
In a single screening examination, unaccompanied
by adequate history, the basic differences be-
tween the two may be overlooked and both be
classified as representing faulty growth or nutri-
tion.
This principle provides a most important rea-
son for following the growth and development of
children periodically. It points up the advan-
tage in evaluating a child’s status by comparing
him with his former self and not solely with his
age group. The question which can be answered
with more assurance in the former than the latter
comparison is whether or not he is making con-
sistent progress according to expectancy for him.
Deviations from expected progress do not neces-
sarily indicate disease, faulty nutrition, or other
abnormality. When they are sudden and pronoun-
ced, however, they are much more likely to repre-
sent the results of environmental factors than uni-
que individuality in respect to normal progress.
Both methods of comparison have independent
values and should be carried out whenever possible,
notably as in the pediatrician’s office. Comparison
of a child with his peers in respect to age, race
and sex reveals status and points out clearly his
general attributes and any unusual characteristics.
Comparison with his former self reveals aspects
of progress and change. Both sets of information
have value for the physician who is attempting to
individualize his advice from the standpoint of
total health. I wish to avoid the implication that
change with time, as, for example, cross channel
progress on a percentile growth chart, is necessar-
ily an indication of abnormality. The natural de-
velopment of a pronounced type of build and a
change of pace when the adolescent cycle of
growth begins, are common aspects of genetically
determined progress. Sudden and pronounced
changes, however, in direction and speed of prog-
ress deserve careful consideration and usually
warrant search for environmental, dietary and not
infrequently psychologic causes.
A few slides were snown at the end of this
lecture to demonstrate the usual consistency in
progress of growth in children with widely differ-
ent characteristics of size, build and speed of mat-
uration. For this purpose, percentile graphs were
used for height, weight, and amount of fat and
of muscle tissue. Also, a chart with skeletal age
in the hand plotted against chronologic age was
used to indicate individual consistencies but inter-
personal differences in the speed of skeletal mat-
uration. It was pointed out that the latter char-
acteristic is highly correlated with the age of onset
of the rapid growth of adolescence and with
menarche in girls and secondary sex character
development in both sexes. Examples of unique
or deviate patterns of individual progress were
also shown.
The cases used in these demonstrations and in
a series of more detailed case studies presented at
two subsequent sessions were selected from a
series of about 135 children followed by the
speaker and his associates from birth to 18 years
under a series of periodic interviews and examina-
tions. This research was broad in the scope of
studies made and included much information
about the family background, course of pregnancy,
labor and delivery, dietary habits of mother, in-
fant and child, social and psychologic factors
operative at successive ages, illness experiences,
and the like.
This project has been operating over the past
26 years at the Harvard School of Public Health
under the general title of “Longitudinal Studies
of Child Health and Development.”
55 Shattuck Street 15.
1224
Volume XI. IV
Number 11
The Pulmonary Manifestations of
Hodgkin s Disease
Robert H. Nickau, M.D.*
AND
Robert J. Reeves, M.D.**
DURHAM, N. C.
Hodgkin’s disease, one of a group of diseases
classified as lymphoma, may have protean mani-
festations not only producing generalized symp-
toms such as fever, weakness, malaise, and loss in
weight, but also involving practically any tissue
of the body. The clinical picture which one most
commonly associates with this disease is lympha-
denopathy, especially in the cervical region, which
early in the disease may or may not be associated
with constitutional symptoms. In addition, there
has been noted involvement of the skin, bones,
intestinal tract, liver, spleen, pancreas, adrenals,
nasopharynx, muscles, central nervous system,
pericardium, gallbladder, thyroid, tonsil, and
genitourinary organs. In fact, any organ in the
body containing lymphoid elements may be affect-
ed. Pulmonary manifestations are the special
problem of interest in this report.
In an extensive review of Hodgkin's disease in
1948, Hoster, Dratman, Carver and Rolnick1
stated: “The lungs may be the primary site of
the disease. In the great majority of reported
cases, however, the pulmonary lesions are said to
be secondary to spread from other foci, directly
from mediastinal nodes or from more distant sites
by way of lymphatics or blood stream. It has
been postulated that the lesions vary according
to their mode of spread: if they result from direct
extension, they originate near the hila and extend
fanwise through the lobe of a lung. If brought
by the lymphatic stream, the lesions spread along
peribronchial and interlobar lymphatics; and if
the route is hematogenous, discrete nodules may
be found scattered throughout the lungs.”
Peirce, Jacox and Hildreth2 correlated the
clinical and radiologic findings of 198 cases of
Hodgkin’s disease. In 37.4 per cent of these
cases the chest was normal, and in 37.9 per cent
there was mediastinal or hilar glandular involve-
ment, in 13.6 per cent infiltration of the paren-
chyma of the lung, and in 1 1 per cent pleural in-
volvement.
* Former Trainee, American Cancer Society. Present ad-
dress, Lakeland, Fla.
"Professor and chairman, Department of Kadiology, Duke
University School of Medicine, Durham, N. C.
In a larger series, Vieta and Graver* noted
pulmonary infiltrations in 38.5 per cent of the
cases, isolated nodules in the lungs in 5.3 per cent,
and pleural effusion in 15.8 per cent. Reports,
however, range from only 16 cases of pulmonary
involvement in a series of 340 cases reported by
Castex, Pavlovsky and Valotta4 to Moolten’s
nine out of 18 cases coming to autopsy.5
Jackson and Parker0 found that 20 per cent
of patients with Hodgkin’s granuloma showing
pulmonary involvement have pleurisy with effu-
sion. Paterson and Paterson7 stated that involve-
ment of the lung is usually associated with pleural
effusion. The purpose of this report is to direct !
attention to the frequency of intrathoracic mani-
festations of Hodgkin’s disease other than the }
ordinary mediastinal and hilar adenopathies and II
their prognostic significance.
The most frequent symptoms produced by ll
pulmonary involvement are not distinctive from >
other pulmonary disease, being dyspnea, cough, I
fever, wheezing, aching chest pain, pleuritic pain,*
and sputum. We encountered no cases in which
hemoptysis was present. In several of our cases,*
however, the patient was asymptomatic when
the pulmonary lesions were first noted, only to
have symptoms develop subsequently.
As the symptoms are not distinctive, the roent- f
genologic findings are extremely variable. Many
types of lesions have been described, including i
radiating strands of peribronchial infiltration,
fine or coarse disseminated masses with ill-defined
edges, massive pneumonic infiltrations with or
without atelectasis, large round nodules resem-
bling metastases, miliary dissemination, tracheo-
esophageal fistulas, pleurisy with effusion, seg-
mental atelectasis, cavitation, endobronchial
tumors, and numerous other types.
The frequency of a mediastinal mass or dis- :
Crete hilar nodes in this disease is well recognized.
This type of process is similar to the adenopathy;
of the superficial nodes. A less frequently noted
intrathoracic manifestation is involvement of the
pulmonary parenchyma and pleura.
T. Florida M.A.
May, 1958
NICKAU AND REEVES: HODGKIN’S DISEASE
1225
Lymphoid tissue is abundant in the lung, be-
ing most prevalent along a peribronchial distribu-
tion, especially at the points of bifurcation of the
bronchi. Lymphoid tissue is also found in the
perivascular connective tissue while the subpleural
area is relatively devoid of it. The collections of
lymphoid tissue in the lungs are just as suscep-
tible as lymphoid tissue elsewhere to the etiologic
factor that causes Hodgkin’s disease.
At Duke Hospital, we reviewed 44 cases of
Hodgkin’s disease with roentgen evidence of pul-
monary parenchymal disease or of pleural effu-
sion. The cases were all proved pathologically,
and only those with complete records available
for study were used. Perhaps the relative propor-
tion of pleural and parenchymal cases is not true
as many of our older films were destroyed by fire.
Cases were used only if their roentgenologic find-
ings were unequivocally present. In four cases
both pleural and parenchymal disease was present
while in 22 there was pulmonary disease only and
in 18 pleural effusion only.
Classification
Instead of using purely descriptive terms, we
prefer to follow Hoster’s line of thought and di-
vide our classification into three main categories
with subcategories for the parenchymal disease
classified by the mode of extension:
1. Pleural involvement, which usually mani-
fests itself by pleural effusion. This is rarely
bloody.
2. Endobronchial lesions, which secondarily
may also produce tracheoesophageal fistulas, ate-
lectasis, or emphysema. Hurd8 and Vieta and
Carver3 reported bronchoscopic biopsies of ulcer-
ated plaques revealing Hodgkin’s disease.
3. Pulmonary parenchymal lesions.
a. Hematogenous dissemination producing
diffusely scattered nodules or a miliary type of
spread (figs. 1 and 2).
b. Lymphogenous spread resulting in linear
or feathery densities corresponding to the distri-
bution of the peribronchial lymphatics (figs. 3
and 4).
c. Direct contiguity from a pre-existing
focus of involvement in mediastinal or hilar nodes
with direct involvement of variable segments or
lobes of the lung. These often give the impression
of having broken through the retaining wall of
lymph node and directly invading the lung
(fig. S).
d. Wessler and Greene9 also described pri-
mary involvement of lymphatic collections in the
Fig. 1. — Widespread nodular lesions throughout the
lung fields, probably from hematogenous dissemination.
lungs. Estimates of the frequency of this primary
type of lesion have ranged from common to
extremely rare.
Kirklin and Hefke10 found 12 of 40 cases of
Hodgkin’s disease with pulmonary involvement,
but in only one of these were enlarged mediastinal
or hilar nodes lacking. Peirce, Jacox, and Hild-
V
Fig. 2. — Scattered nodules bilaterally with central
cavitation of several of the nodules.
1226
NICKAU AND REEVES: HODGKIN’S DISEASE
Volume XI.IV
Number 11
, . . , . Fig. 4. — More diffuse bilateral lymphogenous
Fig. 3. — Pine feathery lymphogenous spread to right J?
lower lung field. spreao.
reth,1 2 3 * however, found 20 per cent of their cases
of parenchymal disease without obvious node in-
volvement. It is difficult of correlation roentgen-
ologically, however, as the involved nodes may
be too small to be visualized. In all of our cases
with nodular involvement, this feature, appeared
to be related to the generalized involvement as in
none of these could we prove that the Hodgkin’s
disease was limited strictly to the lung.
We encountered several cases of lobar atelec-
tasis of the lung in our study, but it was thought
better to omit this category from our classification
on the grounds that this does not represent pri-
marily intrinsic disease of the lung but only the
secondary effect from the mediastinal and hilar
nodes. Endobronchial lesions may also cause
atelectasis; these rare cases should be included
under category 2. Moolten5 recorded a case
which at autopsy showed a massive polypoid en-
dobronchial mass to be the cause of atelectasis.
Table 1 shows the relative occurrence of the
different types in our cases.
Table 1. — Pulmonary Manifestations in a Series
of 44 Cases of Hodgkin’s Disease
1. Pleural 22
2. Endobronchial 0
3. Parenchymal 26
a. Hematogenous S
b. Lymphogenous 17
c. Direct contiguity 4
d. Primary in lung 0
Discussion
The results of the study of our series of cases
are summarized in table 2. Of the 44 cases, only
three occurred in Negroes. This represents a
significantly low figure in comparison to the gen-
eral white-Negro ratio of patients seen at Duke
Hospital. Some authors maintain that there is no
Fig. 5. — Large tumor mass in right lung field due
to direct extension from hilar nodes.
J. Florida M.A.
May, 1958
NICKAU AND REEVES: HODGKIN’S DISEASE
1227
Table 2. — Analysis of Series of 44 Cases
Pulmonary
Pleural
Both*
White
24
21
41
Negro
2
1
3
Male
13
16
26
Female
13
6
18
Oldest
62
64
Youngest
3
S
Average age
32
33
32
Average months between Hodgkin’s
disease and pulmonary lesions 23.8
29.5
27.2
Average months between pulmonary
lesions and death.
20.3
4.7
12.5
*Four patients had both pulmonary disease and massive
pleural effusion.
essential difference in the incidence among races,
but others assert the disease is definitely less com-
mon among Negroes. In a study of the cancer
incidence in Birmingham, Ala., Marcus11 found
the incidence of Hodgkin’s disease to be one and
one-half times greater in whites than in Negroes.
The sex distribution in the patients having
pulmonary disease was about even, but pleural
effusion developed in only six women as con-
trasted to 16 men. This is more in accord with
the accepted 2:1 or 3:1 male-female ratio in
Hodgkin’s disease.
The ages recorded were for the patients at the
time of onset of the pulmonary disease, not at
the onset of the Hodgkin’s disease. It is note-
worthy that the average age of the pulmonary
and pleural groups was essentially the same, be-
ing 32 and 33 years respectively. Our oldest pa-
tient was 64 years of age, the youngest three
years. This range confirms the general impression
that Hodgkin’s disease predominantly affects per-
sons of early and middle adult life, but childhood
and old age are not exempt.
Invasion of the lung may occur at any time
during the course of the disease or at any age.
Jackson and Parker0 demonstrated the appearance
of pulmonary lesions as early as one month after
the apparent onset of the disease and as late as
12 years afterward. It must be remembered, how-
ever, that unless frequent roentgenograms of the
chest are obtained during the course of the dis-
ease, it is difficult to judge the onset as these
lesions may cause only minimal symptoms at
first, which could be overshadowed by the gener-
alized symptoms or by the symptoms due to the
enlarged mediastinal nodes. In our cases, we
dated the onset of the Hodgkin’s disease to the
time in the history of the appearance of enlarged
nodes or to the onset of symptoms unquestionably
due to Hodgkin’s disease. The onset of the pul-
monary manifestation was timed with the first
roentgenogram giving positive evidence and not
by symptoms. There was a wide variation in the
relative time between the onset of disease and
the pulmonary and pleural involvement, ranging
from a case of pleural effusion in which the initial
manifestation was an acute pleuritic syndrome to
one in which the disease had been present 93
months prior to pulmonary findings. The average
time elapsed before parenchymal disease started
was 23.8 months while that for pleural effusion
was 29.5 months.
The extreme variability of the period of sur-
vival of patients with Hodgkin’s disease is widely
recognized. Jackson and Parker0 related prog-
nosis to histologic subgroups designated as Hodg-
kin’s paragranuloma, Hodgkin’s granuloma, and
Hodgkin’s sarcoma, the last being the most ma-
lignant. To those who believe this concept, this
might seem a logical way of explaining differences
in survival of various patients. In general, it is
thought that the development of pulmonary le-
sions is evidence of a more aggressive disease, a
fart which further darkens the prognosis. Hoster
and his associates1 listed pulmonary parenchymal
involvement as a factor associated with a poor
prognosis.
Our results do not seem to substantiate the
finding that pulmonary parenchymal disease in
itself is an ominous sign; instead, they indicate
that it is merely another manifestation of dis-
semination of the disease. It is no more serious a
sign than involvement of bone or generalized
adenopathy. We believe that the factors of most
importance in patients either with or without
pulmonary manifestations are the presence of
constitutional symptoms, such as fever, chills,
anorexia, loss in weight, and weakness, and also
the extent of the generalized dissemination of the
disease. In several of our cases the patient was
relatively asymptomatic when first seen and usual-
ly had a survival time after the onset of the pul-
monary disease of one to three years with one pa-
tient surviving as long as 85 months. The average
period of survival for our patients after the onset
of parenchymal disease was 20.3 months.
The onset of a recognizable pleural effusion,
however, was found to be an extremely poor
prognostic sign as the average length of survival
after its onset was 4.7 months in the cases fol-
lowed to death. There were two cases of pleural
effusion not followed to death, the first in a pa-
tient with involvement of the wall of the chest
1228
NICKAU AND REEVES: HODGKIN’S DISEASE
Volume XLIV
Number 11
and the ribs on the same side as the effusion.
This patient received considerable roentgen ther-
apy over this region with gross disappearance of
the involvement of the wall of the chest and of
the pleural effusion. This case probably repre-
sents a pleural effusion secondary to the disease
in the wall of the chest with only localized reac-
tion and not generalized pleural involvement.
When last seen, this patient had survived 141
months after the discovery of the pleural effusion
and was still in good condition. In the other
case, the patient has been followed for 18 months
and is in fair condition on chlorambucil.
The exceptional sensitiveness of lymphocytes
to ionizing radiation was established by many
early experiments. When the entire body of an
animal is exposed to irradiation, the spleen, lymph
nodes, thymus, bone marrow, and even the lymph
follicles of the intestinal tract show' a more or
less pronounced destruction of the lymphocytes,
and the degree of destruction is proportional to
the roentgen ray dose. This is well correlated with
the usual accepted clinical knowledge of the good
initial response of Hodgkin’s tissue to roentgen
rays.
In treating intrathoracic Hodgkin’s disease
Desjardins12 preferred irradiation generated by
moderate voltage rather than the 200 to 250 kv
that is usually used. Earlier, Desjardins, Habein
and Watkins13 reported a rapid response of lesions
of the lung to irradiation and at times they used
a therapeutic trial of roentgen rays in aiding in
the differential diagnosis of Hodgkin’s infiltrate
and tuberculosis. Later, however, Desjardins12
indicated “that the radiosensitivity of pulmonary
lesions in Hodgkin’s disease is distinctly less than
that of the peripheral and mediastinal foci. Never-
theless, the effectiveness of radiation therapy in
achieving a notable regression of pulmonary dis-
ease in a significant percentage of cases is in-
contestable.”
Scheinmel, Roswit and Lawrence14 noted in-
stances of favorable response in a majority of the
types classified, with the exception of the lymphog-
enous type of dissemination. They found, how-
ever, no logical means for predicting the response
of a specific lesion to therapy. Wolpaw, Higley
and Hauser15 recommended a dose of at least
1 ,000 r of deep roentgen therapy to each of the
anterior and posterior portals in pulmonary in-
volvement and they observed two cases in which
good temporary regression occurred. Jackson and
Parker'* not infrequently noted that mediastinal
masses entirely disappeared with irradiation while
the parenchymal lesions remained relatively un-
changed. Cantril1'* found x-radiation ineffective
and observed that chemotherapy at times will
give no more than a transitory regression without
any lasting benefit. He suggested the possible use
of radioactive gold or chromic phosphate in re-
ducing the pleural effusion in these cases.
Our experience in treating Hodgkin’s effusion
and parenchymal disease has been that irradiation
therapy over the pulmonary lesions has not been
satisfactory. The usual treatment was around
600 to 800 r tumor dose. With the smaller doses
the process frequently recurred. These same find-
ings were noted in patients treated with chemo-
therapy. The danger of intensive irradiation is
that of pulmonary fibrosis, which occurred in two
of our cases.
Conclusion
In such a small series of cases, any analysis
in regard to therapy of the pulmonary lesions is
of little value. One fact seems consistent, how-
ever. that when pulmonary manifestations appear,
the prognosis is not good because there is usually
widespread systemic involvement.
It was difficult to determine in all cases wheth-
er the pulmonary lesions might be lymphogenous,
hematogenous, or a direct extension of the disease.
References
1. Hoster, H. A.; Dratman, M. B.; Craver, L. F., and Rol-
nick, H. A.: Hodgkin’s Disease, Cancer Research 8:1-48
(Jan.); 49-78 (Feb.) 1948.
2. Peirce, C. B.; Jacox, H. W., and Hildreth, R. C. : Roent-
genologic Considerations of Lymphoblastoma; Roentgen Pul-
monary Pathology of Hodgkin’s Type, Am. J. Roentgenol.
36:145-164 (Aug.) 1936.
3. Vieta, J. O., and Craver, L. F. : Intrathoracic Manifesta-
tions of Lymphomatoid Diseases, Radiology 37:138-158
(Aug.) 1941.
4. Castex, M. R.; Pavlovsky, A., and Valotta, J.: Lesiones
pulmonares de la linfogranulomatosis maligna, Medicina,
Buenos Aires 2:117-139 (Jan.) 1942.
5. Moolten, S. E. : Hodgkin’s Disease of Lung, Am. J. Can-
cer 21:253-294 (June) 1934.
6. Jackson, Henry Jr., and Parker, Frederic Jr,: Hodgkin’s
Disease and Allied Disorders, New York, Oxford Univer-
sity Press, 1947.
7. Paterson, R., and Paterson, E. : Hodgkin’s Disease, Brit.
M. J. 2:1315-1318 (Dec. 4) 1954.
8. Hurd, L. M.: Early Hodgkin’s Disease in Which Endoscopy
Led to Diagnosis, Laryngoscope 32: 290-291 (April) 1922.
9. Wessler, H., and Greene, C. M.: Intrathoracic Hodgkin's
Disease, J. A. M. A. 74:445 (Feb. 14) 1920.
10. Kirklin, B. R., and Hefke. H. W. : Roentgenologic Study
of Intrathoracic Lymphoblastoma, Am. J. Roentgenol.
26:681-690 (Nov.) 1931.
11. Marcus, S. C.: Cancer Illness Among Residents of Bir-
mingham, Alabama, 1948, Cancer Morbidity Series 8, 1952,
Federal Security Agency, Public Health Service.
12. Desjardins, A. U. : Roentgen Treatment for Hodgkin’s Dis-
ease and Lymphosarcoma of Chest, Dis. of Chest 11:565-589
(Nov.-Dee.) 1945.
13. Desjardins, A. U. ; Habein, H. C., and Watkins, C. H.:
Unusual Complications of Lymphoblastoma and Their Radia
tion Treatment, Am. J. Roentgenol. 36:169-179 (Aug.)
1936.
14. Scheinmel, A.; Roswit, B., and Lawrence, L. R. : Hodg-
kin’s Disease of Lung; Roentgen Appearance and Thera-
peutic Management. Radiology 54:165-179 (Feb.) 1950.
15. Wolpaw, S. E.; Higley, C. S., and Hauser, H.: Intra^
thoracic Hodgkin’s Disease, Am. J. Roentgenol. 52:374-387
(Oct.) 1944.
16. Cantril, S. T.: Radiation Therapy in Management of
Lymphomas, Texas J. Med. 50:755-766 (Nov.) 1954.
Drawer 873, Lakeland (Dr. Nickau).
J. Florida M.A.
May, 1958
1229
Puerperal Breast Abscess
Report of a Small Epidemic
Major Thomas D. Cook, (MC), U.S.A.R.*
This report describes an outbreak of staphy-
lococcal puerperal breast abscess among the wom-
en delivered at a military hospital of medium
size having a large obstetric service. The United
States Army Hospital at Fort Bragg, N. C., is
rated as a 325 bed general hospital. Three thou-
sand and four women were delivered on its ob-
stetric service during the calendar year 1956.
Among the 1,843 women delivered during the
first eight months of 1956, nine were treated by
the surgical service for puerperal breast abscess.
This number amounted to slightly more than one
case per month for a usual incidence of 0.5 per
cent. In all of these cases the abscess was caused
by Staphylococcus aureus organisms showing con-
siderable heterogeneity.
Of the 1,161 women delivered during the last
four months of 1956, 36 were treated surgically
for puerperal breast abscess, averaging nine cases
per month for an incidence of 3.1 per cent. Only
one of the 215 women delivered during January
1957 required such treatment, suggesting a return
to the usual incidence. It is too early to com-
ment on February, but by the third week in
March only one of these 171 women had been
treated for breast abscess. In all of these cases
the abscess was caused by Staph, aureus organ-
isms showing great homogeneity.1
When the importance of this problem became
apparent in October 1956, the usual measures
were taken to eliminate sources of infection with-
in the hospital. Although several cases of staphy-
lococcal furunculosis and nasopharyngeal infec-
tion among the obstetric personnel were elimi-
nated, general sanitation improved and proper
breast care emphasized, these measures yielded
no apparent benefit. During the same time, a
great many other infections caused by the same
organism were seen in the clinics among persons
who had had no contact with the hospital jt its
personnel. It was slowly accepted that the offend-
ing organism must be widely disseminated among
the population served as well as prevalent within
the hospital.
*Present address, New Smyrna Beach, Fla.
From the Surgical Service of The United States Army Hos-
pital, Fort Bragg, N. C.
An incomplete study of the first part of the
epidemic disclosed that all of the patients had
breast-fed their children and suggested that the
trauma of nursing in the presence of a virulent
organism may be a precipitating factor for the
susceptible puerperal breast. Accordingly, breast
feeding was increasingly discouraged from the
first of December on. It is estimated that, as a
result, breast feeding fell from its usual level of
about 50 per cent to less than 5 per cent during
December, and remained at this new low level
for the period covered in this report. Allowing
for the onset lag, this decrease was followed by
what appeared to be a most gratifying decline
in the incidence of puerperal breast abscess, even
though the high incidence of other Staph, aureus
infections continued unabated. The .final study
showed that only eight of the 37 mothers in the
epidemic group denied nursing. Of these, at least
two were lactating at the time of treatment, and
two others had used a breast pump. Information
is lacking on one case. In the one case in which
delivery took place in January 1957, the patient
had nursed against advice.
The following table demonstrates the epidemic
nature of the outbreak and the assumed beneficial
effect of the reduction in breast feeding started
in December.
It was the impression of the staff that this
simple measure was largely responsible for re-
ducing the incidence to nonepidemic proportions.
In the epidemic group of 37 patients the lesion
was characterized by great homogeneity, both
clinically and bacteriologically. Twenty-eight,
or 75 per cent, had nursed for an average of 15.3
days, varying between two and 59 days. The
average age was 23 years. Nineteen had right-
sided involvement, 15 left, and three bilateral,
for a total of 40 abscesses. There were six recur-
rences. The initial onset of symptoms varied be-
tween seven and 84 days with an average of 18.9
days. Incision and drainage were carried out an
average of 10.2 days after onset, varying between
one and 32 days. Surgery for recurrence in the
same or other breast followed by as much as 75
days. Thirty-one of the patients were hospitalized
1230
COOK: PUERPERAL BREAST ABSCESS
Volume XI. IV
Number 11
Breast Abscess Patients by Month of Delivery
1,956 1957
Tan Feb. Mar. Apr. May June Julv Aug. Sept. Oct. Nov. Dec. Jan. Totals
0 0 .5 5 1 0 0 0 11 8 10 7 1 46
Epidemic 37
for an average of 6.4 days, varying between three
and 13 days, and followed in the clinic for an
average of 22.3 days. Six were treated solely as
outpatients for an average of 27 days. The total
duration of surgical care averaged 28.4 days each
for 35 patients.
All of the initial culture specimens grew
Staph, aureus in pure culture. All were hemol-
ytic. All but one were coagulase-positive among
the 36 tested. All but one fermented mannite, and
all were salt mannite resistant when tested (23
cases) .
Antibiotic sensitivities were determined on all
of these cultures using standard impregnated
paper rings manufactured by National Bio-Test,
Inc., and containing 1.5 units of penicillin, 1 meg.
of erythromycin, 10 meg. each of streptomycin,
Terramycin, tetracycline and Aureomycin, and
500 meg. of triple sulfonamide. All but one were
found sensitive to Chloromycetin. Twelve were
resistant to erythromycin. Only three each were
sensitive to streptomycin and Terramycin. One
was sensitive to penicillin and one to Aureomycin.
None were sensitive to triple sulfonamide or tetra-
cycline. In two instances subsequent cultures
showed the development of resistance to erythro-
mycin following therapeutic use of this drug.
Sixteen cultures were further tested for sensitivity
to 30 meg. of Albamycin, five to a like amount
of carbomycin, and nine to 2 meg. of Matro-
mycin. All of these proved sensitive.2
Treatment
Typically, these patients first presented them-
selves at the postnatal clinic with unilateral or
bilateral mastitis. Nonsurgical treatment includ-
ing an effective antibiotic, usually Chloromycetin,
cured an estimated one third. Only in those,
however, who were started on effective antibiotic
therapy very early in the disease, probably within
first three days and before suppuration had
occurred, could the process be thus aborted. In
the remainder, the lesion progressed to obvious
abscess formation despite such therapy.
Among those with abscesses, there was little
apparent difference in severity between those who
had been treated and those who had not been
treated. The rapidly progressive, extensive, in-
vasive abscesses with many loculations involving
multiple lobules were slower to heal and caused
more tissue destruction than the slowly develop-
ing, small, well demarcated, unilocular abscesses,
but this difference correlated poorly with anti-
biotic preparation and seemed far more a matter
of individual host response. Likewise, following
surgical drainage, antibiotic therapy with erythro-
mycin or Chloromycetin had little effect on either
the course of the particular abscess or the devel-
opment of subsequent abscesses. In short, once
a purulent process had developed, the only cura-
tive treatment was surgical drainage with anti-
biosis contributing but little assistance.
Inadequate surgery, usually due to too small
an incision or not opening into all the loculations,
especially when performed under inadequate local
anesthesia, led to chronicity and multiple sur-
gery. It was found best to work under general
anesthesia, make sure that all indurated areas
were broken into by digital exploration, insert
sizable unfilled Penrose drains into all the major
extensions, leave the drains in place for several
days to insure adequate sinus formation, and
keep the sinuses patent as long as necessary, pref-
erably by gloved finger. Where feasible, peri-
areolar or submammary incisions were preferred
to radial incisions for their superior cosmetic re-
sults. Warm saline compresses were of help in
keeping the sinuses patent, and many of the
patients reported that they gave excellent symp-
tomatic relief.
During this same period, eight newborn in-
fants were treated surgically for breast abscess.
Two of these were patients in the hospital at the
same time as were their mothers for puerperal
breast abscess. Culture and sensitivity reports
in these cases were, for all intent and purpose,
identical with those in the puerperal cases.
Summary
An epidemic of puerperal breast abscess is
reported and its clinical aspects discussed.
The prevalence of a virulent organism among
the population served, rather than contagion
within the hospital, is thought to have been the
primary cause.
T. Florida M.A.
May, 1958
METZGER. ASTHMA AND HAY FEVER
1231
The suspension of breast feeding is believed
to have been instrumental in curtailing the out-
break.
Staphylococcus aureus was grown in pure
culture in all cases, showed little variation from
case to case, and was uniformly resistant to most
antibiotics.
Despite in vitro sensitivity to some antibiotics,
these had little effect on the course of the dis-
ease once suppuration had developed. An effec-
tive antibiotic, if given early, may arrest the
antecedent mastitis.
The treatment of puerperal breast abscess con-
sists primarily of surgical drainage. Other meas-
ures are of adjuvant aid.
References
1. Colbeck, J. C. : Extensive Outbreak ol Staphylococcal In-
fections in Maternity Units; Use of Bacteriophage Typing
in Investigation and Control, Canad. M. A. J. 61:557-568
(Dec.) 1949.
2. Barber, M., and Burston, J.: Antibiotic-Resistant Staphy-
lococcal Infection: Study of Antibiotic Sensitivity in Re-
lation to Bacteriophage Types, Lancet 2:578-582 (Sept. 17).
1955.
Box 1597, New Smyrna Beach.
Asthma and Hay Fever Versus Spells
Of Asthma and Hay Fever
Frank C. Metzger, M.D.
TAMPA
During my practice of allergy, to the treat-
ment of which disease I have confined myself
exclusively for the past 22 years, my figures show
that a new patient has seen or been under treat-
ment by an average of five other doctors, and
consequently has had a lot of advice with which
I do not agree. Add to this the lay information,
misinformation and the patient’s own conclusions
or convictions and one can easily see the difficul-
ties I encounter.
There are a great many ideas presented with
which I do not agree, but the most common ones
can be boiled down to four or five, namely, and I
quote: “I never get asthma unless I get a cold,”
“Gases, smoke and any odors cause my asthma.”
“This or that food causes my asthma,” “A change
in weather, a cold spell, always causes me to have
a spell,” “My trouble is caused by dampness,” “I
have a sinus condition,” and “Antibiotics cure
some of my spells of asthma.”
“Colds”
Let me take these causes one by one and dis-
cuss them. The first and most frequent is “I get
a cold and then asthma.” Since the most common
manifestations of allergic shock are on the part
of the nose, chest and skin and since in the ma-
jority of cases the nose is affected first, one must
look upon the “colds” with a suspicious eye.
In taking an allergic history one finds that in
the majority of cases the nose showed the first
symptoms. Patients have allergic rhinitis or hay
fever before they have allergic, bronchitis. The
nose may have given them trouble for many years
before the asthma starts. Sometimes the period
is short, but it is rather rare to have a patient in
whom the asthma started first. If the doctor will
and can dig out these nasal symptoms, he will find
striking differences between them and those of an
acute coryza.
The average patient will describe all the clas-
sical symptoms of an allergic rhinitis, but still
calls it a “cold.” If such patients have it in the
summer, they are more inclined to call it hay
fever for the idea that hay fever can affect them
in winter has not as yet been accepted. So I hear
about “colds” lasting for an hour to many months.
Since the advent of antihistamines the picture
is further confused. These patients take some
antihistamines, and the “cold” is checked. Now
since colds seem to be due to bacteria or virus
organisms and allergic rhinitis is due to 1 sen-
sitivity to a nonbacterial or nonviral material, I
do not believe any one drug is going to be bene-
ficial to troubles both of infectious and nonin-
fectious origin.
Also, colds seem to be contagious; they run
through a whole family. Allergic rhinitis is not
contagious, although since it is frequently a fa-
milial affair, the same condition producing trouble
in one member of a family may do so in another
member. It looks like one “caught it from the
other,” thereby in the lay mind clinching the con-
viction that the trouble in question is contagious.
Few people will take this explanation. Even
when, after months of treatment of their allergy,
1232
METZGER: ASTHMA AND HAY FEVER
Volume XLIV
Number 11
one succeeds in stopping their nasal symptoms,
they, still report that the treatment has stopped
their “frequent or continuous colds.”
Careful experiments tend to show that an
actual “acute coryza” produces an immunity of
from three to four months. There is no reason
to assume that an allergic person may not con-
tract an acute coryza, but from my experience I
believe that in the big majority of the cases of
this type allergic rhinitis is followed by allergic
bronchitis and not “colds followed by asthma.”
Odors, Chemical Gases and Smoke
The second point is “odors, chemical gases and
smoke cause asthma.” I believe that this again
is a mistake. Asthma and hay fever, in my opin-
ion, are basically allergic in origin. I do think,
however, that a distinction should be made be-
tween asthma and hay fever and a spell of asthma
or hay fever. By that I mean that many allergic
persons may remain under their allergic tolerance
point for varying periods of time and consequent-
ly have no symptoms. In a spell, a combination
of allergy plus an irritant may cause an attack
which otherwise would not happen.
I classify an irritant as any substance which,
when contacted, will cause an irritation in at least
90 per cent of all persons. An allergen I classify
as a substance which, when inhaled or swallowed,
will cause trouble only in persons termed allergic,
about 7 to 9 per cent of the people. Thus a nor-
mal individual and an allergic one are subject to
dust on the road or elsewhere. Each will experi-
ence some irritation of the nasal and bronchial
mucous membrane, but the trouble is transient
and only bothersome to the normal person. In the
allergic one there is added to the swelling from
the allergy the normal swelling from the irritant,
and thus the two cause a complete stoppage of
the nose or bronchioles.
One cannot treat for outside dust or chemical
fumes. Avoidance, both for the normal and al-
lergic person, is the only method left. The same
reasoning holds for infections, usually chronic,
and for emotional factors. They do not cause
asthma or hay fever, but they can and do precipi-
tate a spell of either or both. A history of attacks
may lead one to determine that an irritant, infec-
tion or emotion may be the predominant factor,
or, in others, one may deduce that the allergen
was the big factor and the irritant was of little
importance.
I ntil a differentiation between allergens and
irritants and between asthma and hay fever and
spells of asthma and hay fever is made, one can
frequently make an error in treatment as well as
diagnosis.
Foods
Now I come to the foods “which cause my
asthma.” It is held by the majority of allergists
at the present time that the foods are minor ele-
ments in allergy in adults but most important in
children. Since this idea is relatively recent, it is
not a common belief. There are few adults in
whom I think that certain foods are big factors,
but these will show upon testing with the proper
material, and, I repeat, I find they are rather
rare. But when trying to explain this view to a
patient, one runs up against the widespread con-
victions and food phobias engendered in the pub-
lic by lay articles, television and radio advertise-
ments and the comments of friends. That the
emotion of fear or indecision regarding foods can
and does enter the picture and cause the trouble
and that it is not the foods is the most difficult
thing I encounter to explain to patients. Nearly
all of them are convinced that because “it happens
every time I eat that food,” it is conclusive evi-
dence to them that it is the food, and rarely can
one shake that conviction even in the face of a
negative test.
Having been faced with this reasoning so
many times, I look upon the terms “gastroin-
testinal allergy” with a rather dim eye, particu-
larly in adults.
Weather Changes and Dampness
“Changes in weather and dampness cause
asthma.” Mainly, this statement is true. A sud-
den cold spell will throw' many persons into tem-
porary spells of asthma and hay fever. This is
particularly true of the first cold spell and in de-
creasing degree during the following ones. Why
this happens or what changes take place in the
body which precipitate this trouble I do not know,
nor do I know anyone who does. It is one of the
unsolved problems in this disease of allergy.
Dampness, that is, an increase in relative humid-
ity, I do not believe is a cause, although it is
amongst the most numerous things to which peo-
ple ascribe their spells. With dampness comes
chill, and I believe it is the chilling of the body
and not the humidity which is to blame.
Let us consider a well known combination,
croup and the croup kettle. Now croup is an
allergic manifestation. A croup kettle, with or
without medication, would raise the relative hu-
midity in the room above 80 per cent and yet it
J. Florida M.A.
May, 1958
METZGER: ASTHMA AND HAY FEVER
1233
does relieve this spasm. Why then would a high
humidity help one allergic condition and make an-
other one worse? I do not think it does.
Now into this picture of change in tempera-
ture a large emotional element enters. This I
proved to my own satisfaction by the following
procedures. I took 14 patients who, while sitting
in my office, asked me to turn off my air condi-
tioner. I allowed them to sit in my outer offices,
which are not air-conditioned, while being tested
for from two to four hours. I noted the tempera-
ture out there. It was 82 degrees. I brought them
into my office. The air conditioner was going on
Fan. The temperature in the office was 82. Thir-
teen out of these 14 patients had spells of asthma
and hay fever within five minutes.
Sinus Condition
“I have a sinus condition.” At least nine out
of 10 who tell me this have made their own
diagnosis, or it has been made by a doctor with-
out a transillumination or roentgen examination.
They go on to describe a case of hay fever with-
out a single symptom which leads me to suspect
a sinusitis.
Antibiotics
Now I come to the use and abuse of anti-
biotics. Antibiotics should be used only in the
presence of an infection. With an infection there
is usually an elevation of temperature, aching and
a changed blood picture. As I have said previous-
ly, such a condition often acts as a complicating
or predominant element in spells of asthma and
hay fever, and in such cases their use is definitely
indicated. Antibiotics, however, do not affect
allergens, and when the spell ceases during their
use, it simply means that the infection was the
big factor in said spell, but unless this fact is
recognized, the next asthmatic patient gets anti-
biotics even though he has no infection. The
first I consider good use of antibiotics; in the
latter cases, it is misuse.
Ragweed and grass pollens, animal epidermals
and house dust are allergens, and they are not
affected by antibiotics. In cases in which they
are the sole or principal causes of the spells,
antibiotics should not be used.
Multiple “Allergies”
One frequently hears that a person has “two
or three allergies,” and this nomenclature is gain-
ing ground. Allergy, the basic disease, is singu-
lar. The manifestations or the organs which al-
lergy affects may be multiple, and the things to
which they are sensitized, namely, allergens, may
be numerous, but there is no such thing as al-
lergies. One might just as well speak of a person
having typhoid fevers.
My purpose in writing this paper is not to
present something new, but rather to emphasize
some well known facts and put a slightly different
interpretation upon them.
916 Citizens Building.
Dr. O. W. Hyman Is President’s Guest
At Eighty-Fourth Annual Convention
Dr. O. W. Hyman, of Memphis, Vice President of the University of Tennessee in
charge of Medical Units, is the guest of Dr. William C. Roberts, President of the
Florida Medical Association, for the Eighty-Fourth Annual Convention of the Associa-
tion.
The Convention begins Sunday, May 11, and ends Wednesday, May 14. It is
being held in the Americana Hotel at Bal Harbour.
Dr. Hyman will address the General Session Monday morning at 10:40 on the
subject “The Greatest Problem of Medical Education and Its Relation to Medical
Practice.”
1234
Volume XI. IV
Number 11
Neuromuscular Reflex Therapy for
Spastic Disorders
Temple Fay, M.D.
PHILADELPHIA
Physicians are all aware of the swiftly chang-
ing concepts that characterize our modern world
of science. Strangely enough, neurology, one of
our basic medical sciences, has lagged behind its
fellow specialties for lack of a dynamic therapy to
equal its symptomatic accuracy and its precisional
diagnostic screening.
A Withering Neurology
There are many who deplore the present trend
toward virtual extinction of the organic neurol-
ogist. In the recent past, much mixed patient
material has passed through the diagnostic screen-
ing clinics of the well trained neurologists. Ther-
apy and treatment have become secondary to diag-
nosis and classification. A static state of clinical
neurology has developed, dependent upon a few
drugs such as potassium iodide, the bromides and
Salvarsan. and even fewer physical measures of
benefit, such as hydrotherapy, massage and the
“rest cure.”
In the early nineteen thirties, a change began
to appear in the then already stagnant field of
psychiatry; Freudian analysis gained partial rec-
ognition. Metrazol, electric shock, carbon dioxide
and lobotomy stirred the members of the neuro-
psychiatric specialty and raised the dust from the
bones of many a revered authority, to sweep for-
ward into a clearer concept of mental disease and
establish a variety of dynamic therapies, now di-
rected toward the solution of a host of collateral
aspects, as well as to the problems surrounding
‘‘the mental state” and its response or behavior
to the social structure of a modern civilization.
About the same time there came about an
increase in the number of neurosurgeons, offering
better methods of visualization of the nervous
system through ventriculography and pneumoen-
cephalography, along with instrumentation, skills
and technics for relief and correction of many
organic lesions of the brain and spinal cord. This
direct and dynamic attack upon the acute and
subacute organic aspects of the neurologic field
weaned away a large number of patients who
Kcad before the Florida Society of Neurology and
Psychiatry, Annual Meeting, Hollywood, May 5, 1957.
formerly languished for lack of active therapeutic
consideration by the organic neurologist.
The diagnostic art of neurology became re-
placed by the mechanical processes of the operat-
ing room, the laboratory and the x-ray depart-
ment.
With the functional and organic clinical ma-
terial fading from his practice, the organic neurol-
ogist was forced to turn to the ever present syph-
ilitic, neuritic and chronic “gremlin” diseases,
only to find the dermatologist and chemotherapist
had successfully treated and appropriated the
syphilitic group and the druggists and the cults,
the neuritic group while lay organizations were
dictating the methods of treatment for the “cere-
bral palsied,” the multiple sclerotic, the dystro-
phic, the dyskinetic and retarded groups, formerly
classed as “hopeless,” and so long subjected to
the fate of the leper and the outcast of only a few
decades ago. The psychiatrist now has rightfully
laid claim to this long-neglected group.
The neurologists who had been trained in the
mathematically exact science of organic diagnostic
screening have only themselves to blame for their
smug complacency and the lack of a more dy-
namic therapy. The distractions produced by the
neurophysiologist and the experimental laboratory,
in seeking the answers to vital dynamic function
and the “why” of the nervous system, became a
welcome contrast to the static features of fixed
microscopic tissue pathology after death. This
drama of experimental research became so fasci-
nating that it overshadowed the purpose and the
life objectives for which the nervous system was
created, and the need for a rational and corrective
therapy to meet its demand.
The patient desired an answer for his handi-
cap. rather than a name or explanation as to the
functional disturbance of his parts.
The satisfaction of making a difficult diag-
nosis overshadowed the importance of successful
treatment. The describing and recording of a
new “reflex,” if by chance one had been over-
looked by the many other eager searchers before,
guaranteed immortality to the individual whose
name would then be placed upon it — “the back-
T. Florida M.A.
May, 1958
FAY: THERAPY FOR SPASTIC DISORDERS
1235
door to a neurological Valhalla,” Dr. Chas. K.
Mills used to call it. This feat or the discussion
of curious combinations of symptom complexes be-
came more absorbing than developing therapeutic
measures of relief, and almost completely domi-
nated the programs and meetings of the past. A
dynamic therapy for neurologic disease was almost
unthinkable.
Meanwhile, the patient, a suffering or handi-
capped human being, after being properly labeled,
was mentally catalogued along with former similar
specimens along the walls of the laboratory, given
a palliative program and advised to “try this and
that” type of therapy.
A Dynamic New Therapy
Into this static, reactionary and self-satisfied
atmosphere of withering neurology has recently
come a new and dynamic form of therapy. True,
it may be “too little and too late,” as the trend to-
day is to combine some other more active spe-
cialty with neurology, such as neuropsychiatry,
neurosurgery, neuropediatrics and neuro-opthal-
mology, recognizing the basic value of neurology,
but finding only a diagnostic or descriptive use
for it from a practical therapeutic point of view.
To the “die hards” and the reactionaries of
the Classic Age, a “reflex” is a “reflex,” and its
purpose is measured in terms of its present day
usefulness, such as drawing up the leg when you
step on a tack (reaction of defense), or pulling a
quadrant of the abdomen to the side, when you
scratch around the umbilicus. The purpose of
this latter movement is not quite clear, but “that
is what happens in most people unless they have
multiple sclerosis, are too fat, or have been preg-
nant.”
Thinking usually becomes a little nebulous at
this point, and even more so when you ask:
“What is the purpose of the Babinski sign?” This
sign is the dorsal flexion of the great toe with
fanning of the other toes upon proper superficial
stimulation of the outer half of the plantar area
and is critical in the area supplied by the first
sacral nerve. The reply is something like the fol-
lowing:
“This pathological reflex tells you there is
organic trouble with the upper motor neuron or
pyramidal tract.”
The question is again: “What is the ‘purpose’
of the Babinski reflex? It cannot be ‘pathological’
because every normal human and primate in-
fant demonstrates it at birth.”
The usual answer to this repeated question
varies from a long extemporaneous or ingenious
attempt to explain, “Why a Babinski,” to a curt
“So what?” John Fulton, after many years of ex-
perimental analysis of this interesting phenome-
non, gave me this adroit answer: “I never did
think much of the Babinski reflex anyhow.”
Those of the older school who still worship
at the throne of “the brain,” considering it the
source of all man’s activities (as the Greeks wor-
shipped the many gods and disciplines on Mt.
Olympus), are puzzled to explain a fact known
to every farmer’s child. That fact is that after
the neck and body of the chicken or turkey has
been separated from the head and brain, on the
old chopping block of course, there arises in the
victim for several minutes a strong dynamic activ-
ity with movements throughout various parts of
the body, wings and legs, rather than a sudden
total paralysis after losing its head.
True it is that the violent spontaneous move-
ments are “purposeless,” jerky and sometimes
convulsive in character, without the need for a
brain; but nevertheless, movements they surely
are, whether of simple local reflex type, highly
integrated flapping, hopping and postural mech-
anisms, or aimless gyrations which continue until
loss of function and death come to, of all things,
the spinal cord.
Men have thoughtlessly watched this well
known response throughout the ages without
grasping its significance and potentials, as they
have also looked upon the horizon of a supposedly
flat world, in which the sun “sets” or “goes down,”
refusing to look beyond the illusion into the true
facts regarding the phenomenon. As you know,
the truth of the matter actually reverses the con-
cept without altering the situation. A moving up-
ward of a horizon, on the rim of a rotating globe,
finally obliterates the relatively fixed sun as the
source of light. It appears as though the “sun
had set,” when in fact it is a “horizon rise.”
Within the past few years a similar and com-
plete reversal of concept has arisen, without al-
teration of established detail, to overthrow our
old neurologic beliefs regarding the function of the
brain and spinal cord. We have come to view the
“brain organ” as the child of the spinal cord, de-
veloping through an evolutionary period extend-
ing over 600,000,000 years of vertebrate elabora-
tion, and not the spinal cord as just the loyal
servant and messenger of a capricious brain mas-
ter. One must pause long enough to think this
through.
1236
FAY: THERAPY FOR SPASTIC DISORDERS
Volume XLIV
Number 11 t
Those who can stand on a dear evening and
watch the “horizon rise,” rather than the “sun
go down,” are ready to grasp the significance and
possibilities of a reversal of concept that under-
lies the new dynamic therapy which has recently
been developing. This therapy aids the neurolo-
gist in dealing with chronic and formerly so-called
“hopeless” groups of spastic patients, both during
the problems of infancy and childhood and in the
later years of life, when central nervous system
injury and “strokes” become the common cause
of spastic types of affliction.
When it became evident that powerful and
even highly integrated movements and muscle re-
sponses can be obtained with an intact spinal
cord, without the need of the brain, the question
naturally arose some 15 years ago: “Could we
train these isolated uncontrolled or spontaneous
spinal, bulbar and reflex mechanisms?” Was it
possible to arouse in the background of a patient
who had so-called “paralysis” of spastic type, due
to injury or loss of higher cortical areas, function
from the remaining semiautomatic or automatic
units at the uninvolved more primitive levels? If
control and response from the cortex were lacking,
yet the spinal cord was still willing and able to
respond to proper reflex stimuli, acting directly
upon the less skilled centers below, could a pur-
poseful “conditioning” of an integrated postural
reflex movement be established, using the Pavlov
principle of repeated activation?
The postural reflexes (tonic neck, righting,
vestibular, ocular and others) are already highly
organized for primitive purpose and semiauto-
matic function. They bear the same relationship to
the simple tendon reflex as calculus does to arith-
metic.
The determination to teach and train these
mute units of the central nervous system, rather
than the conscious levels of the spastic patient’s
brain, has produced some remarkable clinical re-
sults.
It is at this point that the static “sun set”
group of neurologists departs, with the traditional
disbelief of the brain worshiper in anything but
robot automatism as the purpose and function of
the spinal cord. Here the modern dynamic trend
in neuromuscular reflex therapy takes over. It
points out that spastic paralysis is the loss of the
ability to control voluntarily the release and modi-
fication of power and movement, and not, there-
fore, a true paralysis such as polio which involves
the loss of both power and movement. The power
and movement can be demonstrated to be present
in the spastic patient by various sensory modal-
ities of posture, pain and the superficial or deep
perceptive senses. It is the proper initiation, modi-
fication, control and skilled application of the
power release, not power production, to the mus-
cles of the spastic patient, which now chiefly con-
cern the clinical therapist. Most spastic patients
are not weak in the involved muscle groups, as
hyperreflexia will easily demonstrate. They do
not lack power; they lack control and the proper
release of power.
The therapeutic measures of the past to exer-
cise the muscles in order to make them “strong”
is all right for the polio victim but not for the
spastic patient. The spastic patient already has
too much power and too little control.
With this concept established, the therapeutic
attack on the spastic forms of paralysis moves
directly toward the problem of not how to make
the patient stronger or more powerful, when he
already manifests violent responses to superficial
and deep tendon reflex responses, but how to
modify, subdue and integrate the crude power
which is present, thanks to the brain stem and
spinal cord, and convert it into some purposeful
skill. A clinical axiom follows: The greater the
primitive power, the less the skill (control), and
vice versa.
It has been apparent in the true spastic hemi-
plegic or paraplegic patient that “the harder the
patient tries,” little or no effect on responsive
movement follows in the afflicted part. This is
the old concept that the “power” resides in the
brain cortex, to be dispensed from that level by
“the will” in desired degree.
Since the power supply does not exist at the
higher levels of the brain organ, but in the primi-
tive and ancient brain stem and spinal cord, the
efforts to “produce” or “make a movement” are
naturally of no avail. You might as well expect
two professional chess players to run through
the University of Miami football team for a
touchdown as to call on the brain organ itself
for a power display.
The crude, primitive power “patterns of move-
ment,” as integrated reflex responses, will be
found in such activities as the homolateral am-
phibian crawling mechanism or the homologous
extremity response seen in the frog style of
swimming response. These complicated activities
are semiautomatic and well under the control of
J. Florida M.A.
May, 19S8
FAY: THERAPY FOR SPASTIC DISORDERS
1237
the postural reflexes (tonic neck, ocular, vestib-
ular, righting and others) provided the higher
levels of the cortex are out of suppressive control.
Relaxation and re-education of the spastic
patient through lower level reflex activity, by re-
moval of partial interference and stubborn sup-
pressive block from an injured or defective cor-
tical area (hemispherectomy) permit uninvolved
control areas to release coordinated power to a
spastic unresponsive part. Thereby, more active
participation is made possible in simple purpose-
ful power activities, required for such activities as
walking, feeding and self care.
The skilled and refined movements of the
hands, fingers and feet are localized close to the
upper brain levels and are the most recent evo-
lutionary additions to the vertebrate nervous sys-
tem, as displayed by man. Such skills suffer most,
or are irrevocably lost, when cortical areas are
injured or destroyed. The ancient activities, how-
ever, of the Amphibian, Reptilian and Mammalian
eras persist in the form of whole or partial postur-
al and defense reflex responses at lower levels
which have lost their original “purpose” in the
primate and man. They may, however, become ap-
propriately aroused to be valuable again, for such
activities as walking, balance and crude postural
and feeding responses, when disaster overtakes
the higher and more recent levels of the brain.
Diagnosis
The first and most important step before select-
ing a program of therapy is to be sure of the pa-
tient’s diagnosis, which of course entails a care-
ful neurologic examination and screening.
It is equally important to establish that a true
spastic type of paralysis exists, whether slight or
severe, if neuromuscular reflex methods of therapy
are to be utilized.
A spastic patient must manifest one or more
of the following signs and symptoms to be classi-
fied as such:
1. The stretch reflex (increased resistance to
stretch, followed by sudden “clasp-knife”
release)
2. Hyperreflexia
3. So-called pathologic reflexes:
(a) Hoffman sign
(b) Babinski sign
(c) Others
4. Clonus (ankle, wrist, patellar)
5. Weakness or loss of movement to volun-
tary effort
Care must be taken to rule out rigidity. “Cog-
wheel” or “lead pipe” types are easily recognized
as the extremity is stretched; the resistance is
usually maintained throughout the range of pas-
sive movement. There is no sudden release, and
in pure types the reflex and so-called “pathologic”
signs are absent. Contracture deformity, immobil-
ity due to pain, fixation of joints and other local
or peripheral causes may account for loss of active
movement and simulate paralysis.
Once it is established that a true spastic type
of paralysis exists in some form, it becomes ob-
vious that the lesion must be situated at or above
the tenth thoracic segment of the cord, because
gross involvement of the lumbosacral area below
this level of the cord produces flaccid paralysis
in the lower extremities, without the Babinski
reflex, clonus, or reflex hyperactivity. Bladder
signs are usually present, along with muscle atro-
phy and a tendency toward decubitus. With spas-
tic paralysis established, we may now determine
if neuromuscular reflex therapy is advisable.
Highlights of Progress
I shall only touch upon the highlights of the
progress that has been made in developing this
more dynamic type of therapy during the past 15
years. They may offer to you certain practical
measures for the benefit of your patients that
we can now recommend.
Valuable therapeutic measures for “unlock-
ing” spastic contraction and the utilization of “re-
flex” movements arose from our studies to deter-
mine the original purpose of a human reflex.
Strange as certain reflexes may seem, they ap-
pear to us today to be uselessly attached to the
super activities of the present glorified human
nervous system. Nevertheless, after tracing them
back to their primitive origin during the evolution
of the central nervous system, we find that they
apparently once were of great importance to
forms of life and development through which the
vertebrate types have transcended and emerged at
various “ages” during the past 400,000,000 years.
The structures (fins) of the water forms (fish)
eventually began to solve the problems of land
and air (amphibians) through the development
of extremities with paddles (reptilian), wings
and feet. This required approximately 200,000,-
000 years, during which time the vertebrate
forms that did not acquire the most favorable
adaptation did not survive to carry on the gain.
I spoke of the so-called “Babinski reflex”
which is present at birth when the human infant
1238
FAY: THERAPY FOR SPASTIC DISORDERS
Volume XEIV
Number 11
emerges from the uterine waters of its mother, to
take its first breath of air, representing an inde-
pendent (amphibian) and lung-breathing type.
Slow motion picture studies of the swimming
frog show that the purpose of the “Babinski re-
flex” to the frog is to respond automatically when
the surface of the hind foot contacts a solid ob-
ject on the floor of the tank (scratch along the
sole of the foot) so that its toes fan to grasp the
surface, or to be ready to “take off” with the
largest webbed area of application against the
surface that is possible. The “purpose” today is
only as a curiosity to the public or a “pathologic
sign” to the neurologist, whereas 300,000,000
years ago it was a necessity to propulsion, and still
is, for those forms of amphibious life that must
survive in liquid surroundings.
As this “reflex action” persists independently
of higher functional levels above the lower tho-
racic level of the cord, its mechanism is intrinsic
to the lumbosacral area. When propulsion of the
mammal type (walking) develops, it becomes
“controlled” by function of higher levels to be
“released” again as an independent activity when
some disturbance removes the higher facilities of
integration. We may say that the patient “drops
back” to a lower evolutionary pattern of function.
If we are to arouse and utilize such activity, we
must attempt to reproduce the posture and the
purpose for which it was designed.
The practical point is this: with organic spinal
cord or brain lesions situated above the tenth
thoracic level (umbilicus as a skin sensory derma-
tomere localization), and associated with spastic
paralysis of the lower extremities, repeatedly
producing the Babinski reflex gives active move-
ment and exercise, reflexly, to the patient’s
muscles and joints concerned with intrinsic move-
ments of the toes, dorsal flexion of the foot, and
flexion and extension of the leg. These responses
are most important while one is teaching a hemi-
plegic patient to regain a more normal pattern of
walking, and these spinal cord responses are of
great value in reducing the contraction of the calf
muscles and heel cord, thus preventing ultimate
contracture. Contracture, once established, can be
corrected only by stretch or orthopedic measures
of relief.
It is a simple undertaking to produce the
“Babinski” response a hundred times by re-
peatedly stroking the bottom of a spastic foot.
One should use a toothbrush or object that will
not scratch or irritate the skin.
The remarkable result from repeating this
procedure (100 strokes) twice or three times a
day for two weeks is that the Babinski sign fre-
quently disappears spontaneously; the response is
no longer confined to the toes and foot, but by
the repeating of this local activity, other muscles
and joints partake in a more integrated and pur-
poseful act such as dorsal flexion of the foot and
withdrawal of the leg, which flexes upward on the
abdomen. This is a movement which is similar to
that normally used in walking, in climbing stairs,
or in a “steppage gait.” All of this arose spon-
taneously from the simple Babinski maneuver.
The central nervous system tends to organize its
“reflex” units for a purposeful expression of motor
function.
In many instances, if this spastically para-
lyzed patient voluntarily tries to make the effort
of “drawing up the leg” (“central reinforcement”)
at the moment the stimulus is applied, he may
learn to augment, influence or even “capture the
reflex.” Thus, with practice and proper coordi-
nation of movements from the upper extremities,
he may learn a more primitive “pattern of walk-
ing,” which, though not normal for the human,
is far better than the typical “dragging of the
foot” and stiff leg gait so common to this type
of hemiplegia.
The results in “capturing” a few of the more
simple reflex mechanisms require the accuracy
and persistence of practice, as one learns to play
chords on a piano. The spastic hemiplegic patient
with severe cortical loss can be taught to walk
again with or without a cane.
As long as one hemisphere of the brain re-
mains in good function, and there is no fixation
of joints or contracture of muscles (assuming the
spastic reflex mechanisms are present and intact
in the paralyzed part) the normal remaining brain
can be taught to regulate the lower centers of
both sides in a greatly improved manner.
Although nothing new has been added to
function at the cortical level, and no regeneration
of lost brain or cord cells is possible, nevertheless
the patient feels improved, and a change of morale
usually follows. As better function appears with
the reflex semiautomatic responses under partial
control, a change from a “hopeless” to hopeful at-
titude ensues.
The danger is that with the limited benefits
of improvement possible by “capturing” remain-
ing responses from lower and more primitive
centers, the patient may come to expect more
T. Florida M.A.
May, 1958
FAY: THERAPY FOR SPASTIC DISORDERS
1239
progress than is possible to attain, and hence be-
come discouraged and disappointed that “full”
recovery is not possible. It is the old story of the
beggar who asks for more, when much has already
been received. The possibilities and limits of this
intrinsic therapy should be carefully explained in
advance.
With this dynamic neuromuscular reflex ap-
proach to the problem merely suggested and out-
lined, it becomes obvious, if we choose to try to
fit the prehistoric mosaic of reflex activities into
a carefully planned matrix of desired response,
that the problem of rehabilitation for the spastic
patient is no longer one of paralysis. Instead, it
becomes one of lack of skill and control of the
crude spinal cord power and highly integrated
reflexes still available.
When “ankle clonus,” for instance, is en-
couraged and sustained two to four hours a day
by a simple device called a “clonometer,” there is
appreciable improvement in the size, power and
response of the calf muscles which, later on, in-
stead of manifesting “atrophy of disuse,” may be
of real value to the patient, should spontaneous re-
covery from a partial “stroke” be possible.
The repeated use of the “Marie-Foix” or
“withdrawal” or “defense” (postural) reflex is
most dramatic. This is obtained by sharply flex-
ing the toes at the metatarsal joint, which causes
withdrawal of the leg and relaxes adductor spasm
(scissors gait), and reduces spasticity even in the
highly spastic paraplegic patient. It has been of
value all the way from the slight but gratifying
relaxation in the severe spinal case (to permit a
urinal between the thighs) to the recovery of the
ability, in the hemiplegic patient, to lift the leg in
going up steps, after “capture” of this reflex.
Other useful reflexes and their “unlocking”
postural components have been described in detail
elsewhere. One more example, however, of this
newer dynamic approach to the spastic problem
concerns the fingers, hands and upper extremities
so important to feeding and self care.
In a true spastic hemiplegia the thumb is
drawn into the palm of the hand and the fingers
enclose it, so that the hand is useless. The first
step is to open or “unlock” the spastic hand. This
release is accomplished by a simple postural re-
flex procedure. Place the patient face down, head
turned away from the paralyzed spastic hand.
Draw the hand and arm downward and back-
ward until the back of the hand rests on the but-
tocks. With a little manipulation, if no pain,
contracture or ankylosis is present, even a long
time useless hand will open and the fingers relax
in extension.
The next phase of the procedure to capture a
a finger movement is to undertake a number of
hours of passive movements of the fingers and
thumb to restore muscle-joint freedom and sen-
sory perceptive awakening of the postural
possibilities.
Because the head is turned away from the
hand in this position, the patient cannot watch
or assist in the results; two mirrors should be
adjusted in order to enable him to see his fingers,
which are behind him. Then, ask him to try to
assist as a finger, the middle finger at first, and
the thumb are approximated passively, or rein-
forced by using the Hoffman reflex (snapping the
tip of the middle or ring finger) ; he may, in
many instances, “capture” the movement and,
with practice, learn to control it. Later, the hand
may be placed shoulder high in front of the seated
patient and “feeding movements” established by
special digital apparatus devised for this purpose.
Amphibian (homolateral) and Reptilian
(crossed) patterns of crawling and extremity co-
ordination lead to better balance and control of
the hemiplegic side.
The measures outlined are part of a large
number of dynamic intrinsic mechanisms, which
are reflex or automatic, but, like the exercises of
arithmetic, underlie the more complicated mathe-
matical computations, primitive movements under-
lie later learned skills. These “reflexes” and pat-
terns are now being employed to develop crawling,
walking, feeding and coordinating mechanisms re-
quired in basic progression, by utilizing the older
unskilled primitive centers of the nervous system
in the brain and spinal cord to aid, when the
higher levels of control at the cortical or midbrain
levels have been partly or severely involved.
As in all other medical problems of long term
nature, cooperation, a favorable mental attitude of
helpfulness and persistent practice and patience
are required to regain a loss that may otherwise
never become re-established.
The psychiatrist has found, within the
functions of the brain itself, a means of helpful
therapy, as developed by Freud and his followers.
The neurologist may find through the intrinsic
and simple, as well as the highly organized, neuro-
muscular reflex mechanisms (that he has so long
described but studiously ignored), the clue to
many helpful features that can assist a patient to
1240
FAY: THERAPY FOR SPASTIC DISORDERS
Volume XLIV
Number 11
express a wider degree of function and independ-
ence in the modern aspects of rehabilitation.
Summary
This new dynamic field of therapy is open to
those whose eyes view the world as a round and
moving horizon, instead of a flat senseless shelf.
In the newer concept of neurology, the brain
organ is no longer the old piano player beating
out and forcing an acquired movement, the vol-
ume of which is dependent on the power of his
fingers. Instead, now in the newer light, it be-
comes an organ player, whose delicate touch re-
leases the patterns of power and combinations of
muscle response to lower control areas, which, if
skillfully blended, give the same symphony in
either case.
The former concept has given rise to the
hopeless prediction that as the power at the brain
source is gone, no movement can be expected, and
hence no rational therapy is available. The pres-
ent and more modern concept is that great but
crude power potentials exist in the lower centers
of the brain stem and spinal cord. In the spastic
patient these may be trained through their re-
maining reflex commands and control areas, which
respond when properly addressed in terms of
these more primitive centers, which understand
the signals of posture, joint, tendon, pain and
skin senses, rather than the voluntary selections
of the will.
Even if we may know and recognize all of this,
as we do a rotating earth and a satellite era, there
will be those who will still prefer to see the “sun
set” and a spastic paralysis continue as a fixed
and hopeless state.
Here on the beaches of Florida, where some of
the old world were first to touch the new, history
repeats itself, and suddenly the opportunity to
exploit a vast new clinical field of neurologic
potentials has opened for those who dare to ex-
plore its possibilities. The neurologist has found
his “Acres of Diamonds” at last, upon his own
doorstep, and in the patient’s bulbospinal reflex
mechanism.
7404 Elbow Lane, 19.
Four Guest Speakers to Appear
On General Session Program of Convention
Four guest speakers are to appear on the program of the General Session of the
Eighty-Fourth Annual Convention of the Florida Medical Association which begins
Sunday, May 11, at Bal Harbour in the Americana Hotel. In addition, Dr. O. W.
Hyman, of Memphis, Tenn., the guest of President William C. Roberts, is scheduled
for an address.
The other guest speakers include Dr. David B. Allman, Atlantic City, President
of the American Medical Association; Dr. David M. Hume, Richmond, Va.; Dr.
David T. Smith, Durham, N. C., and Dr. J. Rocher Chappell, Orlando.
J. Florida M.A.
May, 1958
1241
The Hospital Program in Florida
Alvin D. James
JACKSONVILLE
The past year has been one of intense work
in developing Florida’s first hospital care program
for its medically indigent citizens. The Act of the
1955 legislature, establishing the new program,
Hospital Service for the Indigent, provided that
it become effective Jan. 1, 1956. In lieu of the
$3,000,000 requested for the operation of the pro-
gram, $500,000 was appropriated. It appeared
to be the thinking of the legislature that this
reduced initial appropriation would be sufficient
to establish the administration of the program
and to provide operational experience, looking for-
ward to adequate financing by the 1957 legis-
lature. Although only one sixth of the original
requested appropriation was made available, the
administering state agency, the Florida State
Board of Health, was successful in implementing
the program in 24 of the 67 counties. During
this first year, Jan. 1, 1956 to Dec. 31, 1956, one
third of the counties representing 35 per cent of
the state population elected to participate. With
Dade County coming in the program effective
Jan. 1, 1957, the program is presently effective for
54 per cent of the state’s population.
Through past working experience in initiating
the program, it is evident that more county par-
ticipation would have been attained if sufficient
state-matching funds had been made available.
Because of the small amount of state funds in-
volved, only 24 counties elected to establish hos-
pital care programs for their medically indigent
under the provisions of this law. For the 24
counties that elected to participate, however, there
were sufficient state monies to provide 20 cents
per capita to each participating county. For this
coming biennium, July 1, 1957 to June 30, 1959,
it is expected that the budget request for $4,000,-
000 will be appropriated by the current session
of the legislature, thereby making available suf-
ficient state-matching funds on the basis of the
original recommended need for at least 50 cents
per capita. With the expectation of having avail-
able an adequate amount in state funds for the
program, statewide participation can be expected.
To comment further regarding the future de-
velopment of the hospital care program admin-
Hospital Consultant, Florida State Board of Health
Read before the Florida Health Officers’ Society, Hollywood,
May 5, 1957.
istered by the State Board of Health, both the
Senate and House Appropriation Bills have been
approved providing $4,000,000 for a single pro-
gram: Hospital Service for the Indigent. With
this appropriation grant, it is expected that the
objectives set forth by Chapter 401, Hospital
Service for the Indigent can be and will be ac-
complished.
The July 1956 special session of the legis-
lature adopted a resolution authorizing the State
Welfare Department to utilize certain unencum-
bered state funds together with federal matching
funds to establish the Public Assistance Medical
Service Fund, or what is more commonly referred
to as the Hospital Care Program for Public As-
sistance Recipients. From this fund, the State
Welfare Department is authorized to provide hos-
pital services for recipients of state welfare grants
in accordance with the provisions of the 1955
Act, Hospital Service for the Indigent. Thus the
State Board of Health and its affiliated county
health departments became responsible for the
medical administration of the program initiated
October 1 by the State Welfare Department,
which provides hospital care for public assistance
recipients. Statistical data and operational ex-
perience reveal that approximately one third of
all the medically indigent citizens of Florida are
public assistance recipients; therefore, the State
Welfare Department’s program is meeting approx-
imately one third of the total need in all counties
of the state. This expense is presently paid for
entirely by federal and state funds and does not
require county-matching funds.
Because the State Welfare Department’s pro-
gram for the categorically indigent and the State
Board of Health’s program for the medically in-
digent are both administered under the provisions
of the same state statute, it was believed to be
possible to present a single program to the hos-
pitals and physicians of the state, using identical
forms and regulations. With the objective of
having both state departments proceed with com-
mon administrative policies, the respective Medi-
cal Advisory Committee to each state department
was combined into a single joint advisory com-
mittee to consider problems common to both pro-
grams. Although much has been accomplished by
1242
JAMES: HOSPITAL PROGRAM IN FLORIDA
Volume XLIV
Number 11
this combined effort, it is evident that the medi-
cal administration has not developed as was orig-
inally prescribed.
Statistical Resume
There follows a resume of statistical data
summarizing the activities of the hospital care
programs administered by the State Department of
Public Welfare and the State Board of Health
and its affiliated county health departments. The
activity data are representative of the three pro-
grams: Hospital Service for the Medically In-
digent, Hospital Care for Public Assistance Re-
cipients, and the Cancer Control Program.
A statement of appreciation is extended to the
responsible representatives of the State Depart-
ment of Public Welfare and the Blue Cross As-
sociation for their cooperation in making possible
the compilation of the following statistical data:
Summary
In summarizing the activities of the three pro-
grams:
1. There were 6,454 hospital admissions fi-
nanced in whole or in part by the three programs:
3,361 — Hospital Service for the Medically
Indigent
Summary of Activities
Hospital Program for Indigents
(Jan. 1, 1956 through Dec.
. 31, 1956)
Program
Patients
Days of Hospital
Care
Total Dis-
bursements
Per Diem
Cost
Average Patient Cost
of Hospital Stay
HSI
3,361
33,320
$553,810.53
$16.62
$164.77
HCPAR
872
7,057
129,369.21
18.33
148.35
(10/1/56 -
CANCER
- 12/31/56)
2,221
16,883
236,485.00
14.00
106.47
6,454
57,260
$919,664.74
$16.06 Av.
$142.49 Av.
Comparative Analysis
Indigent Hospitalization Programs
Florida
Tennessee
Average length of stay
8.9 •
10.5
Average cost per admission
$142.49
$136.52
Average cost per day
$ 16.06
$ 13.06
Estimate of Professional Services
Granted Gratuitously
HSI PAR
CANCER
TOTAL
Estimated
professional
fee $226,901.11 $63,356.40 $248,796.42 $541,053.93
Estimated
professional
fee per
patient $67.51 $74.95 $112.02 $74.95 Av.
To comment briefly about the Cancer Pro-
gram, both the Senate and House Appropriation
Committees provide for the merging of this pro-
gram with the Hospital Service for the Indigent
Program, which carries an appropriation of $4.-
000. 000 for the biennium. On the basis of this
recommendation, it is planned that effective July
1, 1957, the Cancer Program, which is presently
operating 19 tumor clinics located in 16 counties,
become an integrated part of the Hospital Serv-
ice for the Indigent Program, therefore requiring
partial financing with county funds.
872 — Hospital Care for Public Assistance
Recipients (2 mos.)
2.221 — Cancer Control Program
2. A total of 57,260 patient days were re-
ported for the 6,454 admissions, giving an aver-
age length of stay of 8.9 days.
3. A total of $919,664.74 was expended for
the programs for an average cost of $142.49 per
admission. This expenditure is not indicative of
actual cost for hospital services provided because
of involvement of third party contributions, pay-
ments made by insurance companies, and the
arbitrary establishment of per diem rate of re-
imbursement.
4. Ninety-seven different hospitals were utiliz-
ed in providing hospital care for certified indigent
patients.
5. A comparative analysis of the Indigent
Hospitalization Programs for the states of Florida
and Tennessee, which administers comparable
programs, reveals the following:
Fla. Tenn.
Average length of stay 8.9 10.5
Average cost per admission $142.49 $136.52
Average cost per day $ 16.06 $ 13.06
J. Florida M.A.
May, 1958
JAMES: HOSPITAL PROGRAM IN FLORIDA
1243
6. Inasmuch as neither of the programs pro-
vides for payment of professional services, a con-
servative estimate of physicians’ services granted
gratuitously amounts to more than a half million
dollars. Based on a study made of representative
cases for each program, the estimated value is
presented thus:
Hospital Service for Medically
Indigent $226,901.11
Hospital Care for Public Assistance
Recipients (First two months
of operation) 65,346.40
Cancer Control 248,796.42
$541,053.93
The value of physicians’ services given “free”
amounts to $74.95 per patient. Projecting this
estimate on a yearly basis, the value of “free
services” given by physicians of Florida would
amount to several million dollars.
In behalf of the State Board of Health, a
sincere expression of appreciation is extended to
the membership of the Florida Medical Associa-
tion for this most generous contribution to the
health needs of the indigent citizens of Florida.
Conclusion
In concluding this report, I should like to
emphasize that the State Board of Health has
endeavored to administer the hospital care pro-
gram for the medically indigent in accordance
with the provisions of the authorizing statute;
therefore, in so far as possible, the responsibility
for making a professional determination regard-
ing a patient’s need for hospitalization has been
left to the treating physicians and the county
health officers.
Many meetings have been held during the
year, over the state, to explain the purpose and
objective of the state aid programs. Meetings
have been held with medical societies, welfare
boards, and hospital representatives in order to
discuss any peculiar or particular administrative
problem.
Considering the magnitude of such a program,
it requires time and experience to put a program
of this nature into operation. Admittedly, errors
have occurred, but efforts have been made to
profit by these mistakes. It is believed that a
substantial foundation has been laid for a prac-
tical, conservative hospital care program for the
indigent. This accomplishment is the result of
some most significant assistance received from the
appropriate committees of the Florida Medical
Association and the excellent cooperation received
from Florida physicians, health officers and hos-
pitals. The State Board of Health appreciates
receiving any constructive criticism that would be
of assistance in the future development of the
hospital care program.
Box 210.
Twelve Florida Physicians to Present Addresses
At Scientific Assemblies of Annual Convention
Twelve physicians from Florida are scheduled to present addresses during the two
Scientific Assemblies of the Eighty-Fourth Annual Convention of the Florida Medi-
cal Association which begins May 11 at Bal Harbour in the Americana Hotel.
The physicians include Drs. Abraham R. Hollender, Miami Beach; Nathan S.
Rubin, Pensacola; Gerard H. Hilbert, Pensacola; David A. Newman, Palm Beach;
Michael M. Gilbert, Miami; Robert G. Cushman, Jacksonville; Edward R. Wood-
ward, Gainesville; Richard G. Connar, Tampa; George H. Hames, Lantana; Wil-
liam W. Stead, Gainesville; John G. Chesney, Miami, and Hawley H. Seiler, Tampa.
1244
Volume XLIV
Number 11
ABSTRACTS
Retroperitoneal Lymphatic Cyst (Cystic
Lymphangioma). By Benedict R. Harrow. J.
Urol. 77:82-89 (Jan.) 1957.
A case of retroperitoneal lymphatic cyst
(cystic lymphangioma) is reported, bringing the
total number in the English literature to 15. The
relationship of this type of cyst to mesenteric,
omental and other types of retroperitoneal cysts
is presented. This paper stresses that the diag-
nosis of a lymphatic cyst depends mainly upon
the histology of the wall of the cyst rather than
upon the mere presence of chylous fluid. The
urologist’s participation in the diagnosis and
treatment of retroperitoneal tumors is briefly re-
viewed.
Oligospermia: A Clinical Study of Treat-
ment with Methylandrostenediol. By John
M. Schultz, M.D. Fertil. & Steril. 7:523-539
(Nov.-Dee.) 1956.
The results of treatment with methylandro-
stenediol, a steroid with a close resemblance to
methyltestosterone, given orally in 50 mg. doses
for eight weeks to 24 infertile males with oligo-
spermia and 5 azoospermic males, are here report-
ed. In oligospermia, there was no significant
improvement in spermatogenesis. The highest
increased motility in both series was during the
therapy phase. An absolute increase of 21 per
cent in motility in pronounced oligospermia (16
cases) was observed, and an absolute increase of
0.8 per cent in motility in the higher subfertile
group (8 cases) also was noted. Six pregnancies
occurred (25 per cent). There was no improve-
ment in nonobstructive azoospermia. Libido im-
proved in 65 per cent of 29 patients treated.
The author concludes that methlyandrostene-
diol therapy in oligospermia has been followed by
enough improvement, especially in motility, to
warrant further clinical investigation. He warns,
however, that methylandrostenediol is not extolled
as a definitive therapy for oligospermia. Its in-
discriminate and promiscuous use in every infertile
male would undoubtedly yield the usual number
of poor results in his opinion, and he adds that a
larger number of patients must be observed over
a longer period of time before the final results can
lie evaluated, with cases carefully selected, studied
and adequately controlled with several semen ex-
aminations prior to the start of therapy.
The Fate of Patients Surviving Acute
Myocardial Infarction: A Study of Clinical
and Necropsy Data in Two Hundred Fifty
Cases. By Richard W. P. Achor, M.D., William
D. Futch, M.D., Howard B. Burchell, M.D., and
Jesse E. Edwards, M.D. A. M. A. Arch. Int. Med.
98:162-174 (Aug.) 1956.
In seeking to learn what lies ahead for pa-
tients surviving an acute attack of myocardial
infarction, the authors studied 250 hearts with
gross myocardial scars indicative of healed in-
farction, selected from necropsies performed at
the Mayo Clinic during the five year period 1946
through 1950, with special regard to the patho-
logic anatomy and its correlation with the clinical
features. The cause of death was primarily cardiac
in origin for nearly two thirds of the patients.
The three major types of cardiac death were death
from congestive heart failure, death from recur-
rent acute myocardial infarction, and “sudden
death” without congestive failure or acute infarc-
tion. The last-mentioned mechanism was the com-
monest of the three and was infrequently associ-
ated with recent coronary thrombosis.
Antemortem diagnosis of a previous acute
myocardial infarction was not made in nearly
half of these patients. There appeared to be a
definite relationship between the size of the scar
indicating the extent of infarction of the ventricu-
lar wall on the one hand and the incidence of
clinical recognition on the other. For those pa-
tients whose acute myocardial infarction was di-
agnosed clinically the average length of survival
following recovery from the acute episode was 43
months, only 24 per cent surviving five years or
more and 7 per cent 10 years or longer. The
period of highest mortality was within the first
year after the acute illness. From the standpoint of
cardiac morphology and clinical features the pa-
tients surviving five years or longer did not differ
significantly from those of the entire series.
Hence, it was concluded that the subsequent
course of patients who had survived an episode of
acute myocardial infarction could not be accurate-
ly predicted on the basis of morphologic or clinical
findings.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411, Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
J. Florida M..\.
May, 1958
1245
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON, M.D., Editor
STAFF
Assistant Editors Managing Editor
Webster Merritt, M.D. Editorial Consultant Ernesi R. Gibson
Franz H. Stewart, M.D. Mrs. Edith B. Hill Assistant Managing Editor
Thomas R. Jarvis
Committee on Publication
Shaler Richardson, M.D., Chairman .... Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D lacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph D Miami
Dean, School of Medicine, University of Miami
What Price Radiation?
The recent emphasis on the fall-out of radio-
active particles from nuclear weapons testing has
produced almost hysterical outbursts in the press.
Scientists have joined the outcry and have signed
statements deploring the tests. These statements
have been used politically both in this country
and abroad. A calm, objective view is needed to
evaluate medically the risk, not only of weapons
tests, but of radiation from other sources.
Physicians have known of the dangers of
radiation for many years. They have recognized,
as well, the benefits to the patient from the intel-
ligent use of radiation. Physicians are accustom-
ed daily to taking calculated risks. Treatment of
patients with any type of drug entails the danger
of a reaction. Widely used drugs, such as digitalis
and atropine, must be used in doses which ap-
proach toxic levels to obtain a therapeutic effect.
Each operation has an irreducible risk attached
to it. Regardless of the care with which the pa-
tient is prepared, patients will die as a result of
the anesthetic or of the operative procedure itself.
Physicians recognize that these risks can be re-
duced to statistical probability. When the doctor
attempts to apply the statistics relating to prob-
ability to any individual case, the data no longer
meet scientific criteria. The reasoning breaks
down because of the inherent biologic variability
of all living things. No two individuals will react
identically under the same circumstances to the
same hazard.
People all over the world are exposed con-
tinuously to all types of radiation. In Florida,
physicians are familiar with the damage done
both by the infrared rays of the sun and other
sources of fire. Doctors treat the sunburn from
overexposure both to the direct and reflected
ultraviolet rays. The much coveted suntan is a
reaction of the body to this potentially harmful
radiation. The production of skin cancer as a
result of prolonged overexposure has been called
to the attention of physicians of the state through
exhibits at the annual meeting.
Cosmic rays constantly bombard the popula-
tion. These rays, from unknown sources in outer
space, penetrate buildings and even can be detect-
ed deep in mines. Gamma radiation, given off
from the earth and its products, constantly bom-
1246
EDITORIALS ANI) COMMENTARIES
Volume XLIV
Number II
bards people. The intensity of the radiation varies
considerably from one part of the country to an-
other. Data are needed on the extent of back-
ground radiation in Florida, particularly since
our phosphates contain uranium and rare earths.
Our beach .sands, roads, and even the sea which
surrounds us give off radiation constantly. Modern
Florida houses, which are largely constructed of
masonry these days, give off more radiation than
do the wooden houses formerly used much more
in the South. In addition to the bombardment
from external sources, people are continuously
receiving small amounts of beta and gamma
radiation from internal sources. The chief offend-
er is the natural radioactive isotope of potassium
which occurs in a definite proportion with the
nonradioactive form in our food.
To these natural forms of radiation, other
man-induced hazards are added. X-radiation is
now widely used not only in medicine, but in
industry. The direction of the primary ray can
be anticipated and some wave-lengths filtered out
without reducing the effectiveness of the beam.
The scatter from x-radiation is more difficult to
predict. Fluoroscopy utilizes a relatively large
amount of penetrating x-radiation. The radiation
of radio waves is used in diathermy, occasionally
with harmful effects. Similar damage has been
reported from close exposure to newer high inten-
sity types of radar. Atomic explosions of either
the fission or fusion variety produce further
hazards which vary with the type of device and
the height at which it is detonated. Those ex-
plosions close to the ground raise clouds of radio-
active dust which rise into the stratosphere and
increase the fall-out as the tiny particles circle
the earth. Florida is relatively safe from this
source of radiation since the prevailing winds tend
to waft the clouds from the test sites in Nevada,
Eniwetok, Australia and Siberia in a more north-
erly direction.
Why are the effects of radiation of such con-
cern to the physician? We know that mutation
is a normal biologic process which occurs natural-
ly at a given rate. Some mutations are good, and
we apply the result in agriculture to the develop-
ment of new strains of plants and better breeds
of animals. Some mutations are harmful. For-
tunately, most harmful mutations result in death
of the organism, but some are not lethal and are
genetically transmitted. In man, more and more
biochemical defects which can be transmitted,
such as diabetes, pernicious anemia and phenyl-
pyruvic oligophrenia are being seen. Radiation
increases the rate of mutation, but it cannot be
predicted whether the result will be good or bad.
In plants and animals, the harmful mutations
can be discarded, but in man, they cannot. The
somatic body cells can be harmed by all types of
radiation. The burns of the skin and bowel from
x-ray therapy are familiar to physicians. The
apparent increase in the rate of leukemia in
radiologists, as compared with other physicians
and other men of similar age, has been the sub-
ject of recent inquiry. The data seem clear that
the incidence of leukemia has increased above
the predicted rate in the survivors of the atomic
explosions at Nagasaki and Hiroshima.1 How
much radiation is involved in the production of
leukemia in children is not yet clear. It is known
that congenital defects can be produced by radia-
tion of embryos early in pregnancy. In man,
most harmful effects occur if the exposure takes
place before the fourth month of the pregnancy.
The reproductive cells of both men and women
are harmed by radiation. The effects, however,
may take several generations to become evi-
dent.'-3 The physician must recognize and pin-
point the risks involved. He should accept these
risks when the use of radiation is necessary in the
care of his patient and must provide all possible
protection against harmful effects to other parts
of the body.
What should the physician do to reduce the
harmful effects of radiation? Diagnostic x-ray
procedures should be restricted to those necessary
on the basis of clinical judgment. The recent
action in curtailing programs of mass photoroent-
gen examinations of the chest for tuberculosis
and the restriction of the technic to groups of
high risk are sound measures which have been
adopted at various places in Florida. For exam-
ple, at the University of Florida, films will be
taken only of those students who give positive
reactions to tuberculin skin tests; this procedure
will doubtless be adopted in other schools.
Elective x-ray examinations of the abdomen in
women should be scheduled ideally for the two
weeks immediately following the menstrual peri-
od. X-rays should not be taken early in preg-
nancy. If there is a pelvic disproportion and a film
had not been taken before the pregnancy began,
it would be wise to wait until the sixth or seventh
month. Patients will readily accept this advice
if the physician explains the reason. X-rays of
children should be kept to a minimum, and the
J. Florida M.A.
May, 1958
EDITORIALS AND COMMENTARIES
1247
pelvic region should be avoided as much as pos-
sible.* 2 3 4 Fluoroscopic examination should be made
only when the data needed cannot be obtained
from films. Fluoroscopic examinations should be
spaced at intervals, and the number of repeat
examination, as of the gastrointestinal tract in
peptic ulcer or colitis, should be kept to a mini-
mum. All diagnostic radiographic equipment
should be monitored regularly. Physicians have
learned to wear protective aprons and gloves, but
we could build better shielding for patients and
technicians.
All radiation is cumulative in its harmful ef-
fects. It would be wise to have each person
keep a personal health log in which medical in-
formation could be entered, especially the doses
of radiation given by physicians. The safe doses
are not known, and scientists are not in agree-
ment, in spite of extensive research, on permissible
cumulative amounts of radiation. The accurate
measurement of an effective tissue dose of pene-
trating radiation is a technical problem which has
not been adequately solved. It is not known what
the relation of the cumulative doses of radiation
from wave lengths, such as those produced by the
sun and radio-generating equipment, is to that
produced by gamma or x-rays. Plants concerned
with nuclear energy, whether operated by the
Atomic Energy Commission or private industry,
have shown an excellent safety record in this
country. Because Florida has no source of fossil
fuels, atomic power will doubtless achieve greater
use in the state in coming years. Power reactors
will not explode. Safeguards for operating per-
sonnel are built in through proper engineering de-
sign. Waste disposal from reactors is a difficult
problem, but in Florida the possibility of burial
deep at sea offers a convenient and safe means
for disposal of spent fuel elements.
In spite of the dramatic character of the
dangers from nuclear materials, the greatest
known hazards, at present, are those produced in
the physician’s own office.
1 lewis. E. B. : Leukemia and Ionizing Radiation, Science
125:965-972 (May 17), 1957.
2. Glass, B. : The Genetic Hazards of Nuclear Radiations,
Science 126:291-246 (Aug. 9) 195 7.
3. Neel, J. V. : The Delayed Effects of Ionizing Radiation,
J. A. M. A. 166:908-916 (Feb. 22) 1958.
4. Lincoln, T. A., and Gupton, E. D.: Radiation Dose to
Gonads from Diagnostic X-ray Exposure, J. A. M. A.
166:233-239 (Jan. 18) 1958.
The Eighty-Fourth Annual Convention of the
Florida Medical Association begins May 1 1 at the
Americana Hotel at Bal Harbour. Final session is
the Second Meeting of the House of Delegates,
May 14.
Annual Graduate Short Course
Discontinued
Held regularly for a quarter of a century, the
Annual Graduate Short Course has this year been
discontinued. This outstanding contribution to
medical postgraduate education in the state has
through the years been a June feature of wide
appeal to members of the Florida Medical Associ-
ation and has been sponsored by the Division of
Postgraduate Education of the College of Medicine
of the University of Florida in cooperation with
the Association and the Florida State Board of
Health. Announcement that it would no longer be
held was made at a meeting of the Association’s
Committee on Medical Postgraduate Course held
on March 16, 1958, in Jacksonville.
At this meeting Dr. William C. Thomas Jr.,
Director of the Division of Postgraduate Educa-
tion of the College of Medicine of the Universi-
ty of Florida, outlined plans for two to three day
courses, each in a particular basic field of medi-
cine and directed at both the general practitioner
and the specialist, to be scheduled approximately
four times a year. Dr. George T. Harrell Jr., Dean
of the College of Medicine of the University of
Florida, announced that in addition to these for-
mal short refresher courses at Gainesville, the Col-
lege of Medicine will put on courses outside the
school if there is sufficient demand. It will also
be glad to co-sponsor graduate courses presented
by recognized medical organizations provided the
College of Medicine is permitted to help plan and
supervise these courses.
Dr. Homer F. Marsh, Dean of the University
of Miami School of Medicine, explained the sev-
eral types of graduate courses offered locally by
the School of Medicine and announced plans for
a series of three day programs throughout the
academic year, starting in October or November,
to which any physican in the state would be wel-
come.
At the request of Dr. Turner Z. Cason, Chair-
man, the members of the Committee and Dr.
Harrell, Dr. Thomas and Dr. Marsh discussed
whether or not there is further need for the Com-
mittee and, if so, what its future functions should
be. It was unanimously decided that the Commit-
tee should be continued and have the following
functions: (1) Represent the Association in spon-
soring postgraduate courses; (2) Offer advice and
coordination to prevent duplication of effort; (3)
Do a certain amount of investigation; (4) Publi-
cize courses and encourage physicians to undertake
1248
EDITORIALS AND COMMENTARIES
Volume XL1V
Number 11
postgraduate courses. The Committee requested
the Chairman to appear before the designated re-
ferral committee at the Association’s annual meet-
ing in Bal Harbour this month to present the con-
sensus of the Committee and its recommendations.
Dr. Cason deserves the hearty commendation
and genuine appreciation of the members of the
Association for the able leadership he has given
the Committee for more than 25 years, and the
Association is fortunate to have his continued ser-
vices in that capacity. His enthusiasm, persistence
and vision in promoting the cause of graduate
medical education in the state have resulted in an
ever expanding program which is now assured on
the highest level under the guidance of the state's
two university medical schools. While many will
miss the annual June Short Course, there is sat-
isfaction in knowing that it yields to progress in
the right direction.
American Medical Association
Annual Meeting
San Francisco, June 23-27
San Francisco will be host to some 12,000 to
15,000 physicians next month when the Ameri-
can Medical Association’s 107th Annual Meeting
is held there. The five days of June 23-27 will
hold countless attractions, such as an outstand-
ing scientific program of diversified lectures, panel
discussions, scientific exhibits, motion pictures,
televised surgical procedures and commercial ex-
hibits. The convenient center for the Scientific and
Technical Exhibits, motion pictures, color tele-
vision and lectures will be the Civic Auditorium,
the adjacent new Plaza Exhibit Hall and other
surrounding buildings. The Sheraton-Palace Hotel
will be the headquarters for the sessions of the
House of Delegates.
Activities are scheduled to begin on Monday
morning, June 23, with the Scientific Exhibit, color
television, and motion pictures, together with the
Technical Exposition. On Monday afternoon and
Tuesday morning, general scientific meetings will
be held. A symposium on the care of the severely
injured patient will open the general scientific
program on Monday afternoon, and Tuesday
morning’s general meeting will feature another
symposium on hazards associated with therapeutic
agents.
Formal scientific section meetings will begin
on Tuesday afternoon and continue through Fri-
day morning. Several sections will meet in build-
ings within easy walking distance of the Civic
Auditorium. The Section on Ophthalmology and
the Association for Research in Ophthalmology will
meet in the Fairmont Hotel. All of the sections
have arranged excellent programs with many
panel discussions and symposiums as well as lec-
tures. Subjects for special panel discussions and
demonstrations include: perinatal problems;
methods of resuscitation of infants; nutrition;
physical examination of physicians, using elec-
trocardiograms and chest x-rays; fresh tissue
pathology, and treatment of fractures. The Sec-
tion on Miscellaneous Topics also is planning
sessions on allergy, prevention of traffic accidents,
prevention of injury in sports, and medical pro-
fessional liability. Other features will be a color
television program of live operations and demon-
strations from San Francisco Hospital and a varied
motion picture program. Among the nearly 300
exhibits arranged by the various sections in the
Scientific Exhibit there will be a group of exhibits
on arthritis and a question and answer conference
on nutrition.
Two high school winners of A. M. A. scientific
awards at the National Science Fair will display
their prize exhibits again this year. In addition,
the top winners of the intern-resident and medi-
cal student exhibit classifications at the Student
American Medical Association convention this
spring will be invited for the first time to exhibit
at an A. M. A. meeting.
Registration officially opens at the new Plaza
Exhibit Hall on Monday, June 23, at 8:30 a. m.
and closes Friday noon. Advance registrations
will be accepted on Sunday, June 22, from 12 noon
to 4:00 p. m. On Tuesday and Wednesday morn-
ings the Scientific and Technical Exhibits will be
open to A. M. A. physician-members only.
A postconvention attraction of interest to many
members is the Hawaii Summer Medical Confer-
ence to be held in Honolulu on July 1-3,1958.
Timed to follow immediately after the San Fran-
cisco meeting, the Conference is under the auspices
of the Hawaii Medical Association, a constituent
society of the A. M. A., which has extended an
open invitation to Mainland physicians to attend.
Included in the program are breakfast panels and
a special afternoon clinic at a local hospital. Such
outstanding speakers as Dr. Frederick C. Robbins
of Cleveland, Dr. Ernest Jawetz of San Francisco
and others of equal stature will present papers of
particular note. Official travel arrangements to
Hawaii to attend the Conference are under the
direction of Lee Kirkland Travel, c/o Medical
J. Florida M.A.
May, 1958
EDITORIALS AND COMMENTARIES
1249
Tours, P. O. Box 3433, Chicago 54, 111. Aside
from attendance at the scientific sessions, various
other official social functions will be provided in
the official trips, and a choice may be made of
traveling round-trip by air or combining air and
steamer travel between the Mainland and Hono-
lulu.
Mount Sinai Hospital
Postgraduate Seminar
Miami Beach, May 22-25
“Recent Advances in Diagnosis and Therapy”
is the theme chosen for the Eighth Annual Post-
graduate Seminar to be sponsored May 22 through
May 25, 1958, by the Mount Sinai Hospital of
Greater Miami at the Deauville Hotel in Miami
Beach. Seven distinguished lecturers will present
two lectures each, and two symposiums will be
featured, one on “Unusual Surgical Emergencies”
and the other on “Critique of Recent Approaches
to Heart Disease.” This course is approved for
Category I, American Academy of General Prac-
tice.
The faculty members and their subjects are:
Dr. Herrman L. Blumgart, Professor of Medicine,
Harvard Medical School, “Clinicopathological
Correlation of the Coronary Circulation” and
“Relationship of Thyroid to Heart Disease;” Dr.
Frederick Fitzherbert Boyce, Professor of Clinical
Surgery, Tulane University School of Medicine,
“Improved Outlook of Carcinoma of Stomach”
and “New Concepts in Surgery of Biliary Tract
and Pancreas;” Dr. Dwight Harken, Associate
Clinical Professor of Surgery, Harvard Medical
School, “New Horizons in Heart Surgery” and
“Surgery of Acquired Valvular Disease;” Dr.
Robert M. Kark, Professor of Medicine, Univer-
sity of Illinois College of Medicine, “Clinical Value
of Renal Biopsy” and “Disease Associated with
Alcoholism,” also a motion picture entitled “Med-
icine and Nutrition in Arab Kingdom of Libya;”
Dr. Hans Popper, Director of Pathology, The
Mount Sinai Hospital, New York, and Professor
of Pathology, Columbia University, “Clinicopath-
ological Correlation in Hepatitis” and “Pathways
of the Formation of Hepatic Cirrhosis;” Dr.
Steven O. Schwartz, Attending Hematologist, The
Hektoen Institute for Medical Research of the
Cook County Hospital, Chicago, “Present Concept
of Pernicious Anemia and Pernicious Anemia-like
Diseases” and “Value of Clinical Observation in
the Diagnosis of Hematologic Diseases;” and
Dr. Leroy D. Vandam, Clinical Professor of Anes-
thesia, Harvard Medical School, “Present Status
of Hypothermia in Anesthesia and Surgery” and
“Problems in Anesthesia for Patients with Heart
Disease.”
Florida Association of Blood Banks
Annual Meeting
Ponte Vedra Beach, June 7-9, 1958
The Twelfth Annual Meeting of the Florida
Association of Blood Banks will be held at Ponte
Vedra Beach on June 7, 8 and 9. The sessions will
take place at the Ponte Vedra Inn, beginning on
Friday night with the annual business meeting.
The scientific session will open at 9:00 on Sat-
urday morning, with Dr. Robert B. Mclver, Pres-
ident of the Jacksonville Blood Bank, delivering
the welcoming address. Two outstanding physi-
cians from the blood bank field will then present
the scientific program. The afternoon meeting, be-
ginning at 2 p. m., will be an administrative ses-
sion. The annual banquet will take place Satur-
day night at the Inn, with Dr. John T. Stage of
Jacksonville serving as toastmaster. The Sunday
morning session will be devoted to a workshop for
technicians. Dr. James J. Griffitts of Miami and
Dr. John B. Ross of Jacksonville will conduct the
workshop.
Mountaintop Medical Assembly
Waynesville, N. C., June 19-21
Of increasing interest to Florida physicians is
the annual Mountaintop Medical Assembly, held
at Waynesville, N. C. For the fifth successive
year, it will be held this summer, the dates being
June 19, 20 and 21. This course gives 15 hours
of Category I credit to members of the American
Academy of General Practice.
At the opening session on Thursday morning,
three lectures are scheduled, to be followed by a
question and answer period. Dr. Willis Hurst,
Emory University School of Medicine, Atlanta,
Ga., lectures on “Cardiology — Diagnostic Points,
Part I;” Dr. Joseph H. Patterson, Emory Univer-
sity School of Medicine, Atlanta, Ga., on “Renal
Diseases and Disorders of Children;” and Col.
James B. Hartgering, Walter Reed Army Medical
Center, Washington, D. C., on “The Worldwide
Fall-Out of Nuclear Fission Products.” At the
afternoon session the lecturers and their subjects
are: Dr. Edward L. Compere, Northwestern Uni-
1250
EDITORIALS AND COMMENTARIES
Volume XI- IV
Number 11
versity Medical School, Chicago, 111., “Whiplash
Injuries of the Neck;” Dr. Robert F. Dickey,
Foss Clinic, Danville, Pa., “Common Dermatoses
Seen in Office Practice;” and Dr. Patterson,
“Chest Diseases in Childhood.” A question and
answer period closes this session.
Only morning sessions are scheduled for Friday
and Saturday. On Friday morning Dr. Compere
will lecture on “Upper Extremity Fractures,” Dr.
Dickey on “Dermal Manifestations of Diabetes
Mellitus,” and Dr. Hurst on “Cardiology — Di-
agnostic Points, Part II.” A question and answer
period will follow. On Saturday morning Dr.
George Crile Jr., Cleveland Clinic, Cleveland,
Ohio, and Col. Hartgering will be the featured
speakers. Dr. Crile’s two subjects are “Changing
Concepts in the Nature of Cancer” and “Cancer
of the Thyroid and Breast.” Col. Hartgering's
lecture is entitled “The Response of Man to Ioniz-
ing Radiation.”
An Impressive Record
After almost a half century of service to the
American Medical Association. Thomas R. Gard-
iner has given up his full time position as busi-
ness manager of that organization. Back in 1909,
at the age of 18, he sought a job at the A. M. A.
office and began his career there by making up ad
dummies for A. M. A. publications, checking ad-
vertising records and copy, and editing display
and classified ads. Since then he has handled
every phase of work in the advertising depart-
ment. Since 1913, when he took over technical
exhibits, the total annual revenue from that source
has increased 34 times. He was appointed busi-
ness manager in 1945, and since that time the
yearly advertising revenue has increased about
400 per cent.
Fortunately, the benefit of his invaluable ex-
perience will continue to be available for he will
stay on as a consultant on advertising and con-
ventions. His many friends may continue to look
forward to seeing him at the annual and clinical
meetings and may still seek his wise guidance at
A. M. A. headquarters in Chicago, where he will
maintain an office. During his long tenure of office
he has come to be known as “a fast-moving, un-
tiring worker, who has a knack for making friends
among doctors, advertisers, exhibitors, and fellow
employees.” The staff of The Journal of the Flor-
ida Medical Association salutes Tom Gardiner as
friend and counselor, congratulates him on his
impressive record of service and wishes him well
in his new advisory post.
His successor as Advertising Manager and Di-
rector of the Technical Exhibition is Robert J.
Lyon, who has assisted him for the last 11 years.
He may be counted on to follow in the footsteps
of his illustrious predecessor and make a distin-
guished record in his new post.
Another County Medical Society
Employs Lay Executive Secretary
Miss Sigman
The announcement of the Broward County
Medical Association that it has employed an Exec-
utive Secretary brings to five the number of com-
ponent county societies of the Florida Medical
Association now having a lay executive secretary.
This society is to be congratulated on taking this
step.
Chosen for this important post is Miss Sally
Jane Sigman, who starts her professional career in
this field at the age of 22. She is a graduate of
East High School in Cleveland, Ohio, and has been
employed as a medical secretary for four years.
She is a member of the National Secretaries As-
sociation and of the National Registry of Medical
Secretaries.
Executive secretaries of county medical socie-
ties have been invited to meet with Dr. Jere W.
Annis, President-Elect of the Florida Medical
Association, for breakfast Tuesday morning, May
13, at 8:00 in the Caribbean Room, Americana
Hotel. This will be the second Conference of Coun-
ty Medical Society Presidents and Secretaries held
in connection with the Association’s Annual Con-
vention.
T. Florida M.A.
May, 1958
1251
Pro-Banthine “proved almost invariably
effective in the relief of ulcer pain,
in depressing gastric secretory volume and in
inhibiting gastrointestinal motility
“Our findings were documented by an in-
tensive and personal observation of these
patients over a 2-year period in private prac-
tice, and in two large hospital clinics with
close supervision and satisfactory follow-up
studies.”*
Among the many clinical indications for
Pro-Banthine (brand of propantheline bro-
mide), peptic ulcer is primary. During
treatment, Pro-Banthine has been shown
repeatedly to be a most valuable agent when
used in conjunction with diet, antacids and
essential psychotherapy.
Therapeutic utility and effectiveness
of Pro-Banthine in the treatment of peptic
ulcer are repeatedly referred to in the recent
medical literature.
Pro-Banthine Dosage
The average adult oral dosage of Pro-
Banthine is one tablet (15 mg.) with meals
and two tablets at bedtime.
G. D. Searle & Co., Chicago 80, Illinois.
Research in the Service of Medicine.
*Lichstein. J.; Morehouse, M. G., and Osmon. K. L.:
Pro-Banthine in the Treatment of Peptic Ulcer. A
Clinical Evaluation with Gastric Secretory, Motil-
ity and Gastroscopic Studies. Report of 60 Cases,
Am. J. M. Sc. 232: 156 (Aug.) 1956.
s
1252
Volumk XLIV
Number 11
OTHERS ARE SAYING
The Problem and The Forand Bill
(Care of The Aged)
It has always been a tenet with me that, what-
ever the job. private enterprise can do it better
than any other method. Today, there are many
idea encroachments on that basic principle. Today,
we hear doctrines and plans, by which, supposedly,
all present problems are easily solved. Today we,
also, have a problem: How shall we care for the
aged ? The Forand Bill merges all of these, in
flood fashion, on the stage for a closer look, a
careful study.
Recently, while discussing some of the prob-
lems of indigent care with some of our profes-
sional lay people, I was amazed at some of the
prevailing attitudes. In mentioning that we need
at least 2 more million dollars a year to do a
good job at the County Hospital (Duval Medical
Center), I was told that our approach to indigent
care was archaic, behind the times, inefficient,
and costly. . . “Why, if you pass the Forand
Bill,” I was told, “we could take the current ex-
penditure for the medical center, buy insurance
policies for the remaining indigents and let pri-
vate practitioners care for the indigents under
insurance’ . . . “Protective insurance,” an insur-
ance friend continued, “is the way medicine in the
future *is to be financed, and the sooner everyone
realizes this the better off we will be”. . . Then
a lawyer friend mentioned the all-too-obvious
fact that Florida is a state that caters to the re-
tirement groups of people. He continued by re-
minding me that it is no secret that insurance
companies shy away from writing coverage for
the aged; that the actual cost of coverage for this
group (those over 65) is considerably higher than
for the young and middle-age groups. “Why
should Florida assume the financial obligation for
the indigent care of the aged when in actuality
this is a national obligation? It used to be, prior
to the age of rapid transit and flexibility in travel,
the aged were cared for in the home towns in
which they grew and gave their youthful talent;
now we in Florida inherit many of this group, a
group whose non-inflated retirement payments are
adequate for living but inadequate for modern
medical expenses — many fill our already over-
crowded indigent facilities. Why not accept the
Forand Bill and let the rest of the country help us
with this problem?”
MOUNT SINAI HOSPITAL OF GREATER MIAMI
ANNOUNCES
8TH ANNUAL POSTGRADUATE SEMINAR
“Recent Advances in Diagnosis and Therapy”
May 22-25, 1958 — Deauville Hotel — Miami Beach, Florida
PROGRAM
Herman L. Blumgart, M.D., Professor of Medicine, Harvard Medical School
1. “Clinicopathological Correlation of the Coronary Circulation”
2. “Relationship of Thyroid to Heart Disease”
Frederick Fitzherbert Boyce. M.D., Professor of Clinical Surgery, Tulane University School of Medicine
1. “Iirmroved Outlook of Carcinoma of Stomach”
2. “New Concepts in Surgery of Biliary Tract and Pancreas”
Dwight Harken. M.D., Associate Clinical Professor of surgery, Harvard Medical School
1. "New Horizons in Heart Surgery”
2. "Surgery of Acquired Valvular Disease”
Robert M. Kark. M.D., Professor of Medicine, University of Illinois College of Medicine
1. "Clinical Value of Renal Biopsy"
2. “Disease Associated with Alcoholism”
3. "Medicine and Nutrition in Arab Kingdom of Libya" (Movie)
Hans Popper, M.D., Director of Pathology, The Mount Sinai Hospital, New York; Professor of Pathology, Columbia
University
1. “Clinicopathological Correlation in Hepatitis"
2. "Pathways of the Formation of Hepatic Cirrhosis”
Steven O. Schwartz, M.D., Attending Hematologist, The Hektoen Institute for Medical Research of the Cook County
Hospital, Chicago
1. “Present Concept of Pernicious Anemia and Pernicious Anemia-like Diseases”
2. "Value of Clinical Observation in the Diagnosis of Hematologic Diseases”
Leroy D. Vandam, M.D., Clinical Professor of Anesthesia, Harvard Medical School
1. "Present Status of Hypothermia in Anesthesia and Surgery”
2. "Problems in Anesthesia for Patients with Heart Disease”
SYMPOSIUM (1) SYMPOSIUM (2)
“Unusual Surgical Emergencies" "Critique of Recent Approaches to Heart Disease"
Frederick Fitzherbert Boyce, M.D., Moderator Herrman L. Blumgart, M.D., Moderator
Dwight Harken. M.D. Robert M. Kark, M. D.
Leroy D. Vandam, M.D. Dwight Harken, M.D.
George R. Prout, M.D., Assistant Professor of Urology, Hans Popper. M.D.
University of Miami School of Medicine Robert Boucek, M.D., Associate Professor of Medicine.
University of Miami School of Medicine
REGISTRATION FEE: $20 — Mail check to Medical Secretary, Mount Sinai Hospital. No charge for medical students,
jnterns and residents.
Approved for Category I, American Academy of General Practice
J. Florida M.A.
May, 1958
1253
Then another chimed in, and wanted to know
why some insurance policies gave better protection
than Blue Shield and Blue Cross with less pre-
miums. I thought of Blue Cross’ Phililoo Bird pre-
sentation and how some insurance companies walk
off with the good, top-of-the-mountain risks leav-
ing Blue Cross and Blue Shield with the poor,
down-in-the-valley risks. Is this private enter-
prise, I thought. Is this private enterprise for the
Blue plans to yell from the hill tops, singing the
blues “you have the good risks, we are stuck with
the poor,” all to the tune of “I get the neck of the
chicken.” Isn’t private enterprise free, fair com-
petition, sung more to the tune of “anything you
can do I can do better?” — let’s participate.
One could spend hours arguing and debating
the truths or non-truths of the aforementioned
assertions and use up many reams with counter
arguments. Really and truly, we would not be
touching the real problem — the real problem is
care for the aged indigent.
There is little doubt that private enterprise
can handle this problem, better than the Forand
Bill, better than government intervention, better
than the present system. We must care for the
aged’s medical problems. Each of us is a human-
itarian. Surely our humanism will force the com-
placency of free enterprise to solve this problem.
The aged indigent will be cared for, better than
he is cared for today, without government inter-
vention.
Much can be done by private insurance com-
panies, the Blue Plans included, offering to the
old people benefit of voluntary health insurance.
Yes, if necessary, cover everyone up to the age
of a hundred and ten. Impossible!. . . . no!. . . .
By prorating over the general population and at
the same premium this can be accomplished. This,
of course, may require some control, but not near-
ly the dictatorial control of government regimented
medicine. Perhaps, a high commissioner of medi-
cal insurance, selected by insurance companies,
could be set up to help prorate the risk more
equitably, over the entire population. Each com-
pany would be required to accept the poorer risk
in equal ratios to the good. A precedent has been
set in the handling of workman’s compensation
risks. Whenever the “steeple jacks” and “ground
hogs” have trouble getting coverage, the work-
man’s compensation insurance commissioner pro-
rates fairly and equally over the entire insurance
industry these poor-risk groups. In the field of
Twenty-two years devoted exclusively to the design and
production of the world’s choicest electronic medical-surgical
equipment is now culminated in the presentation of
this new — finest of all, electrocardiograph.
a
completely new
NEW
electro-
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Department FM-558
4371 Valley Boulevard, Los Angeles 32, California
Please send me descriptives detailing
the 19 new engineering features found exclusively
in your all-new Electrocardiograph
Dr.
Address
City Zone State
Unusual Antibacterial and Anti -infective Properties. More rapid ab-
sorption . . . higher and better sustained plasma concentrations . . . more
soluble in acid urine than other sulfonamides . . . freedom from crystal-
luria and absence of significant accumulation of drug, even in patients
with azotemia. 1
Unprecedented Low Dosage. Less sulfa for the kidney to cope with . . .
yet fully effective. A single daily dose of 0.5 to 1.0 Gm. (1 to 2 tablets)
maintains higher plasma levels than 4 to 6 Gm. daily of other sulfonamides
— a notable asset in prolonged therapy. 2
New Control Over Sulfonamide-sensitive Organisms. Kynex maintains
the prolonged, high tissue concentrations of primary importance in treat-
ment of urinary infections ... a therapeutic asset toward preventing
manifest pyelonephritis as a complication of persistent bacteriuria during
pregnancy and puerperium. Maintenance of sterile urine in such patients
was accomplished with 1 tablet of Kynex daily. 3
Dosage: The recommended adult dose is 1 Gm. (2 tablets) the first day,
followed by 0.5 Gm. (1 tablet) every day thereafter, or 1 Gm. every other
day for mild to moderate infections. In severe infections where prompt,
high blood levels are indicated, the initial dose should be 2 Gm. followed
by 0.5 Gm. every 24 hours. Dosage in children, according to weight; i.e., a
40 lb. child should receive of the adult dosage. It is recommended that
these dosages not be exceeded.
KYNEX -WHEREVER SULFA THERAPY IS INDICATED
Tablets: Each tablet contains 0.5 Gm. (7}/£ grains) of sulfamethoxypyri-
dazine. Bottles of 24 and 100 tablets.
Syrup: Each teaspoonful (5 cc.) of caramel-flavored syrup contains 250
mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
References: 1. Grieble, H. C. and Jackson, G. G.: Prolonged Treatment of Urinary-Tract Infections
with Sulfamethoxypyridazine. New England J. Med. 258:1-7, 1958. 2. Editorial New England J. Med.
258:48-49,1958. 3. Jones, W. F., Jr.and Finland, M., Sulfamethoxypyridazine and Sulfachloropyridazine.
Ann. New York Acad. Sc. 60:473-483, 1957.
♦Reg. U. S. Pat. Ofl.
LEOERLE LABORATORIES
a Division of
AMERICAN CYANAMID COMPANY
Pearl River, NewYork
1256
Volume XLIV
Number 11
sports, particularly baseball, many of their prob-
lems are solved by the coordinated efforts of such
a commissioner.
Surely, with more standardization of private
voluntary insurance we can solve our problem in
a free enterprise economy. If we ignore the prob-
lem, hoping for it to solve itself, we’ll find our-
selves swamped in the current sea of socialism.
Reutherian “logic” will engulf the modern practice
of medicine. This last remaining island of free
enterprise need not have a fading coastline, pro-
viding we act now and save ourselves the headache
of continued procrastination.
Attention should be given the comprehensive
or single major medical insurance as recently
outlined by Dr. Elmer Hess in the February 1,
1958, issue of the J. A. M. A. This plan essentially
includes a $25.00 deductible provision with the
patient paying 15% of the excess of expense
over $225.00 Proverbially, we remind ourselves to
keep our eye upon the doughnut and not upon
the hole.
Let us keep at all times our eye upon the
problem! In this case it is the care of the aged.
Solve the problem by private free enterprise means
and the Forand Bill will have no basis in fact,
for passage.
E. F. F. Jr.
Monthly Bulletin, Duval County Medical
Society
March, 1958
Former Grady Hospital House Staff
An organization is being formed of all former
members of the house staff of Grady Memorial
Hospital, Atlanta. Two years ago, letters were
sent to most former house officers, however, some
were excluded because of incomplete addresses. If
you did not receive a notice, or failed to reply,
please contact Grady Hospital Clinical Society.
Office: G-610, 80 Butler Street, S. E., Atlanta.
MICROSCOPE REPAIR
SERVICE
Microscopes, pHmeters, balances,
colorimeters, microtomes, etc.
Factory authorized repairs for
B.&L., A.O., Zeiss, Becker, etc.
PRECISION INSTRUMENTS
30 KINGS COURT, SARASOTA, FLA.
Phone: RIngling 7-2687
Write for shipping instructions
and containers.
STATE NEWS ITEMS
A five day Seminar on Care of Premature In-
fants is being held May 19-23 at the Premature
Demonstration Center, University of Miami
School of Medicine, Jackson Memorial Hospital.
Miami. It will consist of a series of demonstrations
and lectures on various phases of premature care.
Included are demonstrations of equipment and
its use, discussions on feeding, skin care, infection
and handicaps of prematurity and the newer
developments regarding infection in nurseries.
There will be specific suggestions regarding home
care, parents instructions and nursery set-ups.
Applications and additional information are avail-
able from the Bureau of Maternal and Child
Health, Florida State Board of Health, P.O. Box
210, Jacksonville.
Dr. Jere W. Annis of Lakeland, President-
elect of the Florida Medical Association, address-
ed a group in Dunedin recently on the subject
“Modern Medical Education.”
Drs. Donald W. Smith and James J. Griffitts
of Miami, and Dr. George T. Harrell Jr. of Gaines-
ville appeared on the program of the 104th Annual
Session of the Medical Association of Georgia
held April 27-30 at Macon. Drs. Smith and
Griffitts presented "Blood Replacement and Trans-
fusion Reactions” at the Orthopedics, Surgery,
Anesthesiology, Pathology and Industrial Surgery
Joint Section on April 28. Dr. Harrell discussed
“LTrinary Infections in Diabetes” at the Medicine,
Chest, Diabetes and EENT Joint Section held
Tuesday morning. April 29, and Dr. Griffitts pre-
sented a paper on "‘Erythroblastosis” at the Ob-
stetrics and Gynecology, General Practice, and
Pathology Joint Section on Tuesday afternoon.
RADIUM
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician.Radiologist)
HAROLD SWANBERG, B.S., M.D., Director
W. C. U. Bldg. Quincy, Illinois
J. Florida M.A.
May, 1958
1257
. . . without the necessity of dietary restrictions,.
'Cytellin’ provides the most rational
and practical therapy available.
Without any dietary adjustments,
it lowers elevated serum cholesterol
concentrations in most patients.
In a number of studies, every
patient who co-operated obtained
good results from 'Cytellin’ ther-
apy. On the average, a 34 percent
reduction of excess serum choles-
*‘Cytellin' (Sitosterols, Lilly)
terol (over 150 mg. p§,
been experienced.
In addition b
cholesteremi
reported Jdeffect
ratio, Sf
proteins,
lipoproteins, \nd toteflipids.
May we senchtQffre complete infor-
mation and bibliography ?
lpo-
beta
ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S. A.
873009
1258
Volume XLIV
Number 11
Dr. Sherman B. Forbes of Tampa has recent-
ly been appointed Florida State Chairman of the
Professional Advisory Committee to the National
Society for the Prevention of Blindness.
Dr. Nelson A. Murray of Jacksonville has
been awarded a grant by the American Cancer
Society for the continued investigation of a
microscopic electronic scanner and computer.
The Second Interamerican Conference on
Occupational Medicine and Toxicology will be
held in Miami August 18-22. It is sponsored joint-
ly by the medical schools of the Universities of
Miami and Havana. With proceedings entirely in
Spanish, the Conference will bring together spe-
cialists in occupational medicine and toxicology
from a dozen Latin American countries, as well
as physicians and industrial hygienists of many
American industries with interests in Central and
South America.
Dr. J. Harold Newman of Jacksonville was
among the group of Florida physicians attending
the meeting of the American Urological Asso-
ciation held the latter part of April in New Or-
leans.
Dr. Richard T. Farrior of Tampa will present
a paper entitled “Cancer and Reconstructive Sur-
gery of the Head and Neck” on the program of
the Section on Laryngology. Otology and Rhinol-
ogy of the American Medical Association during
the annual meeting being held June 23-27 at San
Francisco.
Dr. Harold D. Van Schaick of Miami Beach
has accepted the chairmanship of the 1958 Florida
Cancer Crusade.
The 54th annual meeting of the National
Tuberculosis Association and the 53rd annual
meeting of the American Trudeau Society is being
held May 18-23 at Philadelphia. Among Florida
physicians on the program are Dr. Eunice M.
Lasche of Tampa, and Dr. Albert V. Hardy of
Jacksonville.
(State News Items are continued on page 1264)
and inflammation
withBUFFERir
IN ARTHRITIS
salicylate benefits with
minimal salicylate drawbacks
Rapid and prolonged relief — with less intoler-
ance. The analgesic and specific anti-
inflammatory action of Bufferin helps re-
duce pain and joint edema— comfortably.
Bufferin caused no gastric distress in 70
per cent of hospitalized arthritics with
proved intolerance to aspirin. (Arthritics
are at least 3 to 10 times as intolerant to
straight aspirin as the general population.1)
No sodium accumulation. Because BUFFERIN is
sodium free, massive dosage for prolonged
periods will not cause sodium accumula-
tion or edema, even in cardiovascular cases.
Each sodium-free Bufferin tablet contains acetyl-
salicylic acid, 5 grains, and the antacids magnesium
carbonate and aluminum glycinate.
Reference: 1. J.A.M.A. 158:386 (June 4) 1955.
Bristol-Myers Company
19 West 50 St., New York 20, N. Y
"Most likely candidate
for ORINASE"
more than
000 diabetics enjoy
oral therapy B| 9 Mi If {
now
| Upjohn J
TRADEMARK, REQ. U S. PAT OFT. — TOLBUTAMIOE. UPJOHfl
1260
1 . Recurrent joint pain followed by
long- periods of complete remis-
sion. (Percentages refer to inci-
dence.)
SERUM URIC ACID
CONCENTRATION
3. Elevated serum uric acid levels.
Volume XLIV
Number 11
2. Enlargement of bursae such as in
this case involving the olecranon
bursa.
mg.) every 1 to 2 hours until pain
is relieved or nausea, vomiting or
diarrhea occur. The test requires
usually 8 to 16 doses. Pain relief
is highly indicative of gout.
FROM THESE FINDINGS... SUSPECT GOUT:
^BENEMID
PROBENECID
A SPECIFIC FOR GOUT
Once findings point to gout, long-term management can be started
with Benemid. This effective uricosuric agent has these unique
benefits:
• Urinary excretion of uric acid is approximately doubled.
• Serum uric acid levels are reduced.
• Uric acid deposits (tophi) in tissues are mobilized.
• Formation of new tophi can often be prevented.
• Fewer attacks and severity is reduced.
RECOMMENDED DOSAGE: 0.25 Gm. (% tablet) twice daily for
one week followed by 1 Gm. (2 tablets) daily in divided doses.
Benemid i« u trade-mark of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
J. Florida M.A.
May, 1958
1261
there is one tranquilizer clearly indicated ill pBptiC lllCSI*...
*Tests in a series of 25 patients show that
there is “a definite and distinct lowering
[of both volume of secretions and of free
hydrochloric acid] in the majority of
patients. . . . No patients had shown any
increase in gastric secretions following ad-
ministration of the drug.”1
Now you have 4 advantages when
you calm ulcer patients with atarax:
1. atarax suppresses gastric secretions;
others commonly increase acidity.
2. atarax is “the safest of the mild tran-
quilizers.”2 (No parkinsonian effect
or blood dyscrasias ever reported.)
3. It is effective in 9 of every 10 tense
and anxious patients.
4. Five dosage forms give you maximum
flexibility.
supplied: 10, 25 and 100 mg. tablets, bottles of
100. Syrup, pint bottles. Parenteral Solution,
10 cc. multiple. dose vials.
references: 1. Strub, I. H. : Personal commu-
nication. 2. Ayd, F. J., Jr.: presented at Ohio
Assembly of General Practice, 7th Annual
Scientific Assembly, Columbus, September 18-
19, 1957.
New York 17, New York
Division, Chas. P/iser & Co., Inc.
for
vaginal
douching
that is
physiologically
sound
ethically 'promoted
Meta
Cine
vaginal douche, powder
Meta Cine represents a carefully designed formula which provides the
physician with a vaginal douche preparation which safely and effectively
maintains a clean healthy vagina.
Meta Cine is a combination of several ingredients clinically established as
valuable in promoting proper vaginal hygiene. Diluted for use, Meta Cine
possesses the desired pH (3.5); contains the mucus digestant, papain, which
dissolves mucus plugs and coagulum ; contains lactose to promote growth of
desirable doderlein bacilli, and methyl salicylate for soothing stimulation of
circulation within the vaginal walls.
Its pleasant, deodorizing fragrance also meets the esthetic demands
of your patients.
Meta Cine is promoted exclusively to the medical profession, and recommends
itself as your preparation of choice for patients who might otherwise indulge
in unsupervised self-medication with potentially damaging nonphysiologic
douches.
Supplied in 8-oz. containers. 2 teaspoonfuls in 2 quarts of warm water,
douche as prescribed.
Printed douching instructions for patients available upon request.
BRAYTEN Pharmaceutical Company • Chattanooga 9, Tennessee
m
J. Florida M.A.
May, 1958
1263
Give Us Your Transportation Worries
OUR BENEFITS
TO YOU ARE
COMPLETE
RELEASE OF CAPITAL
New Automobiles
Any Make
No Worries Over
Taxes . . . Fees
Service Cost
Insurance
Repairs
License Fees
Towing Cost
Anti-Freeze
Battery Replacements
Tire Replacements
Inspection Registration
Fees
Piedmtht
Plan
FOR THE
MEDICAL
PROFESSION
EXCLUSIVELY
For Most of You, All This
is 100% Tax Deductible
WE COVER
YOU WITH—
LIABILITY INSURANCE
of, 100,000/300,000
Bodily injury and
50,000 for Property
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With 100% Coverage
On Collision, Fire
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and $2,000 Medical
Payment
If Your Car
Is Out of Service, You
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Replacement
All Repairs, Tire &
Battery Replacement
Are Purchased In
Your Home Town
We are as near as your Telephone!
If You Would Like to Have Our Doctor’s Leasing Plan Explained to You In Detail,
Please Call or Write. We will Manage to Have One of Our Representatives Call
On You at Your Convenience.
Piedincht
Auto and Truck Rental, Inc.
P. O. BOX 427 212 MORGAN STREET
DURHAM, NORTH CAROLINA PHONE 2-8151
G. B. Griffith, President
1264
Volume XLIV
Number 11
( Continued from page 1258 )
The ninth annual publication of “Reviews of
Medical Motion Pictures” is now available on
request from the Film Library of the American
Medical Association. This publication is prepared
by the Council on Scientific Assembly, Motion
Pictures and Medical Television and contains
reprints of all film reviews published in The
Journal of the American Medical Association dur-
ing 1957.
Dr. Sidney Davidson of Lake Worth has been
reappointed Governor for the State of Florida of
the American Diabetes Association. The appoint-
ment is for a three year term expiring in June,
1960.
Dr. James B. Hodge Jr. of Tampa has been
installed as president of the Hillsborough County
Academy of General Practice. Serving with Dr.
Hodge are Dr. Collin F. Baker Jr., vice president,
and Dr. Robert H. Owrey, secretary-treasurer.
Drs. Samuel H. Adams and Lester L. Zipser are
new members of the board of directors. The
physicians are from Tampa.
Dr. John E. Daughtrey of Lakeland, vice
president of the Polk County Medical Association,
was principal speaker at recent commencement
exercises for Polk County’s School of Practical
Nursing held at Central School in Winter Haven.
Dr. George W. Karelas of Newberry has been
honored by the Lions Club there “for his unselfish
service to the community and his devotion to
duty” and particularly for his work as chairman
of the Committee on Rural Health of the Ameri-
can Academy of General Practice.
Dr. Roy W. Brown of Belle Glade was guest
speaker at a recent meeting of the Civitan Club
of that city. He explained the relationship between
the local hospital, the physicians and the com-
munity.
Dr. Erasmus B. Hardee of Vero Beach repre-
sented the Florida State Board of Medical Exam-
iners at the meeting of the Federation of State
Boards of Medical Examiners held in Chicago.
Dr. Harry G. Brownlee of Zephyrhills discuss-
ed diseases of the coronary arteries and trends in
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
m
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HOSPITAL, PHYSICIANS and LABORATORY SUPPLIES t EQUIPMENT
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Orlando
329 N. Orange Ave.
Telephone 5-3537
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FOR PAIN
Percodan
®
(Salts of Dihydrohydroxycodeinone
and Homatropine, plus APC)
TABLETS
ACTS FASTER...
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LASTS LONGER . . .
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AVERAGE ADULT DOSE: 1 tablet every 6 hours. May
be habit-forming. Available through all pharmacies.
Each Percodan* Tablet contains 4.50 mg. dihydrohydroxyco-
deinone hydrochloride, 0.38 mg. dihydrohydroxycodeinone
terephthalate, 0.38 mg. homatropine terephthalate, 224 mg.
acetylsalicylic acid, 160 mg. phenacetin, and 32 mg. caffeine.
ENDO LABORATORIES
Richmond H 1 1 1 1 8, N ew Yo rk
AND THE PAIN
WENT AWAY FAST
*U.S. Pat. 2,628,185
1266
Voi.UME XI. IV
Number II
the treatment of cardiac patients at a recent meet-
ing of District 26, Florida Nurses Association,
held at Dade. City.
Dr. Harold B. Canning of Wewahitchka was
given a surprise party by residents of that city in
celebration of his birthday. The recent affair, held
in the Community Building, was attended by
approximately 200 persons and featured were
tributes to Dr. Canning by community leaders.
He was elected mayor of the city last year by the
largest majority ever given any candidate.
A postgraduate refresher course to be held in
Hawaii and on board the S. S. Matsonia August
5-21 is being offered by the University of South-
ern California School of Medicine. All sessions
have been scheduled for week day mornings and
several programs will be given simultaneously in
order that each physician may have the opportu-
nity to choose the subject most valuable to him.
Information may be obtained from the Director of
the Postgraduate Division, USC School of Medi-
cine, 2025 Zonal Ave., Los Angeles 33. Calif.
The 1958 meeting of the American Goiter
Association is being held June 17-19 in the St.
Francis Hotel at San Francisco. The program
for the meeting will consist of papers and dis-
cussions dealing with the physiology and diseases
of the thyroid gland.
Dr. Robert Y. H. Thomas of Jacksonville dis-
cussed “The Importance of the Industrial Physi-
cian” at the first state-wide conference on “The
Problem Drinker in Industry” held April 10-11
at the J. Hillis Miller Health Center, University
of Florida, Gainesville. The Florida Medical As-
sociation cooperated in sponsoring the conference
with the Florida State Board of Health, Florida
Alcoholic Rehabilitation Program, Florida Feder-
ation of Labor, Florida Industrial Commission,
Associated Industries of Florida and the General
Extension Division of the University of Florida.
Dr. Ralph \Y. Jack of Miami, 1st Vice Presi-
dent of the Florida Medical Association, repre-
sented the Association at the annual convention
of the Florida League of Nursing held April 10
at Miami.
Dr. Jere W. Annis of Lakeland, President-
Elect of the Florida Medical Association, was
principal speaker at a meeting of the Dunedin
Rotary Club on April 22. His subject was medi-
cal education.
OUR
EXPERIENCE IS VALUABLE TO YOU
CONSULT US FOR INFORMATION ON---
1. DIATHERMY EQUIPMENT
2. ELECTROCARDIOGRAPHS
3. ANESTHETIC EQUIPMENT
4. HAMILTON FURNITURE
5. RITTER TABLES
6. HOSPITAL STERILIZERS AND LIGHTS
7. ANY OTHER NEEDS YOU HAVE
ASIA
ica
SUPPLY COMPANY
1050 W. Adams St. P. O. Box 2580 Jacksonville, Fla.
T. B. SLADE, JR. J. BEATTY WILLIAMS
1267
J. Florida
May, 1958
M.A.
running noses . .
caused by
pollen allergies
TRIAMINIC stops rhinorrhea, congestion and
other distressing symptoms of summer allergies,
including hay fever. Running nose, watery eyes
and sneezing are best relieved by antihistamine
plus decongestant action — systemically — with
Triaminic.
This new approach frequently succeeds where
less complete therapy has failed. It is not enough
merely to use histamine antagonists; ideally,
therapy must be aimed also at the congestion of
the nasal mucosa. Triaminic provides such ef-
fective combined therapy in a single timed-
release tablet.
Triaminic provides around-the-clock
freedom from allergic congestion with
just one tablet t.i.d. because of the
special timed-release design.
first— 3 to 4 hours of relief
from the outer layer
then— 3 to 4 more hours of relief
from the inner core
Triaminic brings relief in minutes— lasts for
hours. Running noses stop, congested noses
open— and stay open for 6 to 8 hours.
Dosage: One tablet in the morning, mid-after-
noon and at bedtime. In postnasal drip, one
tablet at bedtime is usually sufficient.
Each timed-release TRIAMINIC Tablet contains:
Phenylpropanolamine HC1 50 mg.
Pheniramine maleate 25 mg.
Pyrilamine maleate 25 mg.
TRIAMINIC FOR THE PEDIATRIC PATIENT
TRIAMINIC Juvelets*, providing easy-to-swal-
low half-dosages for the 6- to 12-year-old child,
with the timed-release construction for pro-
longed relief.
'Trademark
TRIAMINIC Syrup, for those children and
adults who prefer a liquid medication. Each
5 ml. teaspoonful is equivalent to V\ Triaminic
Tablet or >/2 Triaminic Juvelet.
r w "\ * • • ®
1 namimc
SMITH-DORSEY .a division of The Wander Company. Lincoln, Nebraska .Peterborough, Canada
1268
Volume XLIV
Number 11
IN ALL DIARRHEAS . . . REGARDLESS OF ETIOLOGY
comprehensive control
with
CREMOMYCIN
SOOTHING ACTION . . . Kaolin and pectin coat and soothe the inflamed mucosa, ad-
sorb toxins and help reduce intestinal hypermotility.
BROAD THERAPY . . . The combined antibacterial effectiveness of neomycin and
Sulfasuxidine is concentrated in the bowel since the absorption of both agents
is negligible.
LOCAL IRRITATION IS REDUCED and control is instituted against spread of infective
organisms and loss of body fluid.
PALATABLE creamy pink, fruit-flavored CREMOMYCIN is pleasant tasting, readily
accepted by patients of all ages.
* Sulfasuxidine is a trade-mark of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
J. Florida M.A.
May, 1958
1269
NOW.. .A NEW TREATMENT
4
CARDILATE
‘Cardilate' tablets ? ° shaped for easy retention
in the buccal pouch
. . the degree of increase in exercise tolerance which sublingual ery-
throl tetranitrate permits, approximates that of nitroglycerin, amyl
nitrite and octyl nitrite more closely than does any other of the approxi-
mately 100 preparations tested to date in this laboratory.”
"Furthermore, the duration of this beneficial action is prolonged suffi-
ciently to make this method of treatment of practical clinical value.”
Riseman, J. E. F., Altman, G. E., and Koretsky, S.:
Nitroglycerin and Other Nitrites in the Treatment of
Angina Pectoris. Circulation (Jan.) 1958.
♦‘Cordilate’ brand Erythrol Tetranitrate SUBUNGUAL TABLETS, 15 mg. stored
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
1270
Volume XI.IV
Number 11
COMPONENT SOCIETY NOTES
Collier
Dr. Frank M. Bryan of Fort Myers was the
principal speaker for the February meeting of the
Collier County Medical Society held at the Naples
Community Hospital. The title of his address was
“The Diagnosis and Management of Early
Coronary-Artery Disease.”
Dade
Dr. Chester Cassel of Miami discussed “Cancer
Detection in Dade County: Report of a Survey”
at the April meeting of the Dade County Medical
Association.
Duval
Dr. Emerson Day, Director of the Strang Can-
cer Detection Clinic, New York City, was guest
speaker on the program of the April meeting of the
Duval County Medical Society. Dr. Day discussed
“The Application of Vaginal Cytology in a Com-
munity-Wide Project.”
Franklin-Gulf
The Franklin-Gulf County Medical Society
has paid 100 per cent of its state dues for 1958.
Hillsborough
A panel discussion of the subject “Proposed
Blue Shield Changes” was the feature of the April
meeting of the Hillsborough County Medical
Association. Panel members included Drs. William
C. Blake, C. Frank Chunn, Hershel G. Cole and
David R. Murphrey Jr., all of Tampa. Mr. H. A.
Schroder of Jacksonville, executive director of
Blue Shield-Blue Cross, was present to comment
and answer questions.
Lake
The March meeting of the Lake County Medi-
cal Society was held at the Alt. Plymouth Hotel
at Mount Dora. Speaker for the evening was Dr.
Jack H. Bowen of Jacksonville who discussed
tumors of the skin.
Marion
The March meeting of the Marion County
Medical Society was held at the Ocala Municipal
Country Club at Ocala. Principal speaker was Mr.
Richard Mills of Ocala, an attorney, who discussed
the ramifications of malpractice.
Nassau
The Nassau County Medical Society has paid
100 per cent of its state dues for 1958.
Doctors, too,
The reasons are fairly simple. Doctors
like “Premarin,” in the first place, be-
cause it really relieves the symptoms of
the menopause. It doesn’t j ust mask them
— it replaces what the patient lacks —
natural estrogen.
Furthermore, if the patient is suffer-
ing from headache, insomnia, and arth-
ritic-like symptoms before the menopause
and even after, “Premarin” takes care
of that, too.
Women, of course, like “Premarin,”
too, because it quickly relieves their
symptoms and gives them a “sense of
well-being.”
“PREMARIN’’
conjugated estrogens (equine)
Ayerst Laboratories
New York 16, New York
Montreal, Canada
5941
T. Florida M.A.
May, 1958
1271
C! FETIST + (3
(PENTAERYTHRITOL TETRANITRATE) (8RAN0 OF HYDROXYZINE)
why petn?
For cardiac effect: PETN is . the most effective drug
currently available for prolonged prophylactic treatment
of angina pectoris.”1 Prevents about 80% of anginal attacks.
Why ATARAX?
For ataractic effect: One of the most effective— and probably
the safest— of tranquilizers, atarax frees the angina patient
of his constant tension and anxiety. Ideal for the on-the-job
patient. And atarax has a unique advantage in cardiac
therapy: it is anti-arrhythmic and non-hypotensive.
why combine the two?
NEW YORK 17. NEW YORK
Division, Chas Pfizer & Co.. Inc.
•Trademark
For greater therapeutic success: In clinical trials, cartrax
was demonstrably superior to previous therapy, including
PETN alone. Specifically, 87% of angina patients did better.
They were shown to suffer fewer attacks . . . require less
nitroglycerin . . . have increased tolerance to physical effort
. . . and be freed of cardiac fixation.
1. Russek, H. I.: Postgrad. Med. 19: 562 (June) 1956.
Dosage and Supplied: Hegin with 1 to 2 yellow cartrax "10”
tablets (10 mg. pf.tn plus 10 mg. atarax) 3 to 4 times daily.
When indicated this may be increased by switching to pink cartrax
'‘20” tablets (20 mg. petn plus 10 mg. atarax.) For convenience,
write “cartrax 10” or "cartrax 20.” In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on a
continuous dosage schedule. Use PETN preparations with caution
in glaucoma.
HOCH
H C CH — CHCH = CH,
■2HCI*2M,0
QUININE
ATABRINE*
HYDROCHLORIDE
ARALEN
PHOSPHATE
I
I
J. Florida M.A.
May, 1958
1273
Orange
The Orange County Medical Society has paid
100 per cent of its state dues for 1958.
Pasco-Hernando-Citrus
Dr. William C. Roberts of Panama City, Pres-
ident of the Florida Medical Association, was
principal speaker on the program for the March
meeting of the Pasco-Hernando-Citrus County
Medical Society.
Pinellas
Dr. J. Rocher Chappell of Orlando, Chairman
of the Committee on Civil Defense and Disaster
of the Florida Medical Association, was principal
speaker for the April meeting of the Pinellas
County Medical Society. Dr. Chappell discussed
“Medical Aspects of Civilian Defense.”
Polk
Dr. Harold Carron of Tampa was guest speak-
er on the program of the February meeting of the
Polk County Medical Association. The meeting
was held at the Haven Hotel in Winter Haven.
Dr. Carron discussed “The Place of Hypnosis in
Modern Medicine.” Dr. Albert G. King Jr. of
Lakeland was in charge of the program.
Putnam
Dr. William C. Thomas Jr., Director of the
Division of Postgraduate Education, College of
Medicine, University of Florida, was guest speak-
er at the February meeting of the Putnam County
Medical Society. Dr. Thomas discussed the pro-
gram of postgraduate medical education of the
University and showed photographs and plans of
the development of the medical college.
Seminole
The Seminole County Medical Society has paid
100 per cent of its state dues for 1958.
Volusia
Dr. Luther W. Brady Jr., Hospital of the
University of Pennsylvania, Philadelphia, discuss-
ed “Carcinoma of the Breast” at the March
meeting of the Volusia County Medical Society.
County medical society presidents and secre-
taries have been invited to meet with Dr. Jere W.
Annis, President-Elect of the Florida Medical
Association, for breakfast Tuesday, May 13, at
8:00 in the Caribbean Room, Americana Hotel.
This will be the second Conference of County
Medical Society Presidents and Secretaries.
kTORIC DERMATITIS . ECZEMAS • SEBORRHEA • ANOGENITAL PRURITUS • DERM ATITIS VENENATA • PSORIASIS
PERFORMANCE WITH
GREATER PERMANENCE
IN THE MANAGEMENT
OF DERMATOSES...
(Regardless of Previous Refractoriness)
Confirmed by
an impressive and
growing body of published
clinical investigations
JL cream
Hydrocortisone 0.5% and Special Coal Tar Extract 5%
(TARBONIS®) in a greaseless, stainless vanishing cream base.
JLJJ JLL ointment
Hydrocortisone 0.5%, Neomycin 0.35% (as Sulfate) and Special
Coal Tar Extract 5% (TARBONIS) in an okitment base.
*
J.A.M.A. tee : 158,1 958 ; Welsh, A. L. and Ede.M.
...prompt remissions of ...acute phases."
with TARCORTIN
REED A CARNRICK / Jersey City 6. New Jersey
*
1. Clyman, S. G. : Postgrad. Med. 21:309, 1967.
2. Bleiberg, J.: J. M. Soc. New Jersey :37, 1956. **
3. Abrams. B. R, and Shaw, C. : Clin. Med. $:839, 1956.
4. Welsh, A. L.. and Ede. M. : Ohio State M. J. 50: 837, 1964,
6. Bleiberg, J.: Am. Practitioner £:1404, 1957.
s function
Milpath
Mil town" + anticholinergic
Milpatli acts quickly to suppress hypermotility,
hypersecretion and spasm, and to allay anxiety and
tension. The loginess, dry mouth and blurred vision
so characteristic of some barbiturate-belladonna
combinations are minimal with Milpath.
Formula. eacj1 SCOred tablet contains: meprobamate 400 mg., tridihexethyl iodide 25 ni|
1 tablet t.i.d. with meals and 2 tablets at bedtime.
Dosage ,
WALLACE LABORATORIES
J. Florida M.A.
May, 1958
1275
THE FINE NEW ELECTROCARDIOGRAPH
THE VERSATILE ELECTROCARDIOGRAPH
The “Versa-Scribe” is a completely new
instrument offering features of conven-
ience, superior performance and versa-
tility not now available in any other
portable direct-writing Electrocardio-
graph.
Use of the most modern electronic
techniques, including transistors and
printed circuits, combined with the
craftsmanship of skilled instrument
makers of long experience, has not only
made possible a superior performing
electrocardiograph, but one possessing
fine appearance, small size (534" x 1034"
x 17"), and low weight— 20 pounds.
Send for literature or a demonstra-
tion, Doctor. The “Versa-Scribe” will
be your “electrocardiograph of choice.”
CAMBRIDGE
ALSO MAKES
the “Simpli-Scribe” Direct
Writing Electrocardiograph
shown, the “Simpli-Trol”
Portable Model, Multi-
Channel Recorders, Pulmo-
nary Function Tester, Oper-
ating Room Cardioscopes,
Educational Cardioscopes,
Electrokymographs, Ple-
thysmographs, Amplifying Stethoscopes, Research
pH Meters, Automatic Continuous Blood Pressure
Recorders and Instruments for Measuring Radio-
activity. .
KELEKET X-RAY OF FLORIDA
Miami 32, 511 N.E. 15th St. — Phone PR 9-4523
West Palm Beach, 524 Gardenia St. — Phone TE 2-8849
Tampa 6, 800 Grand Central — Phone 8-3565
Orlando, 2430 E. Robinson Ave. — Phone 2-2963
Jacksonville 8, 1831 Pearl St. — Phone EL 6-5781
PIONEER MANUFACTURERS OF THE ELECTROCARDIOGRAPH
CAM B R IDGE
ELECTROCARDIOGRAPHS
1276
Volume XLIV
Number 11
m
EDEMA
Start therapy with one or two 500 mg .
tablets of 'diuriu once or twice a day .
BENEFITS:
• The only orally effective nonmercurial agent
with diuretic activity equivalent to that of the
parenteral mercurials.
• Excellent for initiating diuresis and maintaining
the edema-free state for prolonged periods.
• Promotes balanced excretion of sodium and
chloride— without acidosis.
Any indication for diuresis is an in-
dication for 'D1URIL':
Congestive heart failure of all degrees of severity;
premenstrual syndrome (edema) ; edema and toxe-
mia of pregnancy; renal edema— nephrosis; ne-
phritis; cirrhosis with ascites; drug-induced edema.
May be of value to relieve fluid retention compli-
cating obesity.
SUPPLIED: 250 mg. and 500 mg. scored tablets 'DIURIL'
(chlorothiazide); bottles of 100 and 1,000.
'DIURIL' and 'inversine' are trade-marks of Merck & Co., Inc.
MERCK SHARP & DOHME
Division of MERCK & CO., Inc., Philadelphia I. Pa.
J. Florida M.A.
May, 1958
1277
as simple
as 3
in
HYPERTENSION
£
INITIATE DIURIL' THERAPY
'DIURIL' is given in a dosage range of from 250
mg. twice a day to 500 mg. three times a day.
ADJUST DOSAGE OF OTHER AGENTS
The dosage of other antihypertensive medication
(reserpine, veratrum, hydralazine, etc.) is ad-
justed as indicated by patient response. If the
patient is established on a ganglionic blocking
agent (e.g., 'INVERSINE') this should be con-
tinued, but the total daily dose should be imme-
diately reduced by 25 to 50 per cent. This will
reduce the serious side effects often observed with
ganglionic blockade.
ADJUST DOSAGE OF ALL MEDICATION
The patient must be frequently observed and care-
ful adjustment of all agents should be made to
determine optimal maintenance dosage.
BENEFITS:
0 improves and simplifies the management of hypertension
# markedly enhances the effects of antihypertensive agents
e reduces dosage requirements for other antihypertensive
agents— often below the level of distressing side effects
m smooths out blood pressure fluctuations
INDICATIONS: management of hypertension
Smooth , more trouble-free manage-
ment of hypertension with ' diuril '
1278
VOLUME XI. IV
Number 11
How +o wTr^ friends ...
NOW
SIZE
V/
GR
Childrens Size
ASPIRIN
baye
48 TABLETS
250
^SRS.EA.
The Best Tasting
Aspirin you can prescribe
The Flavor Remains Stable
down to the last tablet.
2bi Bottle of 48 tablets (134 grs. each)
We will be pleased to send samples on request.
THE BAYER COMPANY DIVISION
of Sterling Drug Inc.
1450 Broadway, New York 18, N. Y.
|\ Florida M.A.
May, 1958
1279
t4jwmv» Tin 1 1 am 1 i it* — t
base or the hydrochloride alone. In addition, the
average levels derived from the tetracycline base or
the chlortctracycline base were higher than those pro-
duced by the corresponding hydrochloride though
lower than those resulting from the mixture contain-
ing the base and sodium metaphosphate. In the study
with chlortetraeycline1' capsules containing a mixture
of the hydrochloride and sodium metaphosphate were
also included in the crossover, and the average levels
produced by these capsules were the same as with the
mixture of chlortetraeycline base with sodium meta-
phosphate.
Although the enhancement of blood levels of tetra-
cycline by phosphate, either complexed to the tetra-
cycline or mixed with the base or the hydrochloride,
thus seemed fairly well established, some doubts still
remained because certain reliable observers (includ-
ing many whose results base not been published)
failed to confirm the findings with the materials and
methods they used. Further confusion seemed to be
added by a subsequent report of Welch et al.,: who,
in repeating a crossover study with capsules of tetra-
cycline phosphate complex and tetracycline
chloride with and without, ^
phate, fqun '■ . w
in — Hntr’cwTBspimmnj; *rxt towny wmrMiqmm mctapnu^/crzrti* nni*gncr7StTUiir
antibacterial activity than was observed in their ab-
sence. Oil and sorbitol did not interfere with tetia-
cvclinc absorption.
Dicalcium phosphate is widely used as a filler in
various capsules, including those of the tetracyclines.
The authors cite a large number of other studies that
implicate the presence of calcium ions as the cause of
the reduced absorption of tetracyclines and show that
citric acid can partially neutralize this effect. The
depressing effect of food on the serum levels of tetra-
cycline is likewise explained by the goodly amount of
minerals contained in commercial laboratory diets,
and they postulate that the multivalent cations may
be responsible for the poorer absorption of the drug.
The authors could not explain the failure of citric
acid to enhance serum concentrations when admin-
istered with tetracycline base in contrast to ;ts marked
effect when given as the hydrochloride. However,
they hypothesized that the ability of citric acid to
enhance serum levels of tetrac -'ine.w -«•’
ability to form complex
> '-xsiya liable fpp-
a
nd citric
,:_e hydrochloride
« Tetracychn V . e(j
' . ,,,re produced
mixture, ^
s”'
0{ tetracyclmes
encap
1
acid, in ** .
^ concentrations
vw* “„ce beue. ******
”d ratio* »“d,ed-
ai
ai
cretlous,
than any
other ptePa
ai
i
sti,
d<i
of
t.aneotM^^Wtn t
et al.7 These data we
trolled studies F
additional r
clusivelv^
liter
y Editorial.
•/ The New England Journal of Medicine.
258:97-99, (January 9) 1958.
y wef^^uoiisnea simul-
e Iasi rhentioned report of Welch
based on thoroughly con-
uan9 and include
mentioned paper of
al.T indicates that in their study the capsules
Tetracycline hydrochloride, chlortetraeycline hydro-
chloride and tetracycline phosphate complex all con-
tained dicalcium phosphate as a filler, whereas the
capsules containing citric acid and sodium hexameta-
phosphate did not contain any dicalcium phosphate.
This could clearly explain the discrepancies noted in
that study. Likewise, the inconsistencies in othe
studies may very well have b-^n due th** —
of calcium as fillers in sor
thers.
V however, '
’o its
\en
he
fth
\h
i-
t
i
‘s
ACHROMYCIN*V
TETRACYCLINE HCI BUFFERED WITH CITRIC ACID
is tetracycline and citric acid
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMIO COMPANY. PEARL RIVER. NEW YORK
•Reg. U. S. Pat. Off.
Volume XLIV
Number 11
1281
Gastric distress accompanying "predni-steroid"
therapy is a definite clinical problem — well
documented in a growing body of literature.
J. Florida M.A.
May, 1958
view of the beneficial re*
s observed when antacids
nd diets were used eoncom-
*ith prednisone and predni-
we feel that these measures
be employed prophvlacti-
offset any gastrointestinal
ects.” — Dordick, J. R. el al.:
late J. Med. 57:2049 (June
>7.
*“It is our growing convic-
tion that all patients receiving
oral steroids should take each
dose after food or with ade-
quate buffering with aluminum
or magnesium hydroxide prep-
arations.”— Sigler, J. W. and
Ensign, D. C.: J. Kentucky
State M.A. 54:771 (Sept.) 1956.
:{:“The apparent high inci-
dence of this serious [gastric)
side effect in patients receiving
prednisone or prednisolone
suggests the advisability of
routine co-administration of an
aluminum hydroxide gel.”— •
Bollet, A. J. and Bunim, J. J.:
J. A. M. A. 158:459 (June 11)
1955.
One way to make sure that patients receive
full benefits of ‘'predni-steroid" therapy plus
positive protection against gastric distress is
by prescribing CO-DElTRA or CO- HYDElTRA.
oDeltra
PREDNISONE BUFFERED
itiple compressed tablets
provide all the benefits
of “Predni-steroid"’ therapy—
plus positive antacid protection
against gastric distress
2.5 mg. or 5.0 mg. of prednisone
or prednisolone, plus 300 mg. of
dried aluminum hydroxide gel
and 50 mg. magnesium trisili-
cate, in bottles of 30, 100, 500.
MERCK SHARP & D0HME Oivision of MERCK & CO.. INC., Philadelphia 1. Pa. fflsra
1282
Volume XI. IV
Number 11
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Appen, Raymond C., Cocoa
Brenner, Robert L. Jr., Ft. Lauderdale
Bussey, Dan R., Pompano Beach
Clarke, William P., Jacksonville
Cole, John H., Orlando
Dailey, James O., Bunnell
De Padua, Virgilio B., Jacksonville
Dietrich, James F., Live Oak
Dussia, Evan E., Tallahassee
Edwards, Thomas S., Jacksonville
Ersay, Emil F., Pompano Beach
Failmezger, Theodore R., Clearwater
Favis, Edward A., Daytona Beach
Goodless, Maxwell D., Hollywood
Greenwell, George R., Brandon
Griffith, Daniel P., Winter Haven
Hall, James A., Mims
Hoffeld, George D., Groveland
Johnson, Benjamin A. Jr., Jacksonville
Kesler, Robert M., Mount Dora
Knorr, Keith H., Ocala
Knotts, Benjamin F. Jr., Cocoa Beach
Kurzweg, Frank T., Miami
Langley, Warren F., Pompano Beach
Lucas, Roy H., Winter Haven
McConnell, Ben H., Lakeland
McKell, Joseph P., Tampa
Miles, Clifford B., Pompano Beach
Moore, John C., Lakeland
Newbill, Cannon E. Jr., Jacksonville
Oyen, William, Lake City
Quick, James C., Lakeland
Radkins, Laurent V. Jr., Fort Myers
Roll, Edmund C., Orlando
Sager, Samuel O., Venice
Scott, Thomas C., Cocoa
Scotti, Thomas M., Coral Gables
Squires, John B., Ft. Lauderdale
Stanton, Robert L., So. Miami
Tumlin, Paul F., Leesburg
Weiner. Harry S., Miami Beach
Welch, William B., Miami
Welebir, Andrew J., Winter Park
Wilhelm, Richard J., Jacksonville
Woulfe, James C., Ft. Lauderdale
Gnderson Surgical Supply Go.
r.'tahlisheil 1916
GOOD REPUTATION
takes years to build, but can be
quickly destroyed.
It must be carefully guarded.
“A good name is rather to be chosen
than great riches.”
Distributors of Known Brands of Proven Quality
TELEPHONE 2-8504
MORGAN AT PLATT
P. O. BOX 1228
TAMPA 1, FLORIDA
MEMBER
TELEPHONE 5-4362
9th ST. & 6th AVE.. SO.
ST. PETERSBURG, FLORIDA
J. Florida M.A.
May, 1958
1283
of infant feeding
Standard formulas for WELL INFANTS
Since age, appetite and digestive capacity
vary, hospital practice favors an individual-
ized formula for each infant.
The total daily feeding usually amounts to 2
ounces of milk per pound of body weight, plus
1 ounce of Karo Syrup with enough water to
satisfy fluid requirements.
The newborn usually takes from 2 to 3 ounces
of formula per feeding; the very young infant,
4 to 5 ounces— the daily quota yielding over
50 calories for each pound the infant weighs.
The quantity per feeding should not exceed
8 ounces.
Newborns are fed at 3 to 4 hour intervals
throughout the 24-hour period— the 2 or 3
A.M. feeding is discontinued after the neo-
natal period. In the third or fourth month the
10 or 12 P.M. feeding is discontinued, once
the infant fails to awaken for the bottle.
Standard but individualized formulas which
constitute the hospital infant feeding regimen
are shown here.
WHOLE MILK FORMULAS
Each
Age
Cow's Milk
Water
KABO
Feeding
Feedings
Total
Months
Fluid 0 z.
Oz.
Tbsp.
Oz.
in 24 Hrs.
Calories
Birth
10
10
2
3
6
320
1
12
13
2V2
4
6
390
2
15
13
3
41/2
6
480
3
17
9
3
5
5
520
4
20
11
3V2
6
5
610
5
23
11
4
61/2
5
700
6
26
10
4
7
5
760
EVAPORATED MILK FORMULAS
Evap.
Each
Age
Milk
Water
KARO
Feeding
Feedings
Total
Months
Fluid Oz.
Oz.
Tbsp.
Oz.
in 24 Hrs.
Calories
Birth
6
12
2
3
6
380
1
8
16
3
4
6
532
2
9
14
3
41/2
5
576
3
10
15
31/2
5
5
650
4
12
18
4
6
5
768
5
12
21
4
61/2
5
768
6
13
22
4
7
5
768
ADVANTAGES OF KARO® IN INFANT FEEDING
Composition: Karo Syrup is a
superior dextrin-maltose-dextrose
mixture because the dextrins are non-
fermentable and the maltose is rap-
idly transformed into dextrose which
requires no digestion.
Concentration: Volume for vol-
ume Karo Syrup furnishes twice as
many calories as similar milk modi-
fiers in powdered form.
Purity: Karo Syrup is processed at
sterilizing temperatures, sealed for
complete hygienic protection and
devoid of pathogenic organisms.
LOW Cost: Karo Syrup costs 1/5
as much as expensive milk modifiers
and is available at all food stores.
Free to Physicians —Book of
Infant Feeding Formulas with con-
venient schedule pads. Write:
.*■*, Medical Division
CORN PRODUCTS REFINING COMPANY
*♦*••♦* 17 Battery Place, New York 4, N.Y.
1284
Volume XLIV
Number 11
“No patient failed to improve.”1
pHisoHex washing added to standard
treatment in acne produced results that
. . far excelled . . . results with the many
measures usually advocated.”1
pHisoHex maintains normal skin pH,
cleans and degerms better than soap. In
acne, it removes oil and virtually all skin
bacteria without scrubbing.
For best results — four to six washings a
day with pHisoHex will keep the acne
area ‘'surgically” clean.
1. Hodges, F.T.: GP 14:86, Nov., 1956.
antibacterial
detergent—
nonirritating,
hypoallergenic.
Contains 3%
hexachlorophene.
CLASSIFIED
Advertising rates for tills column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
earh additional word
BRAND NEW AIR CONDITIONED AND
HEATED MEDICAL BUILDING in fast growing
North Miami has three openings. Prefer Board-certi-
fied (or eligible) internist, ophthalmologist, otolaryn-
gologist, dermatologist, or laboratory to complement
present occupants: pediatrician, surgeon, orthopedist,
obstetrician. All independent. See it at 1 545 N.E.
123rd Street and phone PL 4-2744.
SUITE AVAILABLE: St. Nicholas Medical Cen-
ter, 3127 Atlantic Blvd., Jacksonville. 700 square
feet, conveniently located to all Jacksonville by pub-
lic and private transportation, in a balanced clinic,
(anitor and maid service. Air conditioned. All utili-
ties furnished except telephone. W. G. Allen Jr.,
Mgr., Colonial Properties, Inc., 3116 Atlantic Blvd.
Phone EX 8-5500.
FOR RENT : Doctor’s office, 2000 square feet,
available immediately. Carpeting, partially furnished.
Air conditioning and heat. On the waterfront. Contact
Ballard F. Smith, M.D., 3206 N. E. 19th St., Fort
Lauderdale, Fla.
RADIOLOGIST: Aged 32. Finishing residency
June 30, 1958. Will take specialty board exam May
1958 for certification in Radiology, including isotopes.
Would like to become associated with established radi-
ologist in private practice. Florida licensed. Contact
C. R. Merrill Jr., M.D., 8956 Rutherford, Detroit 28,
Mich.
POSITION WANTED: Internist, Board qualified.
Special training in chest diseases. Florida license.
Desires association with Internist or group. Prefer
central Florida. Write 69-266, P.O. Box 2411, Jackson-
ville, Fla.
AVAILABLE: Four suites to round out clinic.
Need General Practitioner, Cardiologist, Urologist,
EENT. Community of 30,000 population surrounding
new' Midway Medical Center located at 10700 Semi-
nole Road (Alternate Route 19) midway between
Clearwater and St. Petersburg. Fully air conditioned,
ample parking and janitor service. Write 69-269,
P. O. Box 2411, Jacksonville, Fla.
WANTED: General Practitioner with Florida lic-
ense to associate with 48 year old G. P. in S. E.
Florida city. No investment. Reply full details, mili-
tary service. Send photo. Write 69-267, P. O. Box
2411, Jacksonville, Fla.
WANTED: Board certified or eligible Obstetrician-
Gynecologist under 35 years of age. East coast of Flori-
da. Write 69-268, P. O. Box 2411, Jacksonville, Fla.
American Medical Golfing Association
Announces Forty-Third Tournament
The American Medical Golfing Association i
holding its forty-third annual tournament June 2.
at the Olympic Lakeside Golf and Country Club
San Francisco, in conjunction with the conventioi
of the American Medical Association.
Information may be obtained from James J
Leary, M. D.. Secretary, 450 Sutter St., San Fran
cisco, Calif.
LABORATORIES
New York 18, N. Y.
INCREMIN*
LYSINE-VITAMINS
witK IRON syrup
EG. U. S. PAT OFF.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY. PEARL RIVER. N.Y.
M
CORRECTS
IRON DEFICIENCY
AS IT
STIMULATES
APPETITE
r', Vic
DELICIOUS CHERRY FLAVOR
DESIGNED TO APPEAL TO
BOTH CHILDREN AND ADULTS
FOR CHILDREN
Supplies essential Iron as ferric pyrophos-
phate, highly stable, well-tolerated, readily
absorbed; essential vitamins Bi, Bgand B12,
established as appetite stimulants; essential
1-Lysine for greater protein economy in the
pediatric diet.
FORMULA: Each teaspoonful (5 cc.) contains:
1-Lysine HCI 300 mg.
Ferric Pyrophosphate (Soluble) 250 mg.
Iron (as Ferric Pyrophosphate) 30 mg.
Vitamin B12 Crystalline 25 megm.
Thiamine Mononitrate (Bi) 10 mg.
Pyridoxine HCI (B6) 5 mg.
Alcohol 0.75%
Average dosage is 1 teaspoontul daily.
Available in bottles of 4 ft. oz.
INCREMIN Syrup
1286
Volume XI. IV
Number 11
probably the easiest-to-use x-ray table in its field
A
'
i ff
■
iij!|n
I
Instant swing-through from fluoroscopy to
radiography (and vice versa). Self-guid-
ing to correct operating distance. Nothing
to match up . . . you do it without leaving
the table front.
Horizontal, vertical, interme-
diate, or Trendelenburg posi-
tions by equipoise handrock
(or quiet motor-drive).
Choice of rotating or
stationary anode x-ray
tubes. Full powered
100 mo at 100 KVP.
m
Certainly the simplest automatic x-ray control ever devised
MAMomi|iiniMirT
MftlllU
**11010
know why? look ...
1 On this board you select the bodypart you want to x-ray
2 Set its measured thickness
3 Press the exposure button
That's all there is to it. No time, KV, or MA adjusting to do.
No charts to check, no calculations to make.
housed in
handsome
upright
cabinet
this
obviously as canny an x-ray Investment as you can make
Modest cost
Excellent value
Prestige "look"
Top Reputation (significantly, “Century" trade-in value has long been highest in its field)
MIAMI 35, FLA., 1363 Coral Way
Jacksonville 7, Fla., 1023 Mary Street
St. Petersburg, Fla., 601 Rutledge Bldp
Orlando, Fla., 1711 Oakmont Street
W. Palm Beach, Fla., 305 South Flagler Drive
ONE HALF MNI
OK
-8 RUtDOUNOS,
ag
HOUSTON. tt»*
salcolan
kirns, ScaWs and tea*85
Cos?, . Sa1^ C04 u—* t*-1***' -
■ ■ G»~ -'>:
s wo v. RICH COMPANY. * A
movstom T*xM
• TESTED • APPROVED . ACCEPTED
SAFE
0/1
BURNS * SCALDS - ABRASIONS
★ "Initial rapid pain relief, early tissue
regrowth, control of secondary
infection.”
★ "A marked reduction in total healing
time.”
★ ’ Clinical reports, samples, and descrip-
tive brochure may be had upon
request. Please write us on your
letterhead.
RICH COMPANY, INCORPORATED
3518 Polk Avenue Houston, Texas
References: 1. Council on Drugs, A.M.A.:
J.A.M.A. 166:52, 1958. 2. Pulaski, E. J.: Prac-
titioner 179:465, 1957. 3. Cronk, G. A., and
Naumann, D. E.: Ant. Med. & Clin. Ther.
4:166, 1957. 4. Kaplan, M. A., Dickison, H. L.,
Hubei, K. A., and Buckwalter, F. H.: Ibid.
4:99, 1957. 5. Prigot, A., Shidlovsky, B. A.,
and Felix, A. J.: Ibid. 4:287. 1957. 6. Pulaski,
E. J., and Isokane, R. K.: Ibid. 4:408, 1957.
7. Putnam, L. E.: Ibid. 4:470, 1957. 8. Rein,
C. R., and Fleischmajer, R.: Ibid. 4:422, 1957.
9. Welch. H., Lewis, C. N.. Staffa, A. W., and
Wright. W. W.: Ibid. 4:215, 1957. 10. Cronk,
G. A., Naumann, D. E., and Casson, K.: Anti-
biotics Annual, 1957-8, ed. by H. Welch and
F. Marti-Ibanez, Medical Encyclopedia, New
York, p. 397. 11. Dube, A. H.: Ibid. p. 409.
12. Hubei, K. A., Palmieri, B., and Bunn, P. A.:
Ibid. p. 443. 13. Kaplan, M. A., Albright, H„
and Buckwalter, F. H.: Ibid. p. 415. 14. Portney,
B., Draper, T., and Wehrle, P. F.: Ibid. p. 386.
15. Shidlovsky,' B. A., Prigot, A., Maynard. A.
de L., Felix, A. J., and Hjclt-Harvey, I.: Ibid.
REMEMBER ABOUT
ORIGINAL TETRACYCLINE
PHOSPHATE COMPLEX
U.S. PAT. NO. 2.791 ,€09
Tetrex requires no "activating additive
//
— it is purely tetracycline phosphate complex, with an inherent,
chemically unique property of being rapidly and efficiently
absorbed.
Each Tetrex Capsule contains:
Active ingredient : Tetracycline Phosphate COMPLEX, 250 mg.
Excipient: Lactose q. S. (tetracycline HO activity)
Tetrex produces "peak high" tetracycline
serum levels
— over 5000 human blood determinations after oral or intramus-
cular administration have consistently demonstrated fast, high,
prolonged serum levels in patients of all ages.3,5,6’7,8,9’10,11’12,13,14’15
etrex has an impressive documented
record of clinical effectiveness
— more than 170 million doses of tetracycline phosphate com-
plex in 1957, with 5 published clinical reports by 9 investigators
on 826 patients. 3’5,7’8, 10 Clinical evaluation: “should probably
be considered an improvement over, and an ultimate replace-
ment for, the older tetracycline hydrochloride.”10
BRISTOL LABORATORIES INC., Syracuse, New York
1290
Volume XI.IV
Number 11
Coleman Graves Buford
Dr. Coleman Graves Buford of West Palm
Beach died on Dec. 23, 1957. He was 85 years
of age.
Born in LaFayette County, Mo., on Jan. 25,
1872, Dr. Buford received his medical training
in Illinois. In 1894, he was awarded the degree
of Doctor of Medicine by the Northwestern Uni-
versity Medical School in Chicago. After serving
two years as resident physician of Illinois Hos-
pital Service in preparation for neurologic surgery,
he became an instructor in surgery at his alma
mater, continuing in that capacity for 10 years,
and for nearly half of that period was special
private assistant to Dr. Christian Fenger, Profes-
sor of Surgery. Between 1900 and 1913, he was
junior surgeon at Mercy Hospital for seven years,
surgeon to Crippled Children’s Hospital for six
years and surgeon to St. Joseph’s Hospital for
four years. From 1913 to 1920, he was surgeon
to Henrotin Hospital and to Policlinic Hospital,
where he was Professor of Surgery at the Poli-
clinic Post Graduate School.
In 1909, Dr. Buford became Assistant Profes-
sor of Clinical Surgery at the University of Chica-
go, the School of Medicine, in affiliation with
Rush Memorial College, and during that period
was head of the surgical division of Children’s
Memorial Hospital. He served as an associate
member of the Medical Staff of St. Luke’s Hos-
pital from 1917 to 1935. In 1935 illness caused
him to retire from Chicago. Thereafter, he prac-
ticed general surgery in Elizabeth, 111., and served
on the Surgical Staff of Deaconess and St. Francis
Hospitals in Freeport, 111.
In 1953, Dr. Buford came to Florida to reside
at West Palm Beach. He became a member of the
Palm Beach County Medical Society and since
1955 had held membership in the Florida Medi-
cal Association. A past president of the North
Side Branch of the Chicago Medical Society, he
was a past vice-president of the Chicago Surgical
Society and a past president of the Jo Daviss
Cancer Society. He was one of the founders of
the American College of Surgeons and served for
many years as a member and for a time as chair-
man of its Chicago Membership Committee. He
was also affiliated with the Chicago Institute of
(Continued on page 1297)
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St., New York 3.
J. Florida M.A.
May, 1958
1291
w/Reserpine
for the aged patient
NICOZOL w/Reserpine
(helps reverse cerebral
deterioration . . . while it
stimulates body function . . .
and calms the emotions.
V \
\
Each tablet NICOZOL w/Reserpine contains:
Pentylenetetrazol .... 100 mg. ( cerebral stimulant & analeptic )
Niacin 50 mg. (vasodilator)
Reserpine 0.25 mg. (tranquilizer-sedative)
Clinically Established^
. . . NOT
IN A HOME
In studies of 75 patients (average age — 72), with typical
mental and emotional symptoms together with alternate
periods of depression and agitation, 87% showed gratifying
response to NICOZOL w/RESERPINE,
“This therapy afforded relief of agitation . . . improved
memory, behavior, sociability, appearance and tidi-
ness. Symptoms of confusion, aggressiveness, hostility
and disorientation also were relieved. Fewer side
effects were noted.
. . patients who other-
wise would have re-
q u i r e d institutionalized
care were managed at
home . . . .”2
Prescribed early, NICO-
ZOL w/RESERPINE
may avoid “later commit-
ment to nursing homes or
state hospitals.”1-2
for professional
nnrl litarntura I ! "-v.
Write
samples and literature
DRUG SPECIALTIES, INC.
1. Proctor, R. C. : Clin. Med. 6: 717
(June) 1957
2. Proctor, H. ., Bailey, W. H. and
Morehouse, W. G. : J. Am. Geri-
atrics Soc. (April) 1958.
WINSTONSAIEM
N. C.
1292
Volume XI. IV
Number II
J2 ^UsidL
"SoAA^tl-
^3ic6^0d^y^^
Bulk — rough or gentle —
makes the rr Regularity" diet work!
The Regularity” Diet
And may we
suggest a
glass of
beer to
increase the
fluid intake?
• Fruits and vegetables, raw or cooked, are
high in cellulose. Oranges and apples, beets and
carrots also provide pectin which absorbs more
fluid to form especially smooth bulk.
Whole grains contain cellulose and Vitamin B
Complex as well. Lots of liquid is important to
make the cellulose bulky — about 8 to 10 glasses
a day. And some of it might be beer.*
For appetite appeal your patient can team apples
with dates. Raisins or fresh cranberries make a
tasty surprise in oatmeal muffins.
When your patient makes these bulk-
producing foods appetizing, he’s likely to in-
clude them in his regular diet.
*An 8-oz. glass of beer supplies about Y% the minimum require-
ment of Niacin as well as smaller amounts of other B Complex
vitamins. (Average of American beers)
United States Brewers Foundation
Beer — America’s Beverage of Moderation
II you'd like reprints of this and 11 other dietary suggestions, please wr.te Uiiited States Brewers Foundation, 535 Filth Avenue. New York 17, N. Y.
Wi
Vi?**
I •1*,*,vv.**1 ••***>:
#!$!: fclfe
llll
research discovery
UNIQUE (Rob
for SELECTIVE, SUPERIOR
skeletal muscle relaxation
ROBAXIN — a completely new chemical formulation — pro-
vides sustained relaxation of skeletal muscle spasm,
without impairment of muscle strength or normal neuro-
muscular function . . . and with essential freedom from
adverse side effects. Beneficial in 94.4% of cases tested.
METHOCARBAMOL 'ROBINS’, U.S. PAT. NO. 2770649
Supply: A. H. ROBINS CO., INC., Richmond 20, Virginia
Tablets, 0.5 Gm., bottles of 50. Ethical Pharmaceuticals of Merit since 1878
Volume XI.IV
1294 Number 11
For Speedier Return to Normal Nutrition
and the Medically Acceptable
Reducing Diet
In any medically acceptable reducing diet prescribed today,
meat can serve as an important nutritional component.
Curtailment of the daily calorie allowance must not deny
the patient the protein, vitamins, and minerals required for
good nutritional health. Fad diets which eliminate certain
basic foods can hardly be considered medically acceptable.
Calorie for calorie, no other commonly eaten fpod supplies
the quality and quantity of protein which lean meat pro-
*
vides. Its B vitamins and minerals are needed daily, regard-
less of calorie restrictions.
Even when coexistent pathological conditions require that
the calorie-reduced diet be further limited to foods low in
fiber or in sodium, meat fills the same important place in
each day’s food allowance. The fat content of lean meat is
relatively low, and meat can be prepared in various ways,
as called for by almost every special diet.
In any diet which must deviate from accustomed eating
habits, the taste appeal of meat makes it easier for the patient
to adhere to the restrictions imposed.
The nutritional statements made in this advertisement
have been reviewed by the Council on Foods and Nutri-
tion of the American Medical Association and found
consistent with current authoritative medical opinion.
American Meat Institute
Main Office, Chicago... Members Throughout the United States
T. Florida M.A.
May, 1958
1295
Combines Achromycin V with Nystatin
SUPPLIED:
CAPSULES contain 250 mg. tetracycline HC1
equivalent (phosphate-buffered) and 250,000
units Nystatin. ORAL SUSPENSION (cherry-
mint flavored) Each 5 cc. teaspoonful contains
125 mg. tetracycline HC1 equivalent (phos-
phate-buffered) and 125,000 units Nystatin.
DOSAGE :
Basic oral dosage (6-7 mg. per lb. body weight
per day) in the average adult is 4 capsules or
8 tsp. of Achrostatin V per day, equivalent
to 1 Gm. of Achromycin V.
Achrostatin V combines AcHROMYcmt V
...the new rapid-acting oral form of Achromycin!
Tetracycline . . . noted for its outstanding
effectiveness against more than 50 different infections
. . . and Nystatin ... the antifungal specific.
Achrostatin V provides particularly effective
therapy for those patients prone
to monilial overgrowth during a protracted course
of antibiotic treatment.
LEDERLE LABORATORIES DIVISION. AMERICAN CYANAMID COMPANY, PEARL RIVER. N. Y.
♦Trademark tReg. U. S. Pat. Off.
1296
Vol.UME XI. IV
Number 11
PRECISION
WORKMANSHIP
Workmanship makes the difference. Mass production
today has often pushed aside precision. Not so when you
place your prescription in the hands of your
guild optician. Today as always the guild optician
knows and practices the ultimate in care
to produce the finest in eye wear.
Guild of Prescription Opticians of Florida
J. Florida M.A.
May, 1958
1297
( Continued from page 1290 )
Medicine, the Illinois State Medical Society and
the American Medical Association.
Surviving are the widow, Mrs. Grace M. Bu-
ford; four sons, Coleman G. Buford Jr., Robert
Lee Buford, Sam Walker Buford and John Bu-
ford; and two daughters, Mrs. Mary Cameron
and Mrs. Margaret Speer.
John Terrell Moore
Dr. John Terrell Moore of Tampa died at a
local rest home on Jan. 11, 1958. He was 74
years of age.
A native of Georgia, Dr. Moore was born
near Canton on March 23, 1883. He attended
rural schools and Waleska Junior College; later,
he was graduated from North Georgia Agricul-
tural College at Dahlonega. He began his profes-
sional career as a teacher in Turner County,
Georgia, and at the age of 26 was elected county
school superintendent. After teaching five years
he enrolled in Emory University School of Medi-
cine. He studied medicine during the day and
at night took a course in pharmacy which he
finished in two years. Completing his medical
training with a high scholastic average, he was
awarded the degree of Doctor of Medicine by
Emory University on June 1, 1916. During his
senior year he was vice president of his class.
Returning to Turner County, he practiced
medicine and surgery there until 1925. He en-
gaged in postgraduate studies in New York, Bos-
ton, New Orleans and Chicago. For one year,
while in Chicago, he was assistant chief surgeon
in the American Hospital. During World War I,
he served as a first lieutenant in the medical
corps.
In 1925 Dr. Moore located in Tampa and
continued to practice there for 32 years. He was
a member of the staff of Tampa General Hospital,
St. Joseph’s Hospital and Centro Asturiano Hos-
pital. Locally, he was a member of the American
Legion and the Palm Avenue Baptist Church, and
was a past president of the Seminole Civic Cen-
ter. He was a Mason and had been a Shriner
since 1909.
Dr. Moore was a member of the Hillsborough
County Medical Association, the Florida Medical
Association and the American Medical Associa-
tion. He also held membership in the Interna-
tional Surgeons Association.
Dr. Moore’s wife, the former Mamie Susan
Lacy, and also a son recently preceded him in
death. Survivors include three daughters, Mrs.
Curtis D. Maddox and Mrs. Hector J. Caron of
Tampa, and Mrs. Ira Haden of Plant City; two
sisters, Mrs. G. W. Southern and Mrs. J. P.
Southern of Marietta, Ga.; two grandsons, John
Robert Moore of Bartow, and William Terrell
Moore of Miami; three granddaughters, Mrs.
Charles Haigler, Susan Caron and Cheryl Caron,
all of Tampa; and one great granddaughter, Ann
Haigler of Tampa.
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
Tfoilfinactcce “Pro^i/ufleixc^
AVOIDING INSURANCE
EXPOSURE
S/zeccaiijed Service
tttrz&ea. oei* docto* <xa£e*
"the?
Medical P hot eotive: Company-
FoktWayve. Indiana
Professional Protection Exclusively
since 1899
I 1
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. PLAZA 4-2703
1298
Volume XLIV
Number 11
i Allen's Invalid Home
I
| MILLEDGEVILLE, GA.
s Established 1890
For the treatment of
NERVOUS AND MENTAL DISEASES
Grounds 600 Acres
Buildings Brick Fireproof
i Comfortable Convenient
Site High and Healthful
E. W. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
Terms Reasonable
*-« —
Whatever your first requi-
sites may be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
QUALITY HOOK HKINTINC
riiHi.icAi ions yy iwoaimti.s
2 18 West C ii u it c: ii Sr.
J a c k s o n v i i i. e , F i. o it i n A
iumiti:
MINOR
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
Wm.
• Modern Treatment Facilities
0 Psychotherapy Emphasized
• Large Trained Staff
0 Individual Attention
• Capacity Limited
0 Occupational and Hobby Therapy
0 Healthful Outdoor Recreation
0 Supervised Sports
0 Religious Services
0 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
SAMUEL G. WARSON, M.D.
TARPON SPRINGS •
Consultants in Psychiatry
ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
• ON THE GULF OF MEXICO * PH. VICTOR 2-1811
FLORIDA
J. Florida M.A.
May, 1958
1299
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond, Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dk. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
- -
Aged adjudged cases
will be accepted on
either permanent or
temporary basis.
Safety against fire — by Auto-
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St,
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tampa 9. Florida
BRAWNER’S SANITARIUM
ESTABLISHED 1910
Jas. N. Brawner, Jr., M.D. Albert F. Brawner, M.D.
Medical Director Associate Director
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Member
Georgia Hospital Association, American Hospital Association
National Association of Private Psychiatric Hospitals
P.O. Box 218
HEmlock 5-4486
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Ciiarman Carroll, M.D. Robert L. Craic, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
T. Florida M.A.
May, 1958
INDEX TO ADVERTISERS
1301
• Allen’s Invalid Home 1298
• American Meat 1294
• Ames Co., Inc Third Cover
• Anclote Manor ... 1298
• Anderson Surgical Supply Co. 1282
• Appalachian Hall . 1302
• Ayerst Laboratories 1270
• Ballast Point Manor 1299
• Bayer Co. 1278
• Birtcher Corp. 1253
• Brawner’s Sanitarium 1300
• Bray ten Pharmaceutical Co. 1262
• Bristol Labs. 1288, 1289
• Bristol-Myers Co. 1258
• Burroughs Wellcome & Co. 1212, 1269, 1282a
• Carlton Corp. 1290
• Convention Press 1298
• Corn Products Refining Co. 1283
• Drug Specialties, Inc 1291
■ Duvall Home 1297
• Eaton Laboratories 1215
• Endo Laboratories 1265
• Guild of Prescription Opticians 1296
• Charles C. Haskell 1214
• Highland Hospital, Inc. 1300
• Hill Crest Sanitarium 1301
• Keleket X-ray of Fla. 1275
• Lakeside Laboratories 1205
• Lcderle Laboratories
1210a, 1254, 1255, 1279,
1285, 1295
1218, 1257
1211
1297
1264
1206, 1207, 1260,
1268, 1276, 1277, 1280, 1281
1303
2nd Cover, 1203
1286
1263
1256
1273
1287
1216, 1293
1208, 1213, 1261, 1271
1209, 1251
1217
1267
Back Cover
1266
1299
1259
1292
1210, 1274, 1274a
1302
1272, 1284
• Eli Lilly & Co.
• Mead Johnson & Co.
• Medical Protective Co.
• Medical Supply Co.
• Merck Sharp & Dohme
• Miami Medical Center
• Parke-Davis & Co.
• Picker X-ray
• Piedmont Auto & Truck Rental, Inc.
• Precision Instruments
• Reed & Carnrick
• Rich Co., Inc.
• A. H. Robins & Co.
• Roerig & Co.
• G. D. Searle Company .
• Schering Corp
• Smith-Dorsey
• Smith, Kline & French Labs.
• Surgical Supply Co
• Tucker Hospital, Inc.
• Upjohn Co.
• LT. S. Brewers Foundation
• Wallace Laboratories
• Westbrook Sanatorium
• Winthrop Laboratories, Inc.
HILL CREST SANITARIUM
Established in 1925
Out-Patient Clinic and Offices
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1151
1302
Volume XUV
Number 11
S.
WestirooA Sanatorium
Rl CHMOND
established 1<)IJ
VIRGINIA
v . — i
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin, psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff PAL L ' • ANDERSON, M.D., President
REX BLAN KINSHIP, M.D.. Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES. M.D.. Associate
JAMES k. HALL. JR.. M.D., Associate
CHARLES A. PE ACHEE. JR., M.S., Clinical
Psychologist
R. IV. CR^TZER, Administrator
Brochure of Literature and l lews Sent On Request - I*. (). Bttx 1514 • Rhone 5-3245
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
IDA M.A.
158
SCHEDULE OF MEETINGS
1303
ORGANIZATION
Medical Association
Medical Districts
irthwest
irtheast
uthwest
utheast
Specialty Societies
ly of General Practice
Society
biologists, Soc. of
’hys., Am. Coll., Fla. Chap.
ology, Soc. of
Officers’ Society
ial and Railway Surgeons
1 Medicine
i Gynec. Society
1. & Otol., Soc. of
edic Society
igists, Society of
ic Society
& Reconstructive Surgery
ogic Society
trie Society
igical Society
as, Am. Coll., Fla. Chapter
cal Society
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
ANNUAL MEETING
Miami Beach, May 10-14, ’58
Marianna
Cocoa
Fort Myers
Miami
Henry L. Harrell, Ocala
Norris M. Beasley, Ft. Lauderdale
Stanley H. Axelrod, Miami Beach
Clarence M. Sharp, Jacksonville
Louis C. Skinner Jr., C. Gables
Paul W. Hughes, Ft. Lauderdale
Francis T. Holland, Tallahassee
Donald F. Marion, Miami
S. Carnes Harvard, Brooksville
Carl S. McLemore, Orlando
Robert P. Keiser, Coral Gables
Wray D. Storey, Tampa
Henry G. Morton, Sarasota
Geo. W. Robertson III, Miami
George Williams Jr., Miami
William H. Everts, W. Pm. Bch.
Donald H. Gahagen, Ft. L’derdale
Julius C. Davis, Quincy
W. Dotson Wells, Ft. Lauderdale
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George C. Austin, Miami
M. Eugene Flipse, Miami
Kenneth J. Weiler, St. Petersburg
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Elwin G. Neal, Miami
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Sam N. Sulman, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Edwin W. Brown, W. Palm Bch.
Miami Beach, May 1958
>* ft » ft
Miami Beach, May 1958
Miami Beach, May 11, ’58
: Science Exam. Board
J Banks, Association
Cross of Florida, Inc.
Shield of Florida, Inc.
er Council
etes Assn
al Society, State
t Association
ital Association
cal Examining Board
cal Postgraduate Course
e Anesthetists, Fla. Assn.
es Association, State
maceutical Assoc., State
ic Health Association
eau Society
rculosis & Health Assn.
Ian’s Auxiliary
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax.
Mr. C. DeWitt Miller, Orlando
Russell B. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Milton S. Saslaw, Miami
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax.
Howard M. DuBose, Lakeland
DeWitt C. Daughtry, Miami
Mrs. Perry D. Melvin, Miami
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
C. G. Hooten, Clearwater
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Nathan J. Schneider, Jax.
Frank Cline Jr., Tampa
Mrs. R. H. McIntosh, Port St. Joe
Mrs. Wendell J. Newcomb, Pensa.
Miami, June 7, 1958
Ponte Vedra, May 1958
Miami Beach, May 1958
>> ii ii „
Miami Beach, May 18-21, ’58
June 29, 1958
Jacksonville, May 18-21, ’58
W. Palm Beach, Oct 2-4, ‘1958
Miami Beach, May 10-14, ’58
an Medical Association
A. Clinical Session
rn Medical Association
la Medical Association
i, Medical Assn, of
lospital Conference
astern Allergy Assn
astern, Am. Urological Assn.
astern Surgical Congress
'oast Clinical Society
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City ..
John A. Martin, Montgomery .
W. Bruce Schaefer, Toccoa
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
1. O. Morgan, Gadsden, Ala.
Lee Sharp, Pensacola
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles V/. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
B. T. Beasley, Atlanta
J. J. Baehr jr., Pensacola
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Miami Beach, May 14-16, ’58
Pensacola, Oct. 23-24, ’58
MIAMI MEDICAL CENTER j
P. L. Dodge, M.D. O
Medical Director and President X
1861 N.W. South River Drive X
Phones 2-0243 — 9-1448 X
A private institution for the treatment of ner- §
vous and mental disorders and the problems of y
drug addiction and alcoholic habituation. Modern y
diagnostic and treatment procedures — Psycho- y
therapy. Insulin, Electroshock. Hydrotherapy, y
Diathermy and Physiotherapy when indicated, y
Adequate facilities for recreation and out-door y
activities. Cruising and fishing trips on hospital y
yacht. y
information on request A
.Vcmiier American Hospital Association A
1304
Volume XLIV
Number 11
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
ADVISORY TO BLUE SHIELD
WILLIAM C. ROBERTS, M.D., President ..Panama City
JERE W. ANNIS, M.D., Pres.-Elect Lakeland
RALPH W. JACK, M.D., 1st Vice Pres Miami
WALTER E. MURPHREE, M.D.,
2nd Vice Pres Gainesville
JAMES T. COOK JR., M.D.,
3rd Vice Pres Marianna
SAMUEL M. DAY, M.D., Secy. -Treas. .. .Jacksonville
SHALER RICHARDSON, M.D., Editor. .Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Assistant Jacksonville
HENRY ]. HABERS JR., M.D., Chm AL-58 Gainesville
HENRY L. SMITH JR., M.D. A-58 Tallahassee
JOHN J. CHELEDEN, M.D. B-58 Daytona Beach
JOHN M BUTCHER, M.D. C-58 Sarasota
PAUL G. SHELL, M.D D-58 Fort Lauderdale
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
HENRY L. HARRELL, M.D B-59 Ocala
I AMES R. BOULWARE JR., M.D. C-59 Lakeland
RALPH M. OVERSTREET JR., M.D. D 59 W. Palm Beach
MERRITT R. CLEMENTS, M.D A 60 Tallahassee
ROBERT E. ZELLNER, M.D. B 60 Orlando
WHITMAN C. McCONNELL, M.D C-60 St. Petersburg
RALPH S. SAPPENFIELD, M.D D 60 Miami
HAROLD E. WAGER, M.D A-61 Panama City
CHARLES F. McCRORY, M.D. B 61 Jacksonville
JOHN S. STEWART, M.D C-61 Fort Myers
DONALD F. MARION, M.D D 61 Miami
BOARD OF GOVERNORS
WILLIAM C. ROBERTS, M.D., Chm.
(Ex Officio) Panama City
EUGENE G. PEEK JR., M.D... AL-58 Ocala
GEORGE S. PALMER, M.D. . . A-58 Tallahassee
CLYDE O. ANDERSON, M.D... C-59 St. Petersburg
REUBEN B. CHRISM AN JR., M.D.. D-60. .Coral Gables
MEREDITH MALLORY, M.D...B-61 Orlando
JOHN D. MILTON, M.D.. .PP-58 Miami
FRANCIS H. LANGLEY, M.D.. .PP-59 St. Petersburg
JERE W. ANNIS, M.D., Ex Officio Lakeland
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
EDWARD JELKS, M.D. (Public Relations) . .Jacksonville
CANCER CONTROL
ASHBEL C. WILLIAMS, M.D., Chm. AL-58 Jacksonville
FRAZIER J. PAYTON, M.D. D-58 Miami
BARCLEY D. RHF.A, M.D. A-59 Pensacola
ALFONSO F. MASSARO, M.D C-60 Tampa
WILLIAM A. VAN NORTWICK, M.D B 61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm. D-58 Coral Cables
WILLIAM F. HUMPHREYS JR., M.D AL-58 Panama City
WILLIAM S. JOHNSON, M.D. C-59 Lakeland
GEORGE S. PALMER, M.D. A 60 Tallahassee
J. K. DAVID JR., M.D B 61 Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D. Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
DOUGLAS D. MARTIN, M.D Tampa
RICHARD A. MILLS, M.D Fort Lauderdale
JAMES L. BRADLEY, M.D Fort Myers
LOUIS M. ORR, M.D. (Advisory) Orlando
2. Blue Shield
RUSSELL B. CARSON, M.D Ft. Lauderdale
Committees
COUNCILOR DISTRICTS AND COUNCIL
CIVIL DEFENSE AND DISASTER
J. ROCHER CHAPPELL, M.D., Chm. AL-58 Orlando
WILLIAM W. TRICE JR., M.D C-58 Tampa
JOHN V. HANDWERKER JR., M.D D-59 Miami
WALTER C. PAYNE JR., M.D -A-60 Pensacola
W. DEAN STEWARD, M.D JB-61 Orlando
CONSERVATION OF VISION
CARL S. McLEMORE, M.D., Chm AL-58 Orlando
HUGH E. PARSONS, M.D C-58 _ Tampa
CHARLES C. GRACE, M.D B-59 St. Augustine
ALAN E. BELL, M.D A-60 Pensacola
LAURIE R. TEASDALE, M.D D 61 W. Palm Beach
S. CARNES HARVARD, M.D., Chm -AL-58 Brooksville
First— ALPHEUS T. KENNEDY, M.D. 1-58 Pensacola
Second — T. BERT FLETCHER JR., M.D. 2 59 Tallahassee
Third — LEO M. WACHTEL, M.D. 3-58 Jacksonville
Fourth — DON C. ROBERTSON, M.D. 4 59 Orlando
Fifth— JOHN M. BUTCHER, M.D. 5 59 Sarasota
Sixth— GORDON H. McSWAIN, M.D 6 58 - Arcadia
Seventh — RALPH M. OVERSTREET JR., M.D.
7-58 W. Palm Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
GRIEVANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm— W. P aim Beach
FRANCIS H. LANGLEY, M.D St. Petersburg
JOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D Orlando
ROBERT B. McIVER, M.D Jacksonville
ADVISORY TO SELECTIVE SERVICE
FOR PHYSICIANS AND ALLIED SPECIALISTS
J. ROCHER CHAPPELL, M.D , Chm
THOMAS H. BATES, M.D. “A”
I BANK I.. FORT, M.D. “B” .
ALVIN I.. MILLS, M.D “C”
JOHN D. MILTON, M l). "D”
Orlando
Lake City
J acksonville
St. Petersburg
Miami
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D AL-58 Fort Lauderdale
EDWARD JELKS, M.D B-58 Jacksonville
CECIL M. PEEK, M.D D-60 _..W. Palm Beach
GEORGE H. GARMANY, M.D A-61 - Tallahassee
WILLIAM C. ROBERTS, M.D. (Ex Officio) Panama City
SAMUEL M. DAY, M.D. (Ex Officio) _ Jacksonville
BLOOD
MATERNAL WELFARE
JAMES N. PATTERSON, M.D., Chm C-61
Ml) I . Rill I.Y, M.D. \l 58
liOP.HU B. McIVER, M.D.. . B-58
GRETCHEN V. SQUIRES, M.D. A 59
DONALD W. SMITH, M.D. D-60
Tampa
Panama City
Jacksonville
Pensacola
Miami
E. FRANK McCALL, M.D., Chm B-60 Jacksonville
WILLIAM C. FONTAINE, M.D AL-58 Panama City
J. LLOYD MASSEY M.D. A-58 Quincy
RICHARD F. STOVER, M.D D-59 Miami
S. L. WATSON, M.D C-61 Lakeland
f. Florida M.A.
May, 1958
1305
MEDICAL ECONOMICS
ROBERT E. ZELLNER, M.D., Chm AL.58 Orlando
DEWITT C. DAUGHTRY, M l). D 58 Miami
S. CARNES HARVARD, M.D C-59 Brooksville
MERRITT R. CLEMENTS, M.D A-60 Tallahassee
FLOYD K. HURT, M.D B-61 Jacksonville
SCIENTIFIC WORK
GEORGE T. HARRELL JR., M.D. Chm B-60 Gainesville
FRANZ H. STEWART, M.D. ...AL-58 Miami
DONALD F. MARION, M.D I>58 Miami
RICHARD REESER JR., M.D. C-59 St. Petersburg
GRETCHEN V. SQUIRES, M.D A 61 Pensacola
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm D-58 Coral Gables
PAUL J. COUGHLIN, M.D AL-58 Tallahassee
WILLIAM G. MERIWETHER, M.D C-59 Plant Citv
WALTER E. MURPHREE, M.D. B-60 Gainesville
RAYMOND B. SQUIRES, M.D. A 61 Pensacola
Subcommittee
1. Medical Schools Liaison
WALTER E. MURPHREE, M.D., Chm AL-58 Gainesville
MERRITT R. CLEMENTS, M.D., A-60 Tallahassee
HENRY H. GRAHAM, M.D. I! -58 Gainesville
JAMES N. PATTERSON, M.D. C-61 Tampa
EDWARD W. CULLIPHER, M.D D-59 Miami
HOMER F. MARSH, Ph.I). Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. American Medical Education Foundation
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, MD„ Chm A 60 Chattahoochee
NELSON H. KRAEFT, M.D AL-58 Tallahassee
WILLIAM L. MUSSER, M.D If 58 Winter Park
WHITMAN H. McCONNELL, M.D C-59 St. Petersburg
DONALD W. SMITH, M.D. 1)61 Miami
TUBERCULOSIS AND PUBLIC HEALTH
LORENZO L. PARKS, M.D., Chm. B-61 Jacksonville
HENRY I. LANGSTON, M.D AL-58 Apalachicola
IOHN G. CHESNEY, M.D D-58 Miami
HAWLEY H. SEILER, M.D. C-59 Tampa
HAROLD B. CANNING, M.D A 60 Wewahitchka
Special Assignment
1. Diabetes Control
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm B-59.
LEO M. WACHTF.L, M.D AL-58
C. FRANK CHUNN, M.D. C-58
WILLIAM I). CAWTHON, M.D. A 60
V. MARKLIN JOHNSON, M.D 1) 61
Jacksonville
Jacksonville
Tampa
DeFuniak Springs
W. Palm Beach
VENEREAL DISEASE CONTROL
C. W. SHACKELFORD, M.D., Chm A-61 Panama City
FRANK V. CHAPPELL, M.D AL-58 Tampa
A. BUIST LITTERF.R, M.D. D-58 Miami
LINUS W. HEWIT, M.D. C-59 Tampa
I.ORENZO L. PARKS, M.D. B 60 Jacksonville
WOMAN’S AUXILIARY ADVISORY
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D., Chm. B-61 Jacksonville
WILLIAM M. C. WILHOIT, M.D AL-58 Pensacola
J. LLOYD MASSEY, M.D A-58 Quincy
W. TRACY H AVERFIF.I.D, M.D. D 59 Miami
MASON TRUPP, M.D C-60 Tampa
MERRITT R. CLEMENTS, M.D., Chm A-60 Tallahassee
JOHN H. TERRY, M.D AL-58 Jacksonville
WILEY M. SAMS, M.D. D-58 Miami
G. DEKLE TAYLOR, M.D. B-59.... Jacksonville
CHARLES McC. GRAY, M.D. C 61 Tampa
A.M.A. HOUSE OE DELEGATES
NECROLOGY
J. BASIL HALL, M.D , Chm. AL 58 Tavares
WALTER W. SACKETT JR., M.D. 1) 58 Miami
LEO M. WACHTF.L, M.D. B-59 Jacksonville
ALVIN L. STEBBINS, M.D A 60 Pensacola
RAYMOND H. CENTER, M.D C-61 Clearwater
REUBEN B. CHRISMAN JIL, M.D., Delegate Coral Gables
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1958)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
WALTER E. MURPHREE, M.D. Alternate Gainesville
(Terms expire Dec. 31, 1958)
LOUIS M. ORR, M.D., Delegate Orlando
RICHARD A. MILLS, M.D., Alternate Fort Lauderdale
(Terms expire Dec. 31, 1959)
NURSING
THOMAS C. KENASTON, M.D., Chm B-59 Cocoa
CARL M. HERBERT, M.D. AL-58 Gainesville
HERBERT L. BRYANS, M.D A-58 Pensacola
NORVAL M. MARR SR., M.D C-60 St. Petersburg
JAMES R. SORY, M.D D 61 W. Palm Beach
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm B 59 Jacksonville
JOHN J. BENTON, M.D AL-58 Panama City
GEORGE S. PALMER, M.D A-58 Tallahassee
EDWARD W. CULLIPHER, M.D D-60 Miami
FRANK H. LINDEMAN JR., M.D C-61 Tampa
REPRESENTATIVES TO INDUSTRIAL COUNCIL
PASCAL G. BATSON JR., M.D., Chm A-60 Pensacola
WILLIAM J. HUTCHISON, M.D AL-58 Tallahassee
CHAS. L. FARRINGTON, M.D C-58 St. Petersburg
THOMAS N. RYON, M.D. D-59 Miami
RAYMOND R. KILLINGEIi, M.D. B-61 -..Jacksonville
Special Assignment
1. Industrial Health
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort Myers
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M l)., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 Pensacola
ORION O. FEASTER, M.D, 1936 Maple Valley, Wash.
EDWARD JELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., Chm., 1939 Fort Lauderdale
WALTER C. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR., M.D. 1943 Ocala
SHALER RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SIL, M.D. 1947 Gainesville
lOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, M.D., 1950 St. Augustine
DAVID R. MURPHEY JR., M.D., 1951 Tampa
ROBERT If. Md VEIL M l)., 1952 Jacksonville
FREDERICK K. HEIIPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D., 1954 Orlando
IOHN 1). MILTON, M.D., 1955 Miami
FRANCIS H. LANGLEY, M.D., Secy., 1956 St. Petersburg
1306
Volume XLIV
Number 11
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AN AMES CLINIQUICK "
CLINICAL BRIEFS FOR MODERN PRACTICE
Which plasma proteins may be
hazardous in renal disease?
The globulins. They are more easily precipitated to form casts with block-
age of renal tubules. The greater the damage to the glomeruli, the greater
the proportion of urinary globulin to albumin and subsequent tubular
impairment.
Source — Hoffman, W. S.: The Biochemistry of Clinical Medicine, Chicago, The Year
Book Publishers, Inc., 1954, p. 233.
colorimetric “dip-and-read” test
for proteinuria
ALBUSTIX
Reagent Strips
just dip . . .
. . . and read in mg. %
for tablet testing— Albutest® Reagent Tablets detect proteinuria with one drop
of urine.
AMES COMPANY, INC • ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto
46158
2
Nt:* v acadcv.y or
v.cn i c i - c
2 L i 0 3ilQ — SJL. — — |Bmn
MCA VOl|« *» * 29 J C-t
premenstrual tension
responds very well to Compazine*
• agitation and apprehension are promptly relieved
• emotional stability is considerably improved
• nervous tension and fatigue are greatly reduced
• appetite and sleep patterns improve
• depression often disappears
For prophylaxis: ‘Compazine’ Spansulet capsules provide all-day or
all-night relief of anxiety with a single oral dose. Also available: Tablets,
Ampuls, Multiple dose vials, Syrup and Suppositories.
Smith Kline & French Laboratories y Philadelphia
* i .M. Reg. U.S. Pat. Off. for prochlorperazine, S.K.F.
tT M. Reg. U.S. Pat. Off. for sustained release capsules, S.K.F,
Vol. XLIV
EFFECTIVE AGAINST A WIDE RJ
CHLOROM
COMBATS MOST CLINICALLY IMPORTANT PATHOGENS
In vitro studies continue to show that a wide variety of gram-
positive and gram-negative microorganisms are highly sensitive to
CHLOROMYCETIN (chloramphenicol, Parke-Davis).19
Clinically, CHLOROMYCETIN “...has proved to be a particularly
valuable agent in urinary tract infections,” where it is often effective
against microorganisms resistant to other antibiotics.10 Among other
infections against which CHLOROMYCETIN has produced excellent
response are severe staphylococcal wound infections,5 Hemophilus
influenzae 11 and Hemophilus pertussis 12 infections, and dysenteries
caused by salmonellae and bv shigellae.1-
CIILOROMYCETIN is a potent therapeutic agent and, because certain blood dyscrasias
have been associated with its administration, it should not be used indiscriminately or for
minor infections. Furthermore, as with certain other drugs, adequate blood studies should
be made when the patient requires prolonged or intermittent therapy.
REFERENCES: (1) Roy, T. E.; Collins, A. M.; Craig, C., & Duncan, I. B. R.: Canad. M.A.J. 77:844
(Nov. 1) 1957. (2) Schneierson, S. S.: J. Mt. Siucii llosp. 25:52 (Jan. -Feb.) 1958. (3) Hasenclever, H. E:
J. Iowa M. Sot. 47:136, 1957. (4) Rhoads, E S.: Postgrad. Med. 21:563, 1957. (5) Caswell, H. T„ and
others: S'nrg. Gtjnec. 6- Obst. 106:1, 1958. (6) Josephson, J. E., & Butler, R. W.: Canad. M.A.J. 77:567
(Sept. 15) 1957. (7) Petersdorf, R. G.; Curtin, J. A., & Bennett, I. L., Jr.: Arch. Int. Med. 100:927,
1957. (8) Waisbren, B. A., & Strelit/.er, C. L.: Arch. Int. Med. 101:397, 1958. (9) Holloway, W. J., &
Scott, E. G.: Delaware M. J. 29:159, 1957. (10) Murphy, J. J., & Rattner, W. H.: J.A.M.A. 166:616
(Feb. 8) 1958. (11) Neter, E., & Hodes, H. L.: Pediatrics 20:362, 1957. (12) Woolington, S. S.; Adler,
S. J., & Bower, A. G., in Welch, H., & Marti-lbanez, E: Antibiotics Annual 1956-1957, New York,
Medical Encyclopedia, Inc., 1957, p. 365.
PARKE, DAVIS & COMPANY - DETROIT 32, MICHIGAN
ORGANISMS
ETIN
523 strains
PROTEUS MIRABILIS
46 strains
H CHLOROMYCETIN
|
46 strains ■ ANTIBIOTIC GROUP 3%
PSEUDOMONAS AERUGINOSA
55 strains
64 strains
CHLOROMYCETIN 38%
ANTIBIOTIC GROUP 14%
Mgg|
m
/
20
40
60
BO
100
•Adapted from Boy, T. E.; Collins, A. M.; Craig, C„ & Duncan, I. B. B.: Cimtul. M.A.J. 77:814 (Nov. 1) 1957.
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
volume xliv, No. 12 ♦ June, 1958
CONTENT S
Scientific Articles
Emotional Growth and Development of the Child with a Key
to His Personality, Richard E. Wolf, M.D. 1327
Glaucoma for the General Practitioner, William J. Gibson, M.D. 1334
Pitfalls in Electrocardiographic Interpretation. Carl M. Voyles, M.D. 1337
Organization of a National Streptococcal Epidemiologic
Survey, Milton S. Saslaw, M.D. 1341
The Relationship of Sex to Childhood Accidents,
Elsie R. Broussard, M.D. 1343
Abstracts
Drs. Morris Waisman, Alvan G. Foraker, Sam W. Denham, Richard E. Strain,
Irwin Perlmutter, H. Clinton Davis, Irwin S. Morse, Donald W. Smith,
Robert M. Lee. Gus G. Casten and Robert J. Boucek 1345
Index
Index to Volume XLIV 1347
Editorials and Commentaries
Whither Goest? 1357
Phenylpyruvic Oligophrenia 1358
Graduate Medical Education Seminars 1358
Medical Lecture Tour to Asia 1359
Sears-Roebuck Foundation Plan for Community Medical Assistance 1359
Statewide Medico-Legal Institute Well Attended 1360
1958 State Science Fair 1361
Sarasota County Medical Society Employs Executive Secretary 1362
Southern Postgraduate Seminar, Saluda, N.C.. July 7-26 1362
Southern Railway Surgeons Annual Meeting Held 1363
General Features
President’s Page 1356
Others Are Saying 1363
State News Items 1372
New Members 1378
Component Society Notes 1382
Classified 1383
Births and Deaths 1390
Medical Licenses Granted 1390
Obituaries 1406
Woman’s Auxiliary 1411
Books Received 1413
Schedule of Meetings 1419
Florida Medical Assoication Officers and Committees 1420
County Medical Societies of Florida 1422
This Journal is not responsible for the opinions and statements of its contributors.
Published monthly at Jacksonville, Florida, Price S5.00 a year: single numbers, 50 cents. Address Journal of Florida
Medical Association, P.O. Box 2411, 735 Riverside Ave., Jacksonville 3. Fla. Telephone EL 6-1571. Accepted for mail-
in V ai ^oecial rate of postage provided for in Section 1103. Act of Congress of October 3, 1917: authorized October 16.
1916 Entered as second-class matter under Act of Congress of March 3, 1879. at the post office at Jacksonville,
Florida. October 23. 1924
TYPICAL IMFERON RESPONSES
feron
CHRONIC BLOOD LOSS:
INTOLERANCE TO ORAL IRON:
LAKESIDE
Raieies Respiratofl
lust and Dirt
the Home
Causei
Irritant:
Patients with dust allergies frequently experience
marked discomfort during home cleaning activities
due to dust and dirt in the air. The Filter Queen
Home Sanitation System relieves such distress by
removing the cause. It operates on an entirely dif-
ferent principle— really two principles in one. First,
by means of an unique, exclusive Sanitary Filter
Cone it actually filters the air, cleans it by aero-
scopic action of the smallest particles, even matter
as fine as smoke. Second, the Filter Queen
Centrifugal Chamber traps all matter collected,
positively eliminates scattering or dispersion of
dust in room air. Unbiased scientific proof of
Filter Queen’s air purifying efficiency is shown in
a recent report* from the Biological Sciences De-
partment of an eastern university which states,
" The Filter Queen cellulose Filter Cone removes
practically all dust and atmospheric pollen’.’ This is
another reason why Filter Queen has been selected
for use in many of America’s leading hospitals.
A Filter Queen demonstration in your home
or office can be easily arranged at no obliga-
tion by writing or calling your local Filter Queen
distributor.
Filter Queen carries the seals of Good Housekeeping Magazine, Rice Leaders of the
World, Underwriters’ Laboratories, and is advertised in A.M.A.'s "Today's Health.”
Guaranteed
Housekeeping
[y’PVERTIStP
•Report on file in offices of Health-Mor, Inc., 203 N. Wabash Ave., Chicago 1,
,1 it, «
XV*1
W
Florida M.A.
une, 1958
1315
FOR FLAGELLATE AND FUNGAL VAGINITIS
; ' ■ ■ ' " ' ; '
Floraquin®
Destroys Common Vaginal Pathogens;
Rebuilds Normal Bacterial Barrier
Whenever a woman complains of vaginal dis-
charge with pruritus, a trichomonal infection1
must be suspected. Moniliasis, the second most
frequent cause2 of leukorrhea, often occurs3 in
conjunction with diabetes mellitus, pregnancy
and estrogen or broad spectrum antibiotic ther-
apy. Commonly used douches wash away nor-
mal acid secretions and protective Doderlein
bacilli, thus tending to aggravate the problem.
Floraquin, containing Diodoquin® (diiodo-
hydroxyquin, U.S.P.), eliminates infection and
provides boric acid and sugar to restore the
acidic pH which favors replacement of patho-
gens by normal Doderlein bacilli. The danger
of recurrence is thus minimized.
Pitt reports2 consistently good results after
daily vaginal insufflation of Floraquin powder
for three to five days, followed by acid douches
and the daily insertion of Floraquin vaginal tab-
lets throughout one or two menstrual cycles.
Intravaginal A pplicator for Improved
Treatment of Vaginitis—
This smooth, unbreakable, plastic plunger de-
vice is designed for simplified insertion of Flora-
quin tablets by the patient; it places tablets in
the fornices and thus assures coating of the
entire vaginal mucosa as the tablets disintegrate.
A Floraquin applicator is supplied with each
box of 50 tablets.
G. D. Searle & Co., Chicago 80, Illinois. Re-
search in the Service of Medicine.
1. Davis, C. H.: Trichomonas Vaginalis Infections: A
Clinical and Experimental Study, J.A.M.A. 157: 126
(Jan. 8) 1955.
2. Pitt, M. B.: Leukorrhea, Causes and Management,
J.M.A. Alabama 25: 182 (Feb.) 1956.
3. Lang, W. R.: Recent Advances in Vaginitis, Phila-
delphia Med. 5J.1494 (June 15) 1956.
SEARLE
1316
Volume XLI'
Number 12
Investigator
after investigator repi
PLACEBO
PLACEBO
CONTROL
Grade
Wilkins, R. W.: New England J. Med. 257:1026, Nov. 21, 1957.
“Chlorothiazide added to other antihypertensive drugs reduced the blood
pressure in 19 of 23 hypertensive patients.” “All of 11 hypertension
subjects in whom splanchnicectomy had been performed had a striking
blood pressure response to oral administration of chlorothiazide.” “. . . it is
not hypotensive in normotensive patients with congestive heart failure, in
whom it is markedly diuretic; it is hypotensive in both compensated and
decompensated hypertensive patients (in the former without congestive
heart failure, it is not markedly diuretic, whereas in the latter in congestive
heart failure, it is markedly diuretic) ”
Freis, E. D., Wanko, A., Wilson, I. H. and Parrish, A. E.: J.A.M.A. 166:137,
Jan. 11, 1958.
“Chlorothiazide (maintenance dose, 0.5 Gm. twice daily) added to the
regimen of 73 ambulatory hypertensive patients who were receiving other
antihypertensive drugs as well caused an additional reduction [16%] of
blood pressure.” “The advantages of chlorothiazide were (1) significant
antihypertensive effect in a high percentage of patients, particularly when
combined with other agents, (2) absence of significant side effects or
toxicity in the dosages used, (3) absence of tolerance (at least thus far), and
(4) effectiveness with -simple ‘rule of thumb' oral dosage schedules.”
RESERPINE {0.5 mg./doy)
HYDRALAZINE
PENTOLINIUM
(ZOO mg. /day)
rmnenTHiAZIDE
(750 mg. /day)
200
BLOOD
PRESSURE
mm. Hg
150
RETINOPATHY
0 3 5 8 12 16 20 24 28 2
In “Chlorothiazide: A New Type of Drug for the Treatment of Arterial Hypertension,"
MERCK SHARPS DOHME
Hollander, W. and Wilkins, R. W. : Boston Med. Quart. 8: 1, SepUA
Division of MERCK & CO., Inc., Philadelphia 1, Pa. HUl
J Florida M.A.
June, 1958
as simple as 2* - 3
INITIATE THERAPY WITH 'DIURIL'. 'Oiuril* is given in a dosage range of from 250
mg. twice a day to 500 mg. three times a day.
ADJUST DOSAGE OF OTHER AGENTS. The dosage of other antihypertensive medication
(reserpine, veratrum, hydralazine, etc.) is adjusted as indicated by patient response. If the patient is
established on a ganglionic blocking agent (e.g., 'inversine') this should be continued, but the total
daily dose should be immediately reduced by as much as 25 to 50 per cent. This will reduce the
serious side effects often observed with ganglionic blockade.
) ADJUST DOSAGE OF ALL MEDICATION. The patient must be frequently observed and
careful adjustment of all agents should be made to determine optimal maintenance dosage.
SUPPLIED: 250 mg. and 500 mg. scored tablets 'oiuril' (chlorothiazide); bottles of 100 and 1,000.
'DIURIL1 is a trade-mark of Merck & Co.. Inc.
ith, more trouble-free management of hypertension with 'DIURIL'
1317
1318
Volume XI. IV
Number 12
AN AMES CLINIQUICK
CLINICAL BRIEFS FOR MODERN PRACTICE
48 72 96 120
Minutes '
S.: Applied Physiology, ed. 8, London,
1947, p. 734.
Whafs wrong with the term
“emptying of the gallbladder”?
The gallbladder discharges bile by fractional evacuation. It is not
emptied completely at any one time even following a fatty meal.
Source — Lichtman, S. S. : Diseases of the Liver, Gallbladder and Bile Ducts, ed. 3,
Philadelphia, Lea & Febiger, 1953, vol. 2, p. 1177.
routine physiologic support for “sluggish” older patients
DECHOLirone tablet t.i.d.
therapeutic bile
increases bile flow and gallbladder function— combats bile stasis
and concentration ... helps thin gallbladder contents.
corrects constipation without catharsis— prevents colonic dehydra-
tion and hard stools . . . provides effective physiologic stimulant.
Decholin tablets (dehydrocholic acid, Ames) 3 3A gr. Bottles of 100 and 500.
/£* AMES COMPANY, INC • ELKHART, INDIANA
Ames Company of Canada, Ltd., Toronto
"EMPTYING" OF GALLBLADDER AFTER FATJY MEAL*
-L5 egg yolks
METRETON
NASAL SPRAY
Meticortelone plus Chlok-Trimeton
unique “Meti”steroid-antihistamine combination
quick nasal clearing — easy breathing within min-
utes . . . without rebound
shrinks nasal polyps — helps revive sense of smell
prolonged effect — aids drainage, relieves itch, con-
trols discharge . . . lastingly effective
broad range of use— cardiac, hypertensive, preg-
nant and elderly patients are safe from sympathomi-
metic vasoconstrictor effects
severe hay fever, pollen asthma, urticaria
perennial rhinitis, allergic dermatoses
response without fail by the systemic route
Metreton Tablets provide uniquely effective
antiallergic, anti-inflammatory benefits in hard-
to-control allergies. Added ascorbic acid helps
counter stress and prevents vitamin C depletion.
safe and well tolerated
Metreton contains Meticorten, the steroid
that does not cause fluid or electrolyte disturb-
ance in average dosage schedules, and Chlor-
Trimeton, the antihistamine noted for its
remarkable record of safety and effectiveness.
Each METRETON Tablet contains 2.5 mg. prednisone, 2 mg. chlorprophenpyridamine maleate and 75 mg. ascorbic acid.
SCHERING CORPORATION • BLOOMFIELD, NEW JERSEY
Each cc. of METRETON Ophthalmic Suspension con-
tains 2 mg. (0.2%) prednisolone acetate and 3 mg.
(0.3%) chlorprophenpyridamine gluconate.
Metreton,® brand of corticoid -antihistamine compound.
Meticortelone,® brand of prednisolone.
Meticorten,® brand of prednisone.
Chlor-Trimeton,® brand of chlorprophenpyridamine
preparations.
Meti — t.m. — brand of corticosteroids.
MT-J-258
J. Florida M.A.
June, 1958
1319
C/tofrf
Sa&icU
— and a
glass of beer,
with your
consent for
a morale-
booster
These ideas may help your elderly patient
enjoy a better-balanced diet
The Geriatric Diet
/
• Meat is as important for elderly people as it
is for the young. Fish steaks, chicken parts,
chops or cutlets can be bought in small portions.
Plenty of good fruits and vegetables mean vita-
mins in proper balance. Chopped or strained
vegetables and canned fruits are easy to chew.
And salads need no cooking. A one-dish casserole
gives free rein to the imagination. The flavor
can be perked up with spices and herbs.
Be sure the fluid intake is liberal. And remind
your patient that it need not necessarily be
water. A glass of beer* before dinner often leads
to improved appetite. And another glass at bed-
time may induce a better night’s sleep.
*Sodium 17 mg., Calories 104/8 oz.
glass (Average of American Beers)
United States Brewers Foundation
Beer — America’s Beverage of Moderation
If you’d like reprints of this and 11 other dietary suggestions, please write United States Brewers Foundation, 535 Fifth Avenue, New York 17, N. Y.
1320
Volume XI.IV
Number 12
(CHLOROTHIAZIDE)
FORD, R. V., Rochelle, J.B.III, Handley, C. A., Moyer, J. H. and Spurr, C. L.:
J.A.M.A. 166:129, Jan. 11, 1958.
. . in premenstrual edema, convenience of therapy points to the selection of
chlorothiazide, since it is both potent and free from adverse electrolyte
actions.” In the vast majority of patients, 'DIURIL' relieves or prevents the fluid
“build-up” of the premenstrual syndrome. The onset of relief often occurs
within two hours following convenient, oral, once-a-day dosage. 'DIURIL' is well
tolerated, does not interfere with hormonal balance and is continuously
effective— even on continued daily administration.
DOSAGE: one 500 mg. tablet 'DIURIL' daily— beginning the first morning of
symptoms and continuing until after onset of menses. For optimal therapy,
dosage schedule should be adjusted to meet the needs of the individual patient.
SUPPLIED: 250 mg. and 500 mg. scored tablets 'DIURIL' (chlorothiazide);
bottles of 100 and 1,000.
DiURIL is a trade-mark of Merck & Co., Inc;
MERCK SHARP & DOHME Division of MERCK & CO.. Inc., PhTlaJelpTiia 1, Pa.
J. Florida M.A.
June, 1958
1321
FOR ' OIURIL1
quickly relieves
Distress
Distention
Discomfort
ANY INDICATION FOR DIURESIS IS AN INDICATION
1322
Volume XLIV
Number 12
when eating moves outdoors . . .
CREMOSUXIDINE
SULFASUXIDINE® SUSPENSION WITH KAOLIN AND PECTIN
CONTROLS “SUMMER COMPLAINT
M
For people at work or on vacation, “summer complaint” is an annoying hazard of
warm weather. Changes in routine or in eating or drinking habits can cause diarrhea
and ruin summer days.
Ciiemosuxidine gives prompt control of seasonal diarrhea by providing antibac-
terial and antidiarrheal benefit. It detoxifies intestinal irritants and soothes inflamed
mucosa.
Chocolate-mint flavored CREMOSUXIDINE is so pleasant to take too !
Ciiemosuxidine ami Sulfasuxidine
are trade-marks of Merck & Co., Inc.
MERCK SHARP & DOHME
DIVISION OF MERCK & CO., Inc., PHILADELPHIA 1, PA.
Raise the Pain Threshold
Phenaphen with Codeine provides
intensified codeine effects with
control of adverse reactions.
It renders unnecessary (or postpones)
the use of morphine or addicting
synthetic narcotics, even in
many cases of late cancer.
Three Strengths —
PHENAPHEN NO. 2
Phenaphen with Codeine Phosphate Vi gr. (16.2 mg.)
PHENAPHEN NO. 3
Phenaphen with Codeine Phosphate V2 gr. (32.4 mg.)
PHENAPHEN NO. 4
Phenaphen with Codeine Phosphate 1 gr. (64.8 mg.)
Also —
PHENAPHEN In each capsule
Acetylsalicylic Acid 2% gr. . (162 mg.)
Phenacetin 3 gr (194 mg.)
Phenobarbital 14 gr (16.2 mg.)
Hyoscyamine sulfate (0.031 mg.)
PHENAPHEN with codeine
Rabins
A. H. ROBINS CO., INC., RICHMOND 20. VIRGINIA
Ethical Pharmaceuticals of Merit since 1878
Unusual Antibacterial and Anti -infective Properties. More rapid ab-
sorption . . . higher and better sustained plasma concentrations . . . more
soluble in acid urine than other sulfonamides . . . freedom from crystal-
luria and absence of significant accumulation of drug, even in patients
with azotemia. 1
Unprecedented Low Dosage. Less sulfa for the kidney to cope with . . .
yet fully effective. A single daily dose of 0.5 to 1.0 Gm. (1 to 2 tablets)
maintains higher plasma levels than 4 to 6 Gm. daily of other sulfonamides
— a notable asset in prolonged therapy. 2
New Control Over Sulfonamide-sensitive Organisms. Kynex maintains
the prolonged, high tissue concentrations of primary importance in treat-
ment of urinary infections ... a therapeutic asset toward preventing
manifest pyelonephritis as a complication of persistent bacteriuria during
pregnancy and puerperium. Maintenance of sterile urine in such patients
was accomplished with 1 tablet of Kynex daily. 3
Suifametfjoxypyriaazlne Leaerio
Dosage: The recommended adult dose is 1 Gm. (2 tablets) the first day,
followed by 0.5 Gm. (1 tablet) every day thereafter, or 1 Gm. every other
day for mild to moderate infections. In severe infections where prompt,
high blood levels are indicated, the initial dose should be 2 Gm. followed
by 0.5 Gm. every 24 hours. Dosage in children, according to weight; i.e., a
40 lb. child should receive of the adult dosage. It is recommended that
these dosages not be exceeded.
KYNEX -WHEREVER SULFA THERAPY IS INDICATED
Tablets: Each tablet contains 0.5 Gm. (7J^ grains) of sulfamethoxypyri-
dazine. Bottles of 24 and 100 tablets.
Syrup: Each teaspoonful (5 cc.) of caramel-flavored syrup contains 250
mg. of sulfamethoxypyridazine. Bottle of 4 fl. oz.
References: 1. Grieble, H. C. and Jackson, G. G.: Prolonged Treatment of Urinary-Tract Infections
with Sulfamethoxypyridazine. New England J. Med. 258:1-7, 1958. 2. Editorial New England J. Med.
268:48-49,1958.3. Jones, W.F., Jr. and Finland, M., Sulfamethoxypyridazine and Sulfachloropyridazine.
Ann. New York Acad. Sc. 60:473-483, 1957.
♦Reg. U. S. Pat. Off.
LEDERLE LABORATORIES
a Division of
AMERICAN CYANAMID COMPANY
Pearl River, New York
132&
Volume XI. IV
Number 12
n
At the last accounting,1 physicians throughout the coun-
try had administered at least one dose of poliomyelitis
vaccine to 64 million Americans — all three doses to an
estimated 34 million. Undoubtedly, these inoculations
have played a major part in the dramatic reduction of
paralytic poliomyelitis in this country.
Incidence of polio in the United States, 1952-1957
(data compiled from U.S.P.H.S. reports)
vaccine is plentiful for the job remaining
There are still more than 45 million Americans under
forty who have received no vaccine at all and many
more who have taken only one or two doses.
As it was phrased in a public statement by the Depart-
ment of Health, Education, and Welfare:
“It will be a tragedy if, simply because of public
apathy, vaccine which might prevent paralysis or even
death lies on the shelf unused.”2
Eli Lilly and Company is prepared to assist you and
your local medical society to reach those individuals who
still lack full protection. For information see your Lilly
representative.
1. J. A. M. A., 165:27 (.November 23), 1957.
2. Department of Health , Education, and Welfare: News Release, October 10,
1957.
ELI LILLY AND COMPANY . INDIANAPOLIS 6, INDIANA, U. S. A.
849008
The Journal of The Florida Medical Association
PUBLISHED MONTHLY
Volume XLIY
Jacksonville, Florida, June, 1958
No. 12
Emotional Growth and Development
Of the Child
With a Key to His Personality
Richard E. Wolf, M.D.
CINCINNATI
No one lives in a vacuum. Human living is
a relatedness, a belonging, and successful living de-
pends on the culture in which the individual finds
himself. Each culture makes its own demands
upon the individual. The criteria for successful
living on Bali are very different from the criteria
for successful living in the United States of
America. To be a success in 1956 implies meet-
ing certain requirements of living which did not
exist in 1900. In our particular culture emphasis
is placed on being independent, self-sustaining
and contributing at the earliest possible time.
When we realize that the human infant is the
most dependent, the most helpless of the young
of any species, that it takes almost 15 years be-
fore he reaches any degree of even biologic matur-
ity, then we see what a tremendous amount of
psychologic growing he must do before he can
achieve the goals we set for him — to be a happy,
self-reliant and constructive person in our society.
Early Infancy
In discussing the significance of the period of
early infancy in the development of the personal-
ity, we often find ourselves assigning attitudes,
thoughts, and feelings to an infant which are ac-
tually beyond the development of his nervous sys-
tem. We refer frequently to the “sense of insecu-
rity” that a two week old baby feels when he is
hungry. Obviously, this infant does not lie in
his crib and contemplate the fact that he is hun-
gry. He does learn that his mother can end his
discomfort; if she does not do it, then he remains
uncomfortable, and mother is associated with this
discomfort. The absence of a capacity for con-
templation does not mean that this infant is not
having feelings, nor does it mean he cannot re-
spond on a very primitive level to a relationship
with another individual. Sometimes we try to
Associate Professor of Pediatrics and Assistant Professor of
Pediatric Psychiatry, University of Cincinnati College of Medi-
cine, and Director, Pediatric Psychiatry Clinic, Children’s Hos-
pital, Cincinnati.
Read before the Florida Pediatric Society, Fall Meeting,
Clearwater, Nov. 1, 1956.
oversimplify matters and differentiate between the
physical and emotional life of the child. This
differentiation cannot be made even for the period
of infancy because both his physical and his emo-
tional life depend upon the mothering activities
of his mother. Mothering is actually a continua-
tion of the prenatal state. A mother stimulates
his larger muscles through carrying her baby,
stimulates his skin through stroking, stimulates
his ears, and hearing, through talking to the baby.
The nervous system of the newborn infant
is poorly integrated. Movements are random and
on a reflex level rather than purposeful, coordi-
nated and controlled. Even his sucking reflex
may be poor, and the mechanism foi "egulating
such vital functions as respiration, temperature
control, and circulation may be immature. The
mothering activities of the mother actually stimu-
late this poorly integrated, immature organism to
better function. When we observe a newborn in-
fant, we readily notice the effect of cuddling and
stroking upon stabilization of his earliest physio-
logic functions, particularly respiration and cir-
culation. Every pediatrician has seen babies who
fail to thrive because of the lack of this essential
stimulation. There is an inherent tendency on the
part of the newborn infant to reach out for
gratification. Ribble has called this “stimulus
hunger.” In the first few weeks this is expressed
by his seeking the breast, reaching out toward it
when he is hungry. A hungry newborn infant
placed near his mother’s breast will root and grasp
the breast with his lips and begin to suck. Al-
though this response has for its purpose the relief
of hunger, the impulse expressed as an effort to
secure food represents a primitive expression of a
drive to turn to someone else for relief of dis-
comfort.
This is the beginning, and in the process of de-
velopment this drive culminates in a pattern by
which the individual turns to the external world
for gratification of both psychologic and physio-
1328
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
Volume XI. IV
Number 12
logic hungers. We can speak of this as the drive
to be loved and we can say that a biologic and
physiologic bond between the infant and his moth-
er is thus converted into a psychologic bond. The
physical benefits that result in a state of well-
being in the child foster a feeling of gratification
from the external world. Because of this inter-
relationship of physical well-being and psycho-
logic gratification, many pediatricians try to help
mothers find the suitable feeding program based
on the child’s apparent needs, rather than by
a predetermined and uniform schedule. 1'here has
been too much ballyhoo, as if this were such a
new method of infant feeding. Is it really so dif-
ferent from a very old approach? Is it not based
on an attitude that the human being instinctively
tends to expect and to respond to contacts with
another human being, and thus to socialize?
Socialization and the ability to live with others
are fostered when the child’s first experience with
his world is one of gratification rather than of
frustration.
Since the child is so completely dependent for
even physiologic needs, the first step in his healthy
development is a capacity to sense a love of his
mother, to have trust in her, and to turn to her
to meet his needs. A child, reared under a regime
where frustration is fostered and he learns to cry
and fight for gratification, grows to become timor-
ous in the face of hazards existing in the external
world. Another meets the problem with anger and
a hostile attack upon an environment that has
proved frustrating and hostile to him. The moth-
er whose love he needed made herself a difficult
person to love. He may need other people to
make up for this lack, but the means to obtain
these contacts are not available to him. His need
to be dependent, if satisfactorily met, allays his
anxiety- -the anxiety that has its roots in his own
physical inadequacy to deal with the unknown.
Anxiety in the infant may be manifested by a
state of physical tension. This, all pediatricians
have seen in babies.
Early infantile dependence is described as oral
dependence because mouth activity is so promi-
nent a part of infants’ activity. I have sketched
the importance of the sucking mechanism in main-
taining biologic requirements, in acquiring food
to meet nutritional needs. Most infants have
strong sucking impulses which manifest them-
selves when food is not required. You know how
babies will suck even though they have had ade-
quate food and in the first days of life can be
observed sucking their fists immediately after re-
ceiving adequate amounts of milk. Studies have
shown that some sucking in older infants is
brought about by inadequate sucking time during
feeding. Children who have had inadequate suck-
ing time, due either to nipples which flow too
easily or to an inadequate amount of milk, may
be more likely to suck thumbs later. Sucking
offers gratification to the small baby over and
above the gratification entailed in obtaining an
adequate amount of food.
Since the child’s first relief from any discom-
fort comes from satisfying physical hunger
through sucking, this experience may lead to self
administration of comfort when tension begins
to develop and cannot be relieved in other ways.
Thus children faced with discomforts other than
hunger turn to a tried and true method of grati-
fication and suck their thumbs. Thumb-sucking
is the child’s attempt to comfort himself when
faced with situations of which he is afraid and
in which he feels insecure. Instead of turning
to mother, he turns back to himself and seeks
gratification from his own thumb as he had been
gratified by sucking in an earlier period of hi£
development. Attempts, therefore, to stop thumb
sucking forcefully only deprive the child of his
limited amount of security and take away from
him the one resource of which he is sure. When
the child has had enough gratifying experiences
from the external world, his thumb will no longer
be necessary, and it is a characteristic of the hu-
man being to turn outward for gratification rather
than to remain isolated and self dependent.
Since the early nursing period is of such great
significance in the establishment of basic security
for the child, it is not surprising that the weaning
period may be extremely disturbing if the child is
not ready to relinquish this oral gratification. The
situation is the same whether the weaning is from
the breast or from the bottle. If weaning is pre-
mature or abrupt, the child may react poorly
since a type of gratification has been removed be-
fore he has learned another form of gratification.
The support upon which he has depended has
disappeared, and the mother, instead of allaying
anxiety, now represents a stimulus for anxiety.
Anxiety aroused by such experiences may mani-
fest itself in a variety of symptoms. The child
may refuse all food, or, if he does eat, may be
unable to tolerate the food; diarrhea, constipation,
or vomiting developing. Even a baby can react
to this experience with anger because of his in-
J. Florida M.A.
June, 1958
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
1329
ability to be rid of this anxiety. Such a hostile
reaction (for it is hostile) may also express itself
in refusal to eat or in vomiting, diarrhea or con-
stipation. Or, he may indicate his disturbance oy
increased restlessness, sleeplessness or sucking his
thumb. Whatever the symptom may be, the cause
of the difficulty lies in the disturbance created by
too sudden or too early withdrawal of the source
of his gratification and the mobilization of more
anxiety and tension than the organism can handle.
Society Begins to Impinge
By the end of the first year, the infant has
progressed in his development, so that he is not
so completely dependent upon others for gratifica-
tion of his needs and desires. Now, in being able
to crawl about, he can explore his environment
with hands as well as mouth. He begins to make
certain sounds as he attempts to communicate his
feelings and desires vocally. He has long since be-
come aware of sounds, of colors, of things, and
of the possibility of playing with objects other
than those directly given to him. He is now able
to attempt to feed himself; he is able to smear his
food over his high chair, himself and his mother.
Because he is able to move about, he can reach
many new goals and can give expression to his
impulsive desires. At first, he has no concept of
forces other than his own wishes. He feels him-
self omnipotent. As he is able to direct his be-
havior more, however, he soon realizes that his
wishes may at times conflict with the wishes of
his parents. He thus reaches the point at which
the demands of society represented by his parent
begin to impinge upon his freedom and sense of
omnipotence. Society’s earliest demands of con-
formity to certain standards are expressed through
the parent’s attitude of approval or disapproval
for certain forms of behavior.
During the early phase of this development,
the child is faced with a dilemma. He wants to
express an impulse, but if he does, this act may
jeopardize the gratification of an equally pressing
need, the need to remain secure in the love his
parents give him. Thus, his aggressive drive comes
into conflict with his need to be loved, and anger
as well as love is felt for the same parent who is
responsible for this dilemma. The child gradually
learns to conform in this early training period be-
cause he fears withdrawal of the parent’s love
and the emotional pain this withdrawal causes.
After weaning, the first impingement of so-
ciety upon the child’s primitive, instinctual im-
pulses is toilet training. Toilet training is some-
thing that the mother wants from the child, not
an activity that the young child desires for him-
self. Training instituted in the early months
illustrates clearly the great premium placed in our
culture on cleanliness and conformity. Actually,
we know from neurophysiologic studies that the
child is not capable of conscious control of
bladder and rectum until sometime after he at-
tains the upright position and walks; yet we
know mothers who insist that their children were
trained during the first year. How often we say
to the mother that she is more trained to “catch’’
the child than anything else.
At about the time that conscious voluntary
control of sphincters becomes possible, a psycho-
logic change in the child occurs. Whereas, before,
his mouth was the center of his universe, his
interest is now partially displaced to the other
end of his gastrointestinal tract. As a result, he
becomes as interested in his excretory functions as
his mother is in controlling them. Under optimum
conditions, the child’s interest in this function will
facilitate toilet training since he will tend to im-
itate the activity of other members of the house-
hold, if allowed to come to these activities on his
own as he does with other activities and uses of
“gadgets.” Under less desirable conditions, his
interest and his mother’s interest come into con-
flict and complicate the training program. This
consciousness of his excretory capacity presents
him with a conflict. Since the child has none of
the feelings of revulsion for his bowel movements
that have developed in his mother, her attitude
has led him to believe that she too prizes his “pos-
session,” so that her demand that he give her this
prized possession seems to him to be an aggressive
act on her part. Since his attained control is
evidence to the child of his own increased power
and his ability to give or to hold back, he can ex-
press his aggression in this way, too. If his moth-
er has been overdemanding and punitive in her
toilet training, he can express his hostility towards
her by dooming her attempts to failure. Toilet
training thus becomes a battle between the
mother and the child, and fathers can be drawn
into it, too. as you know. The child, however,
has the final control of the situation. If his hos-
tility toward his parent is so great that, at least
for the time being, he cannot value her love, noth-
ing can bring him to toilet training for, after all,
final success is entirely in his control.
Clinically, the confusions of this period are
manifested in various ways. Severe constipation
1330
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
may develop. Via his lower bowel the child is say-
ing “I won’t give it to you, I won’t, I won’t.”
Similarly, a child may refuse to comply to
mother’s schedule and refuse to urinate or have
his bowel movement when he is on the toilet,
only to soil himself immediately afterwards. We
all know children who hide their bowel move-
ments or smear them. This behavior is desper-
ate behavior and may have its origin in the re-
quirements of an overly zealous or punitive
toilet training itself, or the parent may be over-
demanding in too many other areas at the same
time, thus arousing too much of his anger. It
may also be that the mother has been a frustrat-
ing person in her entire relationship with her
child, and as a result, he feels more hostile than
loving toward her. It looks as if nature has given
the child a way to frustrate the parent by refus-
ing to comply in something that obviously is im-
portant to the parent.
Just as it was important for feeding experi-
ences to be satisfactory and uncontaminated by
other strong emotions, so is it important that toi-
leting experiences take place without the emotions
being involved and expressed through toilet be-
havior. A child who is helped to come to his
toilet training with a warm permissive attitude
and acceptance and approval when he “con-
forms,” but who does not feel rejected and
punished when he fails to conform, will give up
his own primitive desires where his excretory
functions are concerned for the demands and the
standards of the parent he so loves and wants to
please. Parents can be reassured that with such
an attitude towards toileting (and in a house-
hold where a toilet is present) that a child will
achieve this degree of civilization at least by the
time he is three. The rewards of growing up are
greater than the deprivations entailed.
Mastering Elementary Social Demands
As the child gradually learns to synchronize
his desire to carry out his impulses with his wish
to maintain the security of his relationship with
the parent, there develops a greater capacity to
divert his feelings away from himself, and he
begins the struggle to master the elementary so-
cial demands. By now he has the capacity to give
love as well as to receive it. He shows love for
each parent without differentiation other than that
encouraged by differences in their attitudes to-
wards him. He loves the persons who have been
the source ol his security and his pleasure. This
situation does not remain this way long, however,
Volume XUV
Number 12
for the child normally turns with greater intensity
to the parent of the opposite sex. Because of his
preference for the parent of the opposite sex, the
parent of the same sex becomes a rival for the
other parent's love. Because he also wishes to be
loved by his rival and senses the power of the
rival over him. the situation is sensed as one
fraught with danger. The ramifications of the
problems of this domestic triangle are different
for the boy and the girl.
Both the boy and the girl have been primarily t
dependent upon mother for security and comfort.
In his later development, the love object for the
boy does not change, and he still feels the j
strongest emotional response to his mother.
This response, however, is now more intense
and also has value in itself rather than solely
for the preservation of his security. Thus, father
becomes a rival for mother's love and a dangerous
rival. Since father is large and strong, even if
not actually punitive, he can punish the boy by
destroying that which is most important to him at
this time — his masculinity. Since he has observed
that there are people anatomically different from
him. he may relate this difference to the danger
that he believes he is in. He thinks, “There are
individuals who have lost something I have, and i
the same thing may happen to me.” Such an
event could only be the result of an attack of a
hostile person who has been provoked, and he at-
taches this danger to his father with whom he
feels so competitive. It is in this three to five year
period that the little boy frequently expresses
fears of doctors, dentists, bad men and boogie-
men. His dreams are of being pursued by large
frightening animals and giants. There may be
excessive concern over minor bodily injuries, and
the Band Aid period is on. For this reason, elec-
tive surgical procedures such as tonsillectomy and
particularly circumcision are psychologically con-
traindicated during this period.
His fear of retaliation by his father for his
hostile feelings is only one aspect of the coni ict
that creates anxiety and confusion for the boy.
If relationship with his father has been satisfac-
tory up until now, positive elements remain, and
he wishes to be loved by his father and to be like
him. Since mother loves father, the boy strives to
be like father to share mother’s love- — sort of “if.
you can't lick ’em, join ’em.” In order, however,
to retain the love of the father and avoid the
danger of retaliation, the little boy strives to be
like his father, but renounces his mother as a love
J. Florida M.A.
June, 1958
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
1331
object. This identification with the father go <j
him new security, and father is gratified to s“"
his son become a real boy, more like him. Mother,
too, responds positively to the masculinity of her
son, and the child has gained his goal. Through
this solution to his problem by taking into him-
self the ideal of his father, his own conscience
comes into being. Now, he has a mechanism for
control of his primitive impulses within himself
and no longer needs the control from without as
was necessary up until this time. The solution
of this emotional problem frees energy that can
now go into establishing relationships outside of
the family unit, with the world beyond his fam-
ily. There develops a greater capacity to socialize.
He now takes steps towards making friends
among his peers, and this contact in turn offers
an outlet for his competitive feeling. His competi-
tive activities are in the fantasy world; he plays
cops and robbers or cowboys and Indians or ‘‘good
guys against the bad guys.” In becoming social-
ized, he participates in a team situation, obeys
the laws of sportsmanship and fair play, shows
loyality to friends and hostility to foes, all char-
acteristics of the normal boy as he progresses
through the school age, from five to 12 years.
For the girl the problem in the three to five
year period is somewhat more difficult. Even
though the boy experienced a change in his rela-
tionship, his primary love object remained the
same — a female — his mother. In contrast, for her
emotional maturation the girl turns to father and
thus mother becomes a rival. Mother is, however,
and has been, the object of her dependence and
the source of her security. She struggles between
her wish to have father as a love object and her
fear of losing the security of mother’s love. Ulti-
mately, if the little girl is to attain healthy emo-
tional maturation, she must find gratification and
security in a feminine role. To do so, she identi-
fies with her mother and, like the boy, incorpo-
rates the pattern of her rival parent and, in the
process, establishes her conscience. She, too, then
turns to outside contacts in order to lessen the
intensity of her tie to the parent figures and
diverts her energy into relationships outside of
the family.
Having realized that pleasant adjustment to
parents is not enough, that a bigger task is fitting
into the outside world, the child is now primarily
concerned with fitting into his group. He strives
to pick up the language of the children on his
street; he wants to wear the same kind of pants,
to have the same haircut, to play the same games.
The rules of the outside world do not have to be
forced upon him; he enjoys conforming to them.
Boys, particularly, begin to go in for team games
such as cops and robbers and athletics in which
sides and leaders are chosen and the play goes ac-
cording to rules. This is the age when clubs and
gangs begin. These children are proving to them-
selves that they can run a part of their own life
on a cooperative basis without supervision of
adults, that they can decide who is and who is not
acceptable on the basis of their own codes of
behavior. These codes become very strict indeed.
The child who provokes fights unnecessarily or
who uses unfair methods is frowned on, also the
child who avoids a fight when fighting is the hon-
orable course.
The individual child’s conscience is becoming
strong within, and the boy, particularly, at this
age feels the need to control and make moral
his aggressive instincts. He loves to dream of
bold adventure, but it must be in the cause of
virtue; it must be idealized. Conscientious par-
ents sometimes fear that the artists and authors of
comic books corrupt children’s tastes. Actually,
the themes of the comic book do not originate
there, and children learn from reading them.
These are the same themes as are found in the
typical daydream of the middle age child. Wheth-
er the hero uses a ray gun from a jet-propelled
plane or a bow and arrow, he always triumphs
in the end and on the side of justice. We could
cite examples of the child’s impulse to fit into the
group, to help organize the group and to set up
standards of behavior to regulate his life and his
possessions. In this way he is seeking to establish
himself as a responsible citizen of the outside
world. To accomplish all this, however, it is nec-
essary for him to break down some of his depend-
ence upon his parents, to assert his independence
of them. In doing so, he protests against their
standards in many little ways. He seems to throw
over the table manners that were so well formed
during the early period. He protests against
his parent’s choice of clothes for him. He resents
having to wash his hands and brush his hair. He
is apt to prefer his clothes to look sloppy not be-
cause they are more comfortable that way, but
more because his parents want him to be neat.
Some of the difficulties of this age group are
due actually to parents, school or the community
failing to recognize the child’s needs and capacity
as well as his limitations. Too often the child
1332
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
Volume XI. IV
Number 12
is expected to be an adult now that he is in school.
He is suddenly expected to be ‘able to control his
behavior for six hours of the day in order to con-
form to the school situation. Think of the de-
mands we put upon him: he must arrive at
school on time, properly dressed, properly fed.
He must sit quietly for three consecutive hours
or be active, according to the plans of the teacher.
Then he must go home for lunch, inhibit any de-
sire to play, return to school on time and sit for
another two hours in the unnatural situation of
quiet and study. Six hours of his time are. there-
fore, occupied by regimented activities and.
though as physicians we say that the growing
child should have at least 10 hours of sleep at
night which would theoretically allow eight hours
of freedom for the child, parents often want to
give him music or dancing lessons and to have
him belong to scouts, clubs, and other groups.
In addition, his parent rightfully feels he should
lake some responsibility in helping maintain the
home he enjoys, and a few minor domestic chores
come into the picture. Do we not really owe much
respect to a child who comes even close to meet-
ing the demands we as his parents and society
place upon him during this growth period? May-
be he is doing better than the average adult
about him.
Adolescence
The loosening up of the personality that takes
place during late childhood is a prelude to the
real growth that occurs in adolescence. Adoles-
cence is a physical phenomenon with strong psy-
chologic components. The emotional problems
and the emotional growth have their origin in
the physical changes that occur at puberty. There
now develops in the youngster an intensification
of his impulse to grow toward an adult orienta-
tion. The most obvious manifestations of the
psychologic change fall into two categories. First,
he becomes more self conscious. He is interested
only in himself. No one else has problems, no
one else exists except in relation to him. With
this change comes a need to free himself from his
parents and to establish himself as an adult. This
may often be expressed by the denial of the
standards imposed by parents and by an accept-
ance of a philosophy determined by the peer
group. Secondly, there is a reawakening and in-
tensification of sexual feelings and drive. Small
wonder that the behavior of this age group is con-
tradictory, difficult and confusing. Part of the
confusion can be attributed to confusion in our
culture. It is not a simple step to enter adulthood
and the world as it is today. On the one hand
the adolescent is accepted as a maturing adult.
He may stay out later, he may attend dances, he
is expected to handle some of his own money, he
is encouraged to earn part of that money, and
he may drive a car. He is expected to assume re-
sponsibility for his leisure time and to solve his
problems himself or to seek help upon his own
initiative.
On the other hand, parents and teachers are
frightened by the apparent instability of the
adolescent and tend to inhibit where freedom
formerly was implied. Parents who during the
late childhood years gradually gain confidence in
his judgment now (and often without justifica-
tion) become unsure of this unpredictable per-
son’s capacity to evaluate situations. This con-
tradictory attitude is nicely illustrated in the com-
mon struggle of the adolescent and his parents
concerning the hours of coming in at night. The
adolescent is not only allowed, but is usually en-
couraged by his modern parent to date. The date
may take any one of many forms that are accept-
able provided the child returns at a stated hour.
The magical hour, be it midnight, eleven, or one.
must be respected — -as if the set hour were the
equivalent of a chastity belt. Because the ado-
lescent is less predictable than the well adjusted
preadolescent, the concern of the parents has
some justification. The adolescent’s control of
his impulses is by no means complete.
To the adolescent, however, reality has be-
come a confusing picture of opportunities dangled
before him, but frequently snatched away before
he enjoys them. During adolescence whatever
equilibrium has been established in the past be-
tween primitive impulses, himself, and his con-
science is now upset. The wish to be loved, now
enhanced by the sexual urge, and the aggressive
drive, and desire for independence, have increased
in strength. He now wishes to grow up. This
wish involves a need to tear away from the par-
ent figure and instead to turn to himself and his
peers for standards and support. He may al-
ternate between excessive idealism and periods
in which he tends to overthrow his own conscience.
We observe the unstable, unpredictable behavior
of the adolescent and the pronounced mood
swings which in a more mature personality would
have serious implications. It is because of this
bizarre picture that many have said, half in jest
and half seriously, that adolescence is a disease
in itself.
T. Florida M.A.
June, 1958
WOLF: EMOTIONAL GROWTH AND DEVELOPMENT OF THE CHILD
1333
His feelings of sexual inadequacy may seem
to have a real basis in past experience. During
the three to five year period he was confronted
with the extent of his sexual inadequacy. Ob-
viously, the little boy was not physically equal to
his father and the little girl was equally ineffec-
tive in comparison with her mother. The child
was faced with the fact that actually he could not
compete with the parent of the same sex because
the other parent looked upon him as a child and
upon the marital partner as the sexual object.
Adolescence does not suddenly result in a totally
mature physical structure. The adolescent boy
is not at all sure that he is an adequate man, nor
does the girl necessarily feel that she is an ade-
quate woman. This sense of inadequacy may lead
to trial experience, or it may lead to a sense of
incompetence and defeat. When the adolescent
is concerned about his own potency, the need to
depreciate the parent of the same sex may come
into direct conflict with the wish to see the parent
as a successful example of what he himself can
become. He wishes, however, to be the idealized
version of the parent of the same sex, and in this
way he is reassured about his own potency. The
sexual conflict of the adolescent is by no means
the only conflict of this period. His second con-
flict centers around his emotional need to establish
himself as an independent person when the social
demands of the culture prolong his period of de-
pendency.
The adolescent wishes not only to be an in-
dividual but an independent one and a grown-up
one. Because of the inherent drive toward mat-
uration, he has the urge to emancipate himself
from the domination and protection of his parents.
Accepting the advice of a parent is the acknowl-
edgment of inadequacy which is intolerable. The
only way to be an adult is to act like one.
Such a sense of emancipation is safe as long as
the parent does not permit it in actuality. For
to be truly adult means to have the ability to cope
with all the anxieties of life without the protec-
tion and security extended to the child, and this
is often too much for the adolescent. Although
fighting for independence, the adolescent also
wants to be dependent and taken care of. He is
frightened by his own impulses to emancipate him-
self. If this fright becomes too paralyzing, he
feels impelled to regress to the security of child-
hood and again becomes a dependent child.
Such confusion is inevitable between the par-
ent and the adolescent. The adolescent wishes to
be independent. To be so is frightening. As long as
the parent gives support, it is safe to be independ-
ent. If, however, the parent permits the emanci-
pation, the adolescent is frightened and regresses
to dependency, feeling at the same time much
neglected. As soon as the parent gratifies the
adolescent’s dependency needs, he feels stronger
and with renewed vigor attempts to achieve in-
dependence.
The problems of adolescence are thus, in part,
the inevitable struggles of growing from childhood
to adulthood. The difficulties presented are to a
certain degree inevitable during this transitional
phase. It is obvious, however, that not only does
the parent have to accept the growth of the child,
but he needs to be flexible in maintaining a role
that is supportive and accepting when the ado-
lescent feels the need for a more immature parent-
child relationship. The parent who is eager to
force the child out of the protection of the child-
parent relationship will not be of great assistance
in the maturation process. The better-adjusted
individual has learned to live with his own needs
to be dependent as well as his striving to be in-
dependent.
Pediatricians^as they become more comfort-
able in dealing with adolescents themselves, can
help parents understand them and thus contrib-
ute greatly to the total health of the next pedia-
tric generation. Many pediatricians practice long
enough to see the fruits of their labor in a second
generation of their own practices and thus neve"
feel their patients have outgrown them.
Children’s Hospital.
1334
VnUJ M K X I, I V
Number 12
Glaucoma for the General Practitioner
William J. Gibson, M.D.
ST. AUGUSTINE
In one out of 50 Americans over 40 years of
age glaucoma will develop this year. These 800,-
000 men and women will slowly lose their sight
from glaucoma because of ignorance and neglect.1
One out of eight blind patients ophthalmologists
see is a victim of glaucoma. The general practi-
tioner is in the most strategic position to help
in the control of blindness, particularly blindness
from glaucoma, since he sees these patients earlier
than does the opthalmologist.
Glaucoma literally squeezes the sight out of
the eye. Basically, the process is one of decreased
outflow versus constant inflow of aqueous, with
subsequent rise in the intraocular tension.
The first tissues to suffer are the nerve fibers
at the temporal edge of the optic disks. They are
squeezed against the unyielding scleral ring, with
a resulting nasal field defect (figs. 1 and 2). Next.
Read before the St. John’s County Medical Society, St.
Augustine, Dec. 15, 1956.
the blind spot enlarges and prolongation of this
defect meets the original nasal defect to cause fur-
ther loss of visual fields (fig. 3). 2 If the process
is unchecked, the field diminishes until even cen-
tral fixation is lost (fig. 4).
Diagnosis
The acute type of glaucoma strikes suddenly,
inflicting cloudy vision, and is usually associated
with pain and redness of the eye. By its nature
it is as a rule readily diagnosed, although the fre-
quently associated nausea and vomiting of acute
glaucoma may sometimes be confused with an
abdominal pathologic condition.
Chronic glaucoma, the most frequent type, is
insidious and works slowly and painlessly. An
early complaint of patients may be only of mo-
mentary or transitory attacks of blurred vision
which clear up in a matter of minutes. When
investigated, these may be found to be due to early
glaucoma.
I ig. I. I he normal disk and scleral ring. From Duke Elder, Sir W. Stewart. Textbook of Ophthalmol-
ogy, Vol. Ill, St. Louis, C. V. Mosby Company, 1947, p. 3350.
J. Florida M.A.
June, 1958
GIBSON: GLAUCOMA FOR GENERAL PRACTITIONER
1335
Fig. 2. — Shows early field defect from pressure of
the temporal portion of nerve fibers against the un-
yielding scleral ring, left eye. From Berens, Conrad,
editor, 2 pp. 18 and 70, Chap. XLI.
Another early suggestion of the possibility of
glaucoma is evidenced by frequent change of
glasses, none being satisfactory for long. This
may be considered due to two factors: (1) the
forward movement of the lens of the eye, and
(2) changes in the refractive index of the trans-
mitting media of the eye.3
Faulty dark adaptation may suggest this in-
sidious disease. The cause of this defect, early in
the disease, is not well understood, but is believed
to be faulty function of the retinal elements them-
selves.3
Frequently, early in the course of the disease,
there may be attacks of hazy and blurred vision
which clear up after a period of time. They may
be considered due to alteration of the refraction
by lens movement.
Rainbow-colored halos around lights are fre-
quently seen by victims of this disease. Such
symptoms may be explained as being due to
edema of the corneal epithelium caused by water
imbibition with subsequent spectral dispersion.
Headache of otherwise inexplicable origin is
surprisingly often present in early glaucoma.
Increased intraocular pressure often may read-
ily be recognized by the general practitioner by
palpation through the upper lid with the patient’s
gaze directed downward.
As this insidious process continues, excavation
of the optic disk may appear as the tissue of the
nerve head is pushed downward in response to
the increased intraocular pressure (fig. 5). It
must be pointed out, however, that not all cases
of glaucoma show this indication to any great
extent in time to save the vision.
Loss of side vision occasionally is noted by
the patient and may be mentioned to his family
doctor. This is due to the previously illustrated
peripheral field defects. Chronic glaucoma is al-
most always bilateral, but both eyes may not be
affected simultaneously. One should bear in mind
that having any of these symptoms does not nec-
essarily mean that the person has glaucoma. They
may also be caused by other less serious eye
troubles. On the other hand, these symptoms
may not even be present and the patient may
still have early glaucoma. If medical care is
Fig. 3. — Shows further diminution of visual field if
pressure is allowed to continue unchanged; right eye.
From Evans, J. N. : Classic Characteristics of Defects
of Visual Fields, Arch. Ophth. 22:4 10-431 (Sept.) 1939.
Fig. 4. — Final defect with only a small temporal
island of vision left; central fixation lost; right eye-
From Evans, J. N. : Classic Characteristics of Defects
of Visual Fields, Arch. Opth. 22:410-431 (Sept.) 1939.
GIBSON: GLAUCOMA FOR GENERAL PRACTITIONER
Volume XIJV
Number 12
1336
Fig. 5. — Shows glaucomatous excavation of optic
instituted early, progress of the disease may be
stopped, but visual herds once lost can never be
restored.
Summary
The general practitioner may find some of
the 800,000 victims of glaucoma each year by
remembering these early signs, especially in the 40
year and older age groups:
( 1 ) Glasses, even new ones, do not seem to
help.
(2) Blurred or hazy vision, which clears up
after a time.
(3) Trouble in getting accustomed to a dark-
ened room, such as a motion picture
theater.
nerve head. From Payne, B. F.4
(4) Rainbow halos around lights.
(5) Repeated headaches, often of mild in-
tensity.
(6) Narrowing of the visual fields.
(7) Increased tactile hardness of the eyebails,
which may be felt through the lid.
All or any of these, when present, may aid in the
early diagnosis of glaucoma.
References
1. National Society for the Prevention of Blindness, pub-
lication No. 13.
2. Berens, Conrad, editor: The Eye and Its Diseases, Phil-
adelphia, W. B. Saunders Company, 1936, Chap. XLI.
3. Posner. A., and Schlossman, A.: Development of Changes
in Visual Fields Associated wiith Glaucoma, Arqh. Ophth.
39:623-639 (May) 1948.
4. Payne, B. F.: Pathology of Glaucoma, New York State
J. 'Med. 54:3233-3236 (Dec. 1) 1954.
51 Avista Circle.
J. Florida M.A.
June, 1958
1337
Pitfalls in Electrocardiographic Interpretation
Carl M. Voyles, M.D.
ST. PETERSBURG
In most medical communities the status of
electrocardiography has changed considerably dur-
ing the past decade. This is particularly true
outside of teaching institutions where the trend
away from using a central authority to interpret
electrocardiograms is probably the result of more
thorough training in medical schools and residen-
cies and increasingly simpler technics and reduced
overhead with the acceptance of “direct writer”
machines. There has been an increase in demand
for postgraduate courses in electrocardiography
for internists and general practitioners, and an
increasing number of practicing physicians prefer
to interpret tracings taken on their own patients
with occasional assistance from more experienced
electrocardiographers. The patient’s family phy-
sician, fortified by adequate training, is perhaps
in a better position to interpret accessory studies
than is a stranger to the patient who has a
greater knowledge of the disease involved.
Certain problems, however, have accompanied
the trend to decentralization of electrocardi-
ography, aided and abetted in part by patients
who look to the electrocardiogram as the sine qua
non of diagnosis and prognosis of heart disorders
past, present and future. The physician should
be able to put this notion in proper perspective
by emphasizing the nonspecificity of many elec-
trocardiographic abnormalities and the relatively
small part the electrocardiogram contributes to
the whole, as compared to the careful history and
physical examination by a physician who is will-
ing and able to weigh all components before ren-
dering an opinion. This pressure brought to bear
by patients is akin to that which insists that any
and all complaints must be relieved by an injec-
tion of some kind, apparently sometimes to the
point of brain-washing the physician into believing
it himself.
So with the electrocardiogram which, with-
out other support, proclaims “there is nothing
wrong with your heart,” or conversely orders a
well man to retire because of an electrocardio-
graphic abnormality. The electrocardiogram, as
a measure of electrical depolarization and re-
polarization in the heart, does not necessarily mir-
ror mechanical factors which contribute to its ef-
ficiency as a pump. Under these circumstances,
of course, the electrocardiogram may be normal
under conditions of serious heart disease when the
pump is failing, or it may be abnormal in vary-
ing degrees in perfectly well, healthy persons.
Overinterpretation
The greatest pitfall in electrocardiographic in-
terpretation is overinterpretation. This is usually
fostered by failure to appreciate the limited value
of the electrocardiogram and to what extent
changes from accepted normal are not of a specific
nature. Actually, the only truly specific electro-
cardiographic abnormalities are found in the
relatively small group of arrhythmias and con-
duction disturbances and perhaps with the classi-
cal changes of myocardial infarction. The elec-
trocardiogram may be the only means of distin-
guishing with certainty between a tachycardia
of ventricular and auricular origin, thus being the
means of determining which treatment should be
given. It is the surest way of confirming a sus-
picion that the patient with “acute indigestion”
actually has had a myocardial infarction, but
even here reliability falls off considerably.
Acute myocardial infarction is often a difficult
electrocardiographic diagnosis to make with cer-
tainty and. in some instances, must be made on
the basis of other findings alone, including the
history, temperature curve, white blood cell count
and serum transaminase. It should be fully real-
ized that a bona fide myocardial infarction may
occur without any change being recorded on
electrocardiograms taken at the usual intervals.
Even when the clinical diagnosis is easily made,
the electrocardiographic pattern may be very
slow in its appearance and classical evolution, and
several days may pass before changes are appar-
ent. A slight flattening or inversion of T waves
in only one lead or a change in amplitude of
QRS complexes in one lead may have consider-
able significance in doubtful cases, as might a
transient ST segment shift seen on only one of
several serial tracings. Infarction involving only
the epicardium or subendocardium may present
a pit fall in electrocardiographic diagnosis and
usually requires supporting evidence before an
opinion regarding muscle damage can be given.
Posterior or diaphragmatic wall infarction, be-
1338
VOYLES: ELECTROCARDIOGRAPHIC INTERPRETATION
Volume XIJV
Number 12
cause of its location in relation to the standard
electrodes, often occurs with minimal or equiva-
lent electrocardiographic changes during the acute
phase. The use of esophageal leads and other
special technics1 may be of value.
A point often forgotten but easily demon-
strated in serial tracings involves diagnosis of the
strictly posterior wall, as distinguished from the
diaphragmatic, infarction. The former may pro-
duce no changes upon the limb leads, but in serial
tracings may increase the R wave amplitude in
V1)2,3 sufficiently to be diagnostic.
Old, healed myocardial infarction is an im-
portant electrocardiographic diagnosis, particular-
ly when, as is often the case, there is no clearcut
history of the acute episode. Here again the dia-
phragmatic or posterior wall location is apt to be
a stumbling block. The classical Q:1 and Qhvf of
at least .04 second width with sharply inverted T
waves is the exception rather than the rule. Small
Q waves in these leads, with or without T wave
changes, cannot be ignored, but must not be over-
interpreted. Electrocardiographers often use the
phrase, “consistent with but not diagnostic of old
posterior wall infarction,” when they are not sure
of the origin of such patterns. There are other
aids in evaluating the electrocardiographic prob-
lem of “did or did not this patient have an old
posterior wall infarction?” Tracings taken dur-
ing deep inspiration2 may alter the heart’s rela-
tion to the electrodes sufficiently to produce a
diagnostic Q wave, which otherwise might have
been considered equivocal. Milnor, Genecin,
Talbot and Newman3 presented a method of
evaluating the Q:i and Qsvf by determining the
direction of the first .02 second of the QRS loop
in the sagittal plane, a technic which for the pres-
ent is not readily available to the majority of
electrocardiographers.
The “QS dilemma” is one which often re-
quires examination with a magnifying glass, liter-
ally and figuratively. The tiniest “pip” of deflec-
tion above the base line may be sufficient evidence
to diagnose old infarction if the deflection is at
the end of the QS, or, if there is a tiny R deflec-
tion at the beginning of the QRS, to enable the
electrocardiographer to say unequivocally that
there is no evidence of old infarction. Such fine
points may be overlooked in a hurried reading
Students or interns sometimes interpret left
bundle branch block mistakenly as anterior wall
infarction because of the appearance of the pre-
cordial QRS complexes. After learning to avoid
this error, they may quote an aphorism: “Myo-
cardial infarction cannot be diagnosed in the
presence of bundle branch block.” This of course
is true in some cases, but there are exceptions,
to wit: (a) the evolution of fresh infarction can
usually be detected by sufficiently frequent serial
electrocardiographic tracings during the first few
days of hospitalization, as there are usually tran-
sient ST and T and/or QRS changes; (b) right
bundle branch block seldom interferes with the
diagnosis of either fresh or old anterior wall in-
farction if its pattern is recognized and consid-
ered; (c) the presence of a Q deflection in lead 1
or avL in the presence of classical left bundle
branch block is evidence of septal infarction,
which usually is accompanied by anterior wall
infarction. The initial activation of the septum
from left to right with the resultant “normal sep-
tal Q wave”4 cannot occur with true left bundle
branch block since the septum is then no longer
activated from left to right. A Q wave, therefore,
indicates that the septum is missing electrically.
Both the effect of digitalis and of “left ven-
tricular strain,” the latter usually the result of
hypertension or aortic valve disease, may produce
a somewhat similar electrocardiographic pattern.
This is usually manifested by ST segment de-
pressions in leads 1, 2 avL, Vr, and Vr, and diphasic
or inverted T waves in these leads. Broome, Estes
and Orgain5 have outlined a means of distinguish-
ing between these two, based essentially on the
shortened QT interval and the shortened T vec-
tor which remains unchanged in direction with
digitalis effect. Often the ST segment in the
presence of digitalis has more the appearance of
a thumb impression as seen sagittally than does
the pattern of a more variable ST and an often
sharply inverted, rather than diphasic, T wave
of left ventricular strain. The usual concurrence
of left axis deviation with left ventricular strain
is helpful. Vector analysis is a useful aid in ana-
lyzing and understanding such pattern differences.
There is a shortened T vector with unchanged di-
rection with digitalis effect as compared to re-
versed direction of the T vector in left ventricular
strain.
Pitfalls in considering T wave abnormalities
in the precordial leads include misinterpretation
of the normal juvenile pattern, which consists of
inverted T waves in Vi,2,3,4. This pattern may
persist into adult life. The phenomenon of “iso-
lated T wave negativity,” which may occur with
a normal heart at positions V4 or V5 or both can
J. Florida M.A.
June, 1958
VOYLES: ELECTROCARDIOGRAPHIC INTERPRETATION
1339
be clarified by taking multiple precordial leads
to pinpoint the area involved.
Serial electrocardiograms are advantageous
under several circumstances. Minor changes of
QRS and T within the normal range during myo-
cardial infarction, with or without bundle branch
block, have been mentioned. During observation
with suspected rheumatic fever minor T wave
changes or a changing P-R interval within the
normal range may be helpful or even pathog-
nomonic. Changes in the corrected QT interval
may be of considerable diagnostic importance,
particularly in rheumatic fever in which its dis-
tinct prolongation may be the only electrocardi-
ographic abnormality. Serial tracings are useful in
evaluating changes due to or thought to be due to
digitalis effect or electrolyte disturbances.
Right ventricular hypertrophy is often asso-
ciated with incomplete bundle branch block, but
it may at times be represented by pronounced
right axis deviation in the limb leads with totally
upright complexes and normal interventricular
conduction in Vi and V2. Left ventricular hyper-
trophy is more difficult, but is suggested when
there is left axis deviation with large upright
complexes in leads 1, avL and V-, and V« with
large negative complexes in V2 and V3.
Pitfalls in the interpretation of arrhythmias
are relatively few. An important but rare one is
the rapid, fixed tachycardia with wide QRS com-
plexes, apparently of ventricular origin but actu-
ally of supraventricular origin with accompany-
ing bundle branch block, the P waves being buried
by the preceding complex. A practicable way of
distinguishing between the true ventricular and
the masked auricular tachycardia is by use of
esophageal leads,6 if such maneuvers as carotid
sinus pressure and detection of varying intensity
of the first sound fail the examiner. One wonders
if those who, contrary to usual teaching, ad-
vocate the use of digitalis in the treatment of
ventricular tachycardia have in some cases actu-
ally been treating supraventricular tachycardia
with temporary bundle branch block. A very
rapid sinus tachycardia may be confused with
paroxysmal auricular tachycardia, although us-
ually the slight variation in rate will distinguish
the former. If the patient is at hand, the use of
carotid sinus pressure and the history of rapid
onset are all that is needed.
In both first degree AV block and supraven-
tricular tachycardia P waves may be hidden,
usually in the preceding T waves. Varying am-
plitudes and configuration, particularly notching,
of the T waves may be the key to hidden auricu-
lar activity. Here again the esophageal leads may
solve the problem by demonstrating well defined
P waves.
Lesser Pitfalls
Three relatively minor pitfalls which may mis-
lead the less experienced electrocard iographer are
the auricular T wave, the U wave and the phe-
nomenon of ST segment elevation, occurring nor-
mally, usually in young persons, most often in the
first three or four precordial leads, referred to as
“normal early repolarization.” When early re-
polarization is present in young persons in in-
stances of suspected benign or rheumatic peri-
carditis, serial tracings should demonstrate a slow
evolutionary pattern with pericarditis but not
with the “normal early repolarization.” The
auricular T wave is opposite in direction to the
P wave and usually is buried in the QRS. With
a long or short P-R interval, it may appear as an
apparent ST segment shift occurring before or
after the QRS, or it may alter the contour of the
QRS. Little significance is otherwise attached
to the auricular repolarization process. It is re-
markable that this phenomenon so seldom inter-
feres with electrocardiographic interpretation.
The U wave may obscure the preceding T or fol-
lowing P wave and therefore may cause erroneous
calculations of the QT or P-R intervals. This is
a pitfall to be considered when electrolyte dis-
turbances or rheumatic fever is suspected.
The electrocardiographer should be aware of
faults in technic during the taking of electro-
cardiograms which might significantly alter trac-
ings. At least once in every technician’s career
comes the embarrassing mistake of unintention-
ally reversing the arm leads, causing the physi-
cian to believe he has a true dextrocardia, that
is, until he examines the precordial leads and
finds them in order. Another occasional error in
technic involves the smearing of paste between
precordial leads, an act that tends to give a same-
ness to the six precordial leads which would not
occur with proper preparation. A remarkable
sameness in precordial tracings is also noted when
the lead selector is not moved from avF as these
leads are taken. Unintentional turning of the
standardization switch may produce low voltage
as a technical error. When taking serial tracings,
one must place the precordial electrodes in exactly
the same position from tracing to tracing; other-
1340
VOYLES: ELECTROCARDIOGRAPHIC INTERPRETATION'
Volume XLIV
Number 12
wise, changes in the form of the QRS and T
waves cannot be adequately compared.
Large breasts, pronounced sternal depression,
pneumonectomy, pneumothorax, hydrothorax and
emphysema may alter the relation of the heart
to the electrodes sufficiently to produce an
electrocardiographic abnormality in a normal
heart. Such anatomic variations should be noted
on the request slip if the tracing is to be read by
a person who does not know the patient.
Hyperventilation, fright and exercise can alter
the rate and T wave configuration in normal
hearts and may pose a problem in differentiation
from underlying coronary heart disease. Sedation,
reassurance and a comfortable position help to
standardize the resting tracing, which should
then be compared with a tracing after a calcu-
lated amount of exercise when coronary disease is
suspected and cannot be diagnosed by the history
or resting tracing. Digitalis, adrenalin and atro-
pine are commonly used drugs which may alter
the electrocardiogram and mislead an interpreter
who is unaware of their effect. The electrocardio-
gram after exercise cannot be interpreted satisfac-
torily when digitalis is present in the heart mus-
cle, since RST segment and T wave changes may
occur as the result of digitalis effect alone.
Summary
Considerable information is available regard-
ing the normal and abnormal electrocardiogram
for the benefit of the increasing number of physi-
cians who interpret their own tracings. Most elec-
trocardiograms do not follow a ‘‘text book pat-
tern,” and there are many situations which may
pose problems to the electrocardiographer. Some
of these pitfalls are presented and discussed,
roughly in order of frequency of occurrence and
importance.
References
1. Elek, S. R.; Herman, L. M., and Griffith, G. C.: Study
of Unipolar Left Back Leads and Their Application to
Posterior Myocardial Infarction, Circulation 7:656-668
(May) 1953.
2. Evans, W.: Effect of Deep Inbreathing on Lead III of
Electrocardiogram, Brit. Heart J. 13:457-466 (Oct.) 1951.
3. Milnor, W. R.; Genecin, A.; Talbot, S. A., and Newman,
E. V.: Vectorcardiographic Study of "Q3’’ Deflection in
Cases of Myocardial Infarction and in Normal Subjects,
Bull. Johns Hopkins Hosp. 89:281-287 (Oct.) 1951.
4. Scher, A. M.; Young, A. C. ; Malmgren, A. L. and
Erickson, R. V.: Activation of Interventricular Septum,
Circulation Res. 3:56-64 (Jan.) 1955.
5. Broome, R. A. Jr.; Estes, E. H. Jr., and Orgain, E. S. :
Effects of Digitoxin Upon Twelve Lead Electrocardio-
gram, Am. J. Med. 21:237-245 (Aug.) 1956.
6. Schrire, V., and Vogelpoel, L. : Clinical and Electrocardio-
graphic Differentiation of Supraventricular and Ventric-
ular Tachycardias With Regular Rhythm, Am. Heart I.
49 :162-187 (Feb.) 1955.
666 Sixth Street, South.
J. Florida M.A.
June, 1958
1341
Organization of a National Streptococcal
Epidemiologic Survey
Milton S. Saslaw, M.D.
MIAMI
In 1950, Saslaw, Ross and Dobrin reported
the finding of five children with established rheu-
matic heart disease among 1,001 students in the
12 to 15 year age group born in Dade County.
This prevalence rate was lower than most reports
from other parts of the United States. Because
the group A beta hemolytic streptococcus is con-
sidered to be etiologically related to rheumatic
fever, a study of incidence, prevalence and be-
havior of these organisms was instituted in 1952.
Search of the medical literature failed to reveal
adequate comparative data from other investiga-
tive centers. To make our Miami results more
meaningful, therefore, other likely workers in the
streptococcus-rheumatic fever field were ques-
tioned as to their willingness to participate in a
joint study. Though affirmative replies were com-
mon, funds were not available, so that the years
1952-1955 passed with work carried out in Dade
County alone, and with correspondence elsewhere.
Late in 1955, during a conversation with LT. S.
Public Health Service officials, interest in a co-
operative study was elicited. A tentative plan
and a rough protocol were drawn up, and a num-
ber of investigators were contacted for an ex-
pression of interest in the project, if funds could
be made available. A minimum of six sites was
considered essential for evaluation of climatic ef-
fects on beta hemolytic streptoccci and on rheu-
matic fever. Contact was made with about 15
people, recognizing that only six might be in-
terested. Each area was chosen because of size
and climate represented. For purposes of com-
parison, cities whose metropolitan population
ranged between one-fourth and three-fourths mil-
lion population were sought. Cities of this magni-
tude would provide adequate groups of children
of appropriate ages, adequate numbers of practic-
ing physicians, adequate numbers of schools, and
areas representing different economic levels. Many
cities selected also contained minority racial
groups.
From the Department of Medical Research, National Chil-
dren’s Cardiac Hospital, and the Department of Microbiology,
University of Miami.
Supported in part by a U. S. Public Health Service grant
H-2628.
Read before the Florida Health Officers’ Society, Hollywood,
May 5, 1957.
Climatic Factor
The factor of climate created greatest concern,
since the variations in the United States are in-
numerable when temperature, rainfall and alti-
tude alone are considered. Miami was considered
essential since climatologically it is the only area
in the United States which meets the standards
set for tropical climates. According to geograph-
ers who follow Koppen’s classification, a tropical
climate is one in which the average temperature
over a period of years, for the month of lowest
average temperature, is 64.4 F. or above. An area
along the Eastern seaboard (in our case, New
Hyde Park, Long Island) provided a mesother-
mal marine climate for comparison. A humid
subtropical climate characterizes almost half the
area of the United States, and Nashville, Tenn.
is near the center of this belt. Phoenix, Ariz.
typifies the American desert, with an average sum-
mer temperature of 87 F. (maximum 1 19 F.) , and
a winter level of 53 F. The average annual rain-
fall is 7.5 inches. For Miami, the average annual
precipitation is 47.2 inches. Another reason for
extending our studies to Phoenix is the reported
low prevalence of rheumatic heart disease in that
city.
In contrast to Phoenix is Salt Lake City,
Utah, where the highest prevalence rate for rheu-
matic heart disease in the United States has been
reported. Salt Lake City at an elevation of 4,305
feet has average temperatures of 32 F. in winter
(-20 F. absolute minimum) and 73 F. in summer;
average precipitation is 16.3 inches, twice that
of Phoenix.
The Pacific coast, with its cool aiaritime
weather, characteristic of the area from Alaska to
Southern California, is represented . by, Seattle,
Wash. " f
Cold winters and cool summers prevail in
Montreal, Canada, and the changeable weather
of the Great Lakes area in Winnetka, 111.
Additional climatic types are to be found in
Ga’veston, Texas, and St. Louis, Mo., Anchorage,
Alaska, and the Canal Zone, Isthmus of Panama.
Contact with these areas has been established, but
the advisability of starting the project with a
1342
SASLAW: ORGANIZATION OF A STREPTOCOCCAL SURVEY
Volume XLIV
Number 12
reasonably small number of sites led us to hold
final incorporation of these cities in abeyance.
The Canal Zone is a most interesting site.
Since this region is owned and operated in toto
by the U. S. government, the entire population
consists of middle income workers, living under
highly sanitary conditions, enjoying all the needs
and many of the luxuries of man. Across the
street, in the Republic of Panama, subjected to
the identical climatic environment, are people who
fall almost entirely into two major groups, one
extremely wealthy and the other extremely poor.
Sanitation, formerly a function of the U. S. gov-
ernment, is now entirely in the hands of the
Panamanians. The meticulous attention to the
problems of health no longer exists. Thus, in
one small area, in the same climate, three econom-
ic classes of people could be studied simulta-
neously. Unfortunately, due to the rigid control
of funds and activities of the Canal Zone by the
U. S. government, we have been unable to present
as yet a tenable method of including Panama in
our study. This problem is still under considera-
tion.
Interest Grows
With the widespread interest shown in a co-
operative streptococcal epidemiologic survey, and
the associated rheumatic fever data that could be
collected, we were prompted to request U. S. Pub-
lic Health Service extramural support for the or-
ganization of a national project. After negotia-
tion, this request was granted in January 1957.
Immediately, each of the possible participants
was resurveyed as to his continued interest. Those
who responded affirmatively were visited personal-
ly in the same month. At that time, a brief pro-
visional protocol was distributed to each poten-
tial site leader. The program was discussed, and
questions were answered. All suggestions were
carefully recorded. The investigators were re-
quested to write their opinions and comments
within a month. When all letters were received,
the protocol was revised, and redistributed on
March 6.
Ur. Albert V. Hardy, Director of Laboratories
of the Florida State Board of Health, was asked
to join the program by establishing the Miami
Branch Laboratory as the streptococcal grouping
and typing laboratory, and as the place for per-
forming all antistreptolysin O titrations for all
participants. Financing this portion of the proj-
ect would be by an individual grant from the
U. S. Public Hi dth Service. Dr Hardy agreed.
Dr. Benedict Massell, Research Director,
House of the Good Samaritan, Boston, Mass.,
will serve as coordinator for the study of prev-
alence of rheumatic heart disease in children
living in the participating areas.
Another problem is the supply of adequate
quantities of streptococcal typing serums. Group-
ing serums are available commercially, but typing
serums can be obtained only from the Com-
municable Disease Center of the United States
Public Health Service. Again because of finan-
cial regulations, we cannot reimburse the Com-
municable Disease Center directly for the in-
creased load of work entailed by the large scale
production of serums. Solution to this phase of
supply was approval by the U. S. Public Health
Service to employ a technician from grant funds
to work with Dr. Elaine Updyke at the Com-
municable Disease Center.
Consultants were appointed in the fields of
bacteriology (Dr. L'pdyke), epidemiology (Drs.
Alexander Langmuir, H. F. Dodge and Simon
Doff), climatology (Leonard Pardue), and a
clinical rheumatologist (Dr. Massell). The scope
of consultation will be broadened to include a bio-
statistician.
Full information on the total program has
been made available to the American Heart As-
sociation. Interest and indirect assistance from
this group are anticipated. Financial aid has been
requested from state heart associations in each of
the states in which participation is contemplated.
At the moment, commitments for support have
been obtained from the Ottawa Laboratory of Hy-
giene and from the Florida Heart Association.
Additional Heart Associations probably will aid.
Such aid may be small in amount, but represents
the breadth of interest in the investigation.
With all this preliminary work done, the final
protocol must be ratified, and all participants
must commit themselves definitely. To ensure
complete understanding and rapport, a confer-
ence has been arranged, to allow full discussion
of all aspects of the program. The extent to which
other ancillary studies will be implemented — case
registry of rheumatic fever and glomerulonephri-
tis, efficacy of penicillin prophylaxis in eradicat-
ing beta hemolytic streptococci from the throats
of rheumatic children, investigation of prevalence
of rheumatic heart disease in school children,
and frequency of observation of rheumatic heart
disease at autopsy — must be considered.
J. Florida M.A.
June, 1958
BROUSSARD: RELATIONSHIP OF SEX TO ACCIDENTS
1343
The conference to make these final decisions
starts tomorrow morning and will continue for
three days, May sixth through the eighth.
Summary
In the organization of the present national
epidemiologic streptococcal study, a problem of
national scope was recognized, the problem of
defining the incidence and prevalence of beta
hemolytic streptococcal carrier states and infec-
tions in relation to rheumatic fever. The hypoth-
esis was adopted that these incidence and prev-
alence rates are influenced by climate. A plan
was devised for collecting data adequate to per-
mit evaluation of the hypothesis. Results of the
present investigation are expected to lead to new
approaches in the study of etiology, pathogenesis
and control of streptococcal infections and rheu-
matic fever.
4250 West Flagler Street.
The Relationship of Sex to Childhood Accidents
Elsie R. Broussard, M.D.
PENSACOLA
In 1954 Sowder1 asked the question, “Why
is the sex difference in mortality increasing?” He
suggested that “something” other than a basic
biologic difference between the sexes accounts in
part for the higher mortality among men.
Bowerman2 of the New York Life Insurance
Company was of the opinion that increased mor-
tality rates of the male in late childhood and
early adult life are due to greater environmental
hazards and the greater ability of the female
to adapt to cultural changes. Sowder and Bond3
voiced their agreement with this conclusion.
It is now an accepted fact that accidents oc-
cur more frequently in the male child than in the
female. Jacobziner, Heely and Rich4 reported a
sex incidence of 61 per cent male and 39 per
cent female. Rice, Starbuck and Reed5 reported
similar figures, 60.5 per cent male and 39.5 per
cent female. Bain6 in her report of accidental
poisoning in children gave a sex ratio of 3:2
both for the United States and Britain.
In an attempt to learn more about the “some-
thing” to which Dr. Sowder referred, a survey was
made of 1,168 accidents in children under 16
years of age treated in the accident rooms of
local hospitals. This study also revealed a signif-
icant sex difference — 738, or 63 per cent, oc-
curred in the male and 430, or 37 per cent, in
the female (fig. 1).
The accidents were classified into 10 main
groups, listed in the order of frequency of oc-
currence: Laceration and Contusion, Fracture,
Burn, Puncture, Foreign Body, Animal Bites,
Poison, Concussion, Sprain, and Dislocation.
The only types of accidents in which males
did not outnumber females were sprains and dis-
locations (fig. 2). There may be some relation-
ship here to the type of musculature of the fe-
male. There seemed to be no one age group in
which females outnumbered the males. There was
no significant difference in sex ratio under one
year. Accidents occurred more frequently in the
three to four year age group.
In a special survey of 66 cases of accidental
poisoning in children under six years of age, it
was found that 60.6 per cent of the poisonings
cccurred in males and 39.4 per cent in females.
The public health nurses visited the homes of
57 of the patients in these cases to investigate
the circumstances surrounding the poisoning.
They found that in 58 per cent of the cases the
material ingested had been moved from its regu-
lar storage place by an adult and left within easy
reach of the children.
In 75 per cent of the cases it was not neces-
sary for the children to climb to reach to the
poisonous material.
There seemed to be no sex relationship with
regard to which children climbed in order to gain
access to the poison, as 22.5 per cent of the males
climbed and 19 per cent of the females climbed.
The difference of 3.5 per cent here is certainly
not indicative of any greater curiosity or increased
physical activity on the part of the male which
would account for increased incidence of poison-
ing in males. I realize, however, that this may
be due to the small number of cases in this spe-
cial survey and consequently inconclusive.
TOTAL NUMBER OF ACCIDENTS
1344
BROUSSARD: RELATIONSHIP OF SEX TO ACCIDENTS
Volume X LIV
Number 12
NUMBER OF ACCIDENTS
TYPES OF ACCIDENTS by number and sc*
Discussion
Why do accidents more frequently involve
the male child? Perhaps the answer to this ques-
tion, and the resultant prevention of accidents,
lies in the answer to other questions.
Is it because of greater physical activity,
greater natural curiosity and daring? Is it be-
cause as imitators boys attempt to mimic the
activity of their fathers?
Is there a difference in the parent’s attitude
toward a boy baby and a girl baby? Are parents
less solicitous, less protective towards their male
children?
Do they permit boys to attempt feats which
would ordinarily be considered too dangerous or
too difficult for girls? Are they sometimes misled
by the greater stature of boys and allow them to
fend for themselves unsupervised in situations
where they lack sufficient judgment and coordi-
nation for the task before them?
Do girls have more rest and care during a
minor illness and longer periods of absence from
school while recuperating?
Does the type of toy which parents select
for boys affect the incidence of accidents? When
they buy bows and arrows or firearms for boys,
do they insist that they use them only in a pro-
tected area at a specific target, or do they allow
them to roam the neighborhood with these instru-
ments at will?
I have noted a “resigned” attitude adopted
by some parents towards the type of games which
boys play. I have seen them permit unrestricted
“sword fight” play with pointed sticks and have
watched them sit idly by while boys climbed onto
obviously perilous places and dismiss the situation
with a shrug and a comment, “Boys will be boys.”
It would seem to me that if one accepts the fact
that boys evidence greater physical activity or
daring, then there is a greater responsibility to
supervise their activity and the objects which
they utilize during play. Surely one cannot keep
a boy from climbing, but one can and should
teach him how to climb safely and how to check
for stability the object which he plans to climb.
One cannot keep him from throwing rocks, but
one can teach him not to throw rocks at another
boy.
If boys tend to be more “daring,” are they
seeking recognition in a society which demands
too much of them — expects them to be “tough?”
How frequently a parent says to a child who has
been hurt, “Stop crying! Do you want people
to think you’re a sissy?” — as if to feel pain were
a sign of disgrace. When such an attitude is
adopted in the child’s infancy, it is a natural se-
quence to demand much more of men as adults.
Perhaps parents really need to check their atti-
tudes. Perhaps they expect too much of “The
Fragile Male.”
I desire to express my appreciation to Dr. James O. Bond,
Mrs. H. H. Stanley and the record librarians of the three
hospitals for their valuable assistance in the preparation of
this paper.
References
1. Sowder, W. T. : Why is Sex Difference in Mortality In-
creasing? Pub. Health Rep. 69:860-864 (Sept.) 1954.
2. Bowerman, W. G.: Annuity Mortality, Actuarial Society
of America Transactions 2:76-102 (June) 1950.
3. Sowder, W. T., and Bond, J. O.: Problems Associated
With Increasing Ratio of Male Over Female Mortality,
Geriatrics Soc 4:956-962 (Oct.) 1956.
4. Jacobziner, H.; Heely, P. I., and Rich H.: Accident
Fatality Follow-up Study in Children Under Six, GP
13:88-95 (Feb.) 1956.
5. Rice, R. G.; Starbuck, G. W., and Reed, B. B.: Acciden-
tal Injuries to Children, New England J. Med. 255:1212-
1219 (Dec. 27) 1956.
6. Bain. K.: Deaths Due to Accidental Poisoning in Young
Children, J. Pediat. 44:616-623 (June) 1954.
1721 East Baars Street.
J. Florida M.A.
June, 1958
1345
ABSTRACTS
Side Lights on Treatment of Dermato-
logic Diseases of Children. By Morris Wais-
man. Postgrad. Med. 21:118-123 (Feb.) 1957.
In this article Dr. Waisman outlines some of
the standard procedures that have been crystal-
lized from the experience of his dermatologic prac-
tice and that of his contemporaries and from the
experience of his teachers and their contempor-
aries. After reviewing a considerable number of
therapeutic tools, he offers a half score of random
therapeutic observations, general and specific:
1. Good dermatologic treatment is simple, and
it should be kept simple. 2. Soap and hot water
are almost invariably deleterious to the healing of
an eczematoid eruption of the skin. 3. Strong
sunshine in the summertime usually is harmful
to an eruption, because of the damaging effects
of both ultraviolet light and sweating produced
by heat. 4. Attention to nutritional requirements
should not fail to recognize the desirability of re-
ducing free sugars in the diet of patients who have
bacterial and fungous infections of the skin. 5.
Physical activity must be restricted in all cases of
eruption, and especially in cases of prickly heat
and intertrigo. 6. Clothing must be recognized as
a possible source of injury, apart from its dyes.
7. The more specific eruptions a physician is able
to identify, the fewer become the number of vita-
min deficiency diseases he will diagnose. Genuine
dermatologic evidence of vitamin deficiency is
rare in private practice. 8. Provision for adequate
hours of rest may be all that is necessary to keep
an annoying eruption of childhood atopic derma-
titis under control. 9. X-ray therapy for eczema-
toid dermatoses in children is never indicated.
10. Time is the essential ingredient of successful
dermatologic therapy. Impatience accounts for
more failures than improper medication.
Squamous-Cell Carcinoma of the Uterine
Cervix. A Histochemical Review. By Alvan
G. Foraker, M.D., and Sam W. Denham, M.D.
Am. J. Obst. & Gynec. 74:13-24 (July) 1957.
As part of a continuing study of squamous
cells of the uterine cervix, tissue from 72 examples
of invasive squamous cell carcinoma were sub-
jected to a battery of histochemical technics, in-
cluding localization of dehydrogenase, alkaline
phosphatase, phosphamidase, protein-bound sulf-
hydryl and disulfide groups, glycogen, and lipid.
Comparisons were made with 68 other cervical
biopsies. In general, squamous cell carcinoma
showed a reaction pattern similar to that of the
basal layer of portio vaginalis mucosa, includ-
ing evidence of dehydrogenase and phosphamidase
activity. Keratinizing squamous cells from neo-
plastic and nonneoplastic epithelium contained
disulfide groups. Squamous cells in superficial
layers of squamous mucosa and well differentiated
squamous carcinoma cells in some cases contained
glycogen. No histochemical reaction pattern pe-
culiar to carcinoma was found. These findings are
consistent with previous histochemical and phy-
sical measurement studies, in which growing
squamous cells had essentially similar properties,
whether they came from carcinoma or from re-
gions of nonneoplastic proliferation.
Lobotomy of the Dorsal Medial Quad-
rant for Intractable Pain. By Richard E.
Strain, M.D., and Irwin Perlmutter, M.D. South.
M. J. 50:796-798 (June) 1957.
In this article, the authors observe that lobot-
omy for intractable pain has a limited but defi-
nite place in the surgical treatment of pain. They
believe that it should be reserved primarily for
patients with metastatic malignant disease and
confirmed addiction who cannot be relieved by
other surgical measures. They present a small
series of cases in which upper dorsal medial quad-
rant lobotomy, with its ease of approach and
less extensive destruction of tissue, relieved pain
and addiction in a manner similar to more ex-
tensive medial lobotomies. Their technic is de-
scribed, and illustrative cases are summarized.
Study of Respiratory Liver Metabolism
in Surgical Patients. By H. Clinton Davis.
M.D., Irwin S. Morse, M.D., Edward Larson,
Ph.D., and Mark Wynn, M.S. J. A. M. A. 162:
561-563 (Oct. 6) 1956.
Direct physiologic tests on liver tissue have
been used for many years in experimental work
on small animals, but relatively little work has
been done on the respiratory metabolism of the
human liver. The frequency with which liver
biopsy specimens are taken at the operating
table for pathologic examination, and the
benignity of the procedure, prompted these au-
thors to send a portion of their specimens to both
the pathologist and the physiologist. To their
knowledge, when the study was started in 1952,
oxygen quotient studies had never been reported
on human liver.
1346
ABSTRACTS
Volume XI. I V
Number 12
Liver succinoxidase, oxygen-quotient (QCL)
determinations were made on 10 patients under-
going surgery for gallbladder, colon, or pancreatic
disease or peptic ulcer. Values suggested slight
impairment of in vitro activity of the enzyme
system in the presence of obstructive jaundice in
comparison to apparently normal liver. The con-
cept of performing direct physiologic studies on
human tissue is believed to be of possible value
just as it has been in laboratory animals. It is
suggested that the clinical physiologist could well
fill some of the gaps in the understanding and
assessment of problems of altered metabolism.
Nutritional Management in Duodenal
Fistula. By Donald W. Smith, M.D., F.A.C.S.,
and Robert M. Lee, M.D., F.A.C.S. Surg. Gynec
& Obst. 103:666-672 (Dec.) 1956.
The authors present the present status of duo-
denal fistulas and discuss the immediate and con-
tributing causes of this complication which fol-
lows approximately 2 per cent of all gastrectomies
and results in 16.5 to 85 per cent mortality, vary-
ing with the promptness of diagnosis. They em-
phasize protein depletion and fluid and electrolyte
losses as the most important factors in the patho-
logic physiology of the patient with a duodenal
fistula.
The treatment regimen outlined consists prin-
cipally of continuous nasojejunal drip feeding of
high protein, high calorie solutions through a
fine plastic feeding catheter 24 hours each day
and continuously until the fistula closes. Vita-
mins, antibiotics, sump drainage, and skin care
about the fistula opening are discussed. The
method of nasojejunal intubation in gastrectom-
ized patients is described.
A series of 1 1 cases in which duodenal fistulas
were treated by this method is reported, and five
cases are described. In all of the cases the patient
survived, and the fistula closed in from seven to
28 days.
Controllable Tube Splint for Choledocho-
duodenal Anastomosis in Congenital Ex-
trahepatic Biliary Atresia. By H. Clinton
Davis, M.D. Am. Surgeon 23:298-300 (March)
1957.
Observing that surgical exploration offers the
only hope lor those infants with mechanical ob-
structive jaundice who do not respond to chola-
gogues, the author describes some of the contin-
gencies that may be encountered. In the more
favorable case of atresia, he comments, biliary-
intestinal continuity can be satisfactorily estab-
lished by anastomosing the common duct, hepatic
duct or gallbladder to the duodenum, jejunum or
stomach. The procedure of choice is anastomosis
of the duct to the duodenum whenever possible,
securing an adequate anastomotic lumen by sutur-
ing the duct to bowel over a short length of No.
8 or No. 10 rubber catheter. The desirability of
controlling the anastomotic rubber tube splint
has led to the idea of using the tip of the naso-
gastric catheter, which is routinely placed in the
stomach. This tube can easily be passed from
the stomach into the duodenum and incorporated
in the choledochoduodenal anastomosis. Several
small holes are made on the intragastric portion
for gastric suction in the immediate postoperative
period. The catheter may be pulled up into the
stomach and out of the anastomosis at the will of
the surgeon. It is suggested that this procedure,
which has been successfully performed on dogs,
would appear to be worthy of clinical trial.
Use of Relaxin in the Treatment of
Scleroderma. By Gus G. Fasten, M.D.. and
Robert J. Boucek, M.D. J. A. M. A. 166:319-324
(Jan. 25) 1958.
No consistently successful therapy has been
reported for scleroderma, a chronic disease of un-
known cause associated with remissions and re-
lapses. The experience of the authors with relaxin
therapy indicates that this treatment influences
to a significant degree certain distressing features
of scleroderma and therein represents a note-
worthy therapeutic advance. Parenteral injection
of relaxin was used for periods of from six to 30
months in the treatment of 23 patients with this
disease. The degree of improvement noted varied
considerably, but several patients were sufficiently
benefited to enable them to return to gainful oc-
cupation. The most striking results were relief of
vasospasm, healing of trophic ulceration, and in-
crease in skin elasticity. Other manifestations of
the disease were not appreciably improved by
relaxin therapy. No toxic or undesirable side
effects were observed.
Members are urged to send reprints of their
articles published in out-of-state medical jour-
nals to Box 2411. Jacksonville, for abstracting
and publication in The Journal. If you have
no extra reprints, please lend us your copy of
the journal containing the article.
J. Florida M.A.
June, 1958
1347
The Journal
of THE
Florida Medical Association
INDEX
Volume XLIV
July, 1957 — June, 1958
SHALER RICHARDSON, M.D., Editor
STAFF
Managing Editor
Ernest R. Gibson
Assistant Managing Editor
Thomas R. Jarvis
Editorial Consultant
Mrs. Edith B. Hill
Assistant Editors
Webster Merritt, M.D.
Franz H. Stewart, M.D.
Committee on Publication
Shaler Richardson, M.D., Chairman .... Jacksonville
Chas. J. Collins, M.D ..Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman .. Jacksonville
Walter C. Jones, M.D Miami
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D Jacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D Jacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean. College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
1348
INDEX TO VOLUME XLIV
Volume XI. IV
Number 12
Actions of Florida Legislature
19S7 Session (Commentary)
Adiposity of Heart and Cardiac Enlargement of
Undetermined Etiology (Abst) 723
Advance Planning for Annual Meetings of Specialty
Groups (Commentary)
American Medical Association:
A.M.A. Administrative Changes (Commentary)
A. M. A. Clinical Meeting, Philadelphia, Dec. 3-6
(Commentary)
A.M.A. Annual Meeting, San Francisco,
June 23-27 (Commentary)
First Permanent Disability Guide Published
(Commentary)
Modern Medicine Moves Ahead “AMA in
Action” (Commentary)
Registration FMA Members at Annual Meeting
(Commentary)
Report of Florida Delegates to A.M.A. 1957
Annual Meeting (Commentary)
Report of Delegates to A.M.A. 1957 Clinical
Meeting, Philadelphia, Dec. 3-6,
1957 (Commentary)
Analysis of the Foot in Infants (Abst)
A New Responsibility — Participating Factors
(Edit)
An Impressive Record (Commentary)
Anileridine As An Anesthetic Agent (Scientific)
Annis, Jere Wright, M.D., President 1355
Annual Graduate Short Course Discontinued
(Commentary) 1247
Another County Medical Society Employs Lay
Executive Secretary (Commentary) 1250
Aorta, Complications of Acquired Diseases
(Scientific) 471
Aortic Aneurysm, Abdominal (Scientific) 1091
A Prayer For Physicians (Edit) 614
Arterial Surgery, Reconstructive (Scientific) 480
Artery Bank Problems (Edit) 498
Ascaris Infestation From Use of Human Sludge
as Lawn Fertilizer (Scientific) 964
Asiatic Influenza Epidemic - Fact or Fancy (Edit) 375
Association’s Annual Convention, May 10-14, 1958
(Commentary) 1125
Association Program to Combat Possible Asian
Influenza Outbreak in Florida (Commentary)
Asthma and Hay Fever Versus Spells of Asthma
and Hay Fever (Scientific)
A Statewide Program for Hospitalization of the
Indigent (Abst) 246
A Trend Toward Less Hospitalization? (Edit) 725
161
726
1130
502
1248
1129
267
170
167
855
372
266
1250
143
377
1231
Bacterial Sensitivity Determination (Abst) 613
Blood Vessel Banks (Edit) 484
Blue Shield:
Blue Shield From the Layman’s Viewpoint
(Commentary) 864
Blue Shield Panel (Commentary) 1141
Blue Shield - The Doctor’s Plan (Commentary) 1137
Blue Shield Yesterday, Today and Tomorrow
(Commentary) 984
Information Meeting Held for Blue Shield Active
Members (Commentary) 861
My View of Florida Blue Shield (Commentary) 978
Books Received:
Barnes, Josephine, M.A.: Care of the Expectant
Mother 302
Bauer, W. W.: The Official American Medical
Association Book of Health 317
Bierring, Walter L., M.D.: Rypins’ Medical
Licensure Examination 432
Bluemel, C. S., M.D.: The Riddle of
Stuttering 300
Campbell, Meredith F’., M. D.: Principles of
Urology 300
Cha e Francine: A Visii to the Hospital 429
Cha < Peter Pineo: Your Wonderful Body ..... 1046
Chauvois, Louis William Harvey 547
Coates, Col. John Boyd Jr.: DeBakey, M. M.,
M.D.: Surgery in World War II, Vol 2.
General Surgery 108
Coates, Col. John Boyd Jr.: Surgery in World
War II. Orthopedic Surgery in European
Theater of Operations 109
Coates, Col. John Boyd Jr.: Surgery in World
War II. Orthopedic Surgery in Mediterranean 557
Davison, W. C., M.D., and Levinthal, Jeana
Davison, M.D.: The Compleat Pediatrician 312
DeSanctis, Adolph G., with collaboration of
Varga, Charles, M.D. and Ten Contributors:
Handbook of Pediatric Medical Emergencies 196
Dill, Leslie V.: Modern Perinatal Care 1178
Dunn, Halbert L., M.D.: Vital Statistics of the
U.S. 1954, Vol. I 1186
Dunn, Halbert L., M.D.: Vital Statistics of the
U.S. 1954, Vol. II 108
Fiastman, Nicholson J., M. D.: Expectant
Motherhood ... 196
Forkner, Claude E.: Practitioners’ Conferences 916
F’ox, Joseph: The Chronically 111 774
Gleason, Marion N.; Gosselin, Robert E., and
Hodge, Harold C.: Clinical Toxicology of
Commerical Products 1178
Greenblat, Bernard R.. M.D.: A Doctor’s Marital
Guirle for Patients 108
Harvard University Press: Chronic Illness in the
U.S., Vol. I ... 1046
Hewitt, Donald W.: Alcoholism 554
Hilliard, Marion: A Woman Doctor Looks At
Love and Life 917
Hospital Council of Greater N. Y.: Organized
Home Medical Care in New York City 196
Jessiman, Andrew G., and Moore, Francis D.:
Carcinoma of Breast 298
Lawler, Sylvia D., and Lawler, L. J.: Human
Blood Groups and Inheritance 429
MacBryde, Cyril Mitchell, editor: Signs and
Symptoms 557
MacNeal, Perry S.; Alpers, Bernard J,, and
O’Brien, William R.: Management of the
Patient with Headache 777
Massie, Willman A.: Medical Service for Rural
Areas 427
Matthews, Alexander: A Nurse Named Mary 916
McNeil, Donald R.: The Fight for Fluoridation 315
Modell, Walter, M.D.: Drugs in Current Use in
1957 312
Maloney, James C.: Fear: Contagion and
Conquest 1413
Netter, Frank H„ M.D.: Liver, Biliary Tract
and Pancreas, Part III 317
New York Philosophical Library: Manuel of
Nutrition 1178
Page, Robert Collier: It Pays to be Healthy 774
Pascher, Frances, editor: Dermatologic
F'ormulary 908
Phillipp, Elliot E.: From Sterility to'Fertility 774
Podalsky, Edward, editor: The Neurosis and
Their Treatment 1413
Reich, Walter J., and Nechtow, Mitchell J.:
Practical Gynecology 1040
Sargant, William: Battle for the Mind 302
Smith, Donald R., M.D.: General Urology 302
Statland, Harry: Fluid and Electrolytes in
Practice 554
Steincrohn, Peter J.: You Can Increase your
Heart-Power 1413
University of Miami: Primera Conferencia Inter-
Americana de Medicina del Trabajo
Patrocinada por la Escuela de Medicina
de la Universidad de Miami 1189
U. S. Dept, of Health, Education and Welfare:
Clinical Memoranda on Economic Poisons 298
U. S. Dept, of Health, Education and Welfare:
Health Services for American Indians 432
U. S. Government Printing Office: Vital
Statistics of U.S. 1954 1186
J. Florida M.A.
June, 1958
INDEX TO VOLUME XLIV
1349
Vorhaus, Martin G.: Changing Patient -
Doctor Relationship 547
Wilder, Abraham: The Relation of Psychiatry
to Pharmacology 1413
Wolstenholme, G.E.W. and O’Connor, Cecilia
M., editors for Ciba Foundation: Ciba
Foundation Symposium on Bone
Structure and Metabolism 315
Wolstenholme, G.E.W. and Millar, E. C. P.,
editors: Ciba Foundation Symposium on
Paper Electrophoresis 429
Wolstenholme, G.E.W., and O’Connor, C.M.,
editors: Ciba Foundation Colloquia on
Ageing 917
Wolstenholme, G.E.W., and Millar, E.C.P.,
editors: Ciba Foundation Colloquia on
Endocrinology 917
Wolstenholme, G.E.W., and O’Connor, C.M.,
editors: Ciba Foundation Symposium on
Chemistry and Biology of Purines 1186
Breast Abscess, Puerperal (Scientific) 1229
Bronchial Asthma, Neglected Phase of Management
(Scientific) 364
Cancer Control, Progress in (Scientific) 348
Cancer, Gastric. A New Rapid Detection (Abst) 29
Carcinoma of the Esophagus (Scientific) 604
Carcinoma of the Cervix Uteri (Abst) 613
Carcinoma of Uterine Cervix. New Technics in study
(Scientific) 1089
Carcinoma, Squamous; Histochemical Studies (Abst) 29
Carcinoma, Squamous Cell of Anus (Abst) 159
Carcinoma, Squamous-Cell of Uterine Cervix (Abst) 1345
Cardiac Arrest, Molar Sodium Lactate Compared
with Electrical Stimulation (Abst) 826
Cardiac Arrhythmias, Treatment by Drugs
(Scientific) 367
Cardiovascular Diseases Seminar Program,
Jacksonville, Feb. 20-22, 1958 (Commentary) 854
Cardiovascular Diseases Annual Seminar
(Commentary) 737
Central Florida Medical Meeting, Orlando, March
13, 1958 (Commentary) 736
Cerebral Hemorrhage, Changes Occurring in
Myocardial Infarction (Abst) 1106
Cervical Cancer: Chronic Inflammation, Stress and
Adaptation Factors (Abst) 158
Choledochal Cyst (Scientific) 1099
Contagious Exanthem, Clinical Report of Unusual
(Scientific) 489
Convention:
Annual Meeting - Scientific Program
(Commentary) 499
Annual Meeting Program 1107
Florida Medical Association Golf Tournament
(Commentary) 86
Program for Eighty-Fourth Annual Meeting
(Commentary) 852
Registration Eighty-Third Annual Meeting 70
William Carmel Roberts, M.D., President 81
County Medical Society Lay Executive Secretaries
(Commentary) 1126
Courtesy (Others Are Saying) 88
Cystic Medical Necrosis as Cause of Localized
Aortic Aneurysms Amenable to Surgical
Treatment (Abst) 495
Cytology Value in Accidents of Early Pregnancy
(Abst) 159
Dade County Medical Association Executive Office
Building Dedicated (Commentary) 728
Deaths:
Members:
Adams, Texas A., Daytona Beach 626, 1167
Allen, Ralph F., Coral Gables 396, 766
Bechman, George E., Jacksonville 274, 407
Brooks, Warren A., Winter Park 768, 1175
Buford, Coleman G., West Palm Beach 1004, 1290
Chandler, Gail Ellsworth, Miami 521
Cronkite, Alfred E., Fort Lauderdale 1019
Conklin, Raymond C., Mount Dora 1004
Counts, Noah T., Cocoa 274, 538
Driskell, Simon E., Jacksonville 274
Eaton, Joseph W., St. Petersburg 176, 404
Edmunds, C. Harold, Miami 396, 650
Garcia, Louis J., Tampa 102
Geiger, Hugh S., Kissimmee 274
Henry, Gordon F., West Palm Beach 274, 646
Griffin, Thos. R., St. Petersburg 274, 648
Heath, Guy Wilkerson, West Palm Beach 291
Johnston, Walter B., Winter Park 1004, 1406
Lancaster, William J., Tampa 176, 400
Larrabee, Charles William, Bradenton 104
Lerner, Lee W., Miami 396, 908
McDermid, John Turner, Fort Pierce 1174
McEwan, John S., Orlando 506, 1014
McGugan, Arthur, Denver, Colo. 176, 293
Mason, John F., Bradenton 176
Melvin, Alexis M., Miami 274, 522
Moore, John T., Tampa 1004, 1297
Myers, Lucien E., Winter Park 2 74, 654
Neill, Robert G., Orlando 768, 1172
Nichols, Frank Oliver, Miami 1172, 1410
Nobles, William Daniel, Pensacola 537
Page, Walter C., Cocoa 1026
Palmer, Harrison G., St. Petersburg 293
Price, Cleveland J., Miami 396, 906
Schirmer, Adelbert F., Orlando 176, 398
Smith, James Alonzo, Sanford ... 100, 417
Thomas, Merrick D. Sr., Miami 274, 522
Tolar, Julian N., Sanford 768
Torbett, Ralph S., Tampa 274, 418
Trousdale, Theodore M., Sarasota 100, 768
Webb, Walter D., St. Augustine 274, 900
Wilkins, Charlotte K., Miami 648
Wilkinson, Benjamin A., Tallahassee 418
Young, William C., Chiefland 762
Other Doctors:
Beam, Eugene C., Sarasota 879
Blum, Leo J. Jr., Warner Robins, Ga. 100
Bubis, Jacob L., Miami Beach 506
Burns, Joseph P., Lake City 768
Caraker, Charles T. Jr., Perry 274
Carroll, Charles H., Miami 768
Dalpe, William G., Los Angeles 396
Drennen, Earle, Birmingham, Ala. 396
Edmundson, Susan O., Clearwater 506
Ehrlich, Simon D., Hollywood 396
Elder, James F., Ormond Beach 879
Engle, Ralph Landis, Coral Gables 274
Faver, Henry M., Tampa 274
Fox, John W., St. Petersburg 100
Gibson, Ira M., Valdosta, Ga. 396
Ginsburg, Samuel D., DeBary 879
Hodge, Otto P., St. Petersburg 879
Jordan, Thomas C. Jr., Lakeland 396
Krans, Dehart, Tallahassee 1004
MacLean, J. Arthur Jr., Miami 626
McClure, Herbert A., Vernon, Ala. 100
McElroy, Joseph D., Atlanta 396
Martin, Orel F., Coral Gables 100
Martinson, Martin M., Orlando 1004
Myers, Edmund, St. Petersburg 626
Peel, George T., Anderson, S.C. 396
Sparks, Proctor, St. Petersburg 100
Spooner, Doster S., Pahokee 396
Stormont, Riley M., Webb City, Mo. 768
Thompson, John J., St. Petersburg 100
Twomey, George W., Fort Myers 100
Wallace, Albert W., Tulsa, Okla. 506
Weeks, Joseph C., Lake City 274
Young, Robert U., Tampa 100
Dedicated Service (Commentary) 267
Dependents’ Medical Care Program (Scientific) 27
Dermatitis, Due to Hydrocortisone Ointment (Abst) 373
Dermatologic Diseases of Children (Abst) 1345
Diabetes Mellitus, Value of Entozyme in Clinical
Management (Abst)
494
1350
INDEX TO VOLUME XLIV
Volume XLIV
Number 12
Diabetes Screening in Polk County (Scientific) 957
Distinguished Florida Physician Sponsored for
Highest National Office (Commentary) 617
Diuresis and Antidiuresis (Scientific) 699
Doctors Are Dedicated (Others Are Saying) 867
Dr. Babers Addresses District Meetings
(Commentary) 731
Ectopic Pregnancy, Diagnosis and Management
(Scientific) 599
Edema: Anomalous Type of Salt and Water
Retention (Abst) 159
Editorial (Others Are Saying) 276
Editorial (Others Are Saying) 787
Electrocardiographic Interpretation, Pitfalls
(Scientific) 1337
Emotional Growth and Development of Child with
Key to Personality (Scientific) 1327
Encephalitis in Cat Scratch Disease (Scientific) 491
Encephalomyelitis, Benign Myalgic (Scientific) 1105
Esophageal Diverticulum, Congenital (Abst) 373
Exophthalmic Ophthalmoplegia, Surgical (Abst) 971
Experiences in Intravenous Urography Using
Hypaque (Abst) 722
Facial Agenesia, Bilateral (Abst) 158
Facial Fractures; Their Recognition and Management
(Scientific) 949
Fair Exhibits (1957-1958) Attract Large Crowds
(Commentary) 1133
Fifth Biennial Cardiovascular Seminar, Miami.
April 23-26, 1958 (Commentary) 1136
Fifth International Congress of Internal Medicine
(Commentary) 273
“Fill Our Hearts With Thankfulness” (Edit) 500
First Permanent Disability Guide Published
(Commentary) 1129
Florida Medical Foundation (Others Are Saying) 385
Florida Medical Foundation Progress Report
(Commentary) 1131
Flor'da Medicine and the Future (Commentary) 163
FMA-Blue Shield Liaison Committee (Others Are
Saying) 174
F’ord Foundation 1956 Report (Commentary) 87
Ford Foundation 1957 Report (Commentary) 976
Gangrene of the Skin: Progressive Synergistic
Bacterial (Scientific) 146
Gastrointestinal Wheat Allergy (Abst) 971
Gastroschisis (Scientific) 1097
Glaucoma for the General Practitioner (Scientific) 1334
Graduate Medical Education:
Diabetes Association Meeting, Gainesville, Oct.
24-26 272
Graduate Medical Education Seminars
(Commentary) 1356
Florida Clinical Diabetes Association, Gainesville
(Commentary) 381
Florida Clinical Diabetes Association Program 382
Hematology Seminar and Short Course Held,
Gainesville, June 20-22, 1957 166
History and Development of Postgraduate Medi-
cal Education in Florida (Commentary) 261
Hamman-Rich Syndrome: Diffuse Interstitial
Pulmonary Fibrosis (Scientific) 702
Headaches, Vascular and Allergic (Abst) 29
Heart Surgery, Extracorporeal Circulation for
Open (Scientific) 587
“Heedless Horsepower” (Commentary) 163
Hemicrania - or One-Sided Sphenopalatine Ethmoid
Heada< he ( Abst ) 28
Hemorrhagic Diseases; The Evaluation of Procedures
Used in the Diagnosis (Scientific) 139
Hexocyclium Methosulfate ; Report on a New
Anticholinergic (Scientific) 356
Hi topla mosis of Peyer’s Patches; Recurrent
Intussusception in a Six Year Old Child
(Scientific) 955
History and Development of Postgraduate Medical
Education in Florida (Commentary) 261
Horlgkin’s Disease; Pulmonary Manifestations
(Scientific) 1224
Hospital Plan in Florida (Scientific) 1241
Hyphemia, Traumatic; Clinical Management of
(Scientific) 815
Infertility Problem: Office Study (Scientific) 718
Is It Martyrdom to Serve? (Edit) 1127
Is Your Pride an Asset or Liability? (Others Arc-
Saying) 622
Jacksonville Blood Bank, Inc. (Commentary) 620
Labor With Emphasis on Stage I (Scientific) 720
Laying of Cornerstone University Teaching Hospital
(Commentary) . 618
Letter to the Editor 737, 868
Liver Metabolism, Respiratory Study in Surgical
Patients (Abst) 1345
Lumbar Sympathectomy; Critique on Therapeutic
Value (Abst) 1106
Lymphatic Cyst, Retroperitoneal (Abst) 1244
Massive Hemorrhage into an Adrenal Pheochromocy-
toma (Abst) 29
Medical District Meetings, October 28-31
(Commentary) 380
Medicare - Association Policies Determined at Called
Meeting of House of Delegates (Commentary) 853
Medical Education in Florida:
Postgraduate Obstetric-Pediatric Seminar
(Commentary) 86
Medical Education in Florida (Commentary) 247
Progress Report: University of Miami School
of Medicine 248
University of Florida College of Medicine 254
History and Development of Postgraduate
Medical Education in Florida 261
Remodeling Educational Foundation for
Practice Through Postgraduate Medical
Education 264
1958 Mediclinics of Minnesota, Fort Lauderdale,
March 2-12, 1958 732
Medical Licenses Granted 510, 1390
Medical Officers Returned 100, 396, 1160
Medical Lecture Tour to Asia (Commentary) 1359
Meetings:
Blue Shield Informational Meeting held for Active
Members, Jacksonville, Dec 7, 1957
(Commentary) 861
Cardiovascular Diseases Seminar, Jacksonville,
Feb. 20-22, 1958 737, 853
Cardiovascular Problems of the Aging Seminar,
Miami Beach, April 12, 1958 855
Central Florida Medical Meeting, Orlando, March
13, 1958 736
Cleft Palate Seminar, Miami, November 8-9, 1957 272
Fifth Biennial Cardiovascular Seminar, Miami,
April 23-26, 1958 1136
Fifth International Congress of Internal
Medicine, Philadelphia, April 24-26, 1958 273
Florida Academy of General Practice, St.
Petersburg, Oct. 21 -Nov. 2 383
Florida Association of Blood Banks Annual
Meeting, Ponte Vedra, June 7-9, 1958 1249
Florida Diabetes Association Annual Meeting,
Gainesville, Oct., 1957 619
Fracture Course, Second Annual, Chicago,
April 16-19, 1958 855
Hematology Seminar and Short Course,
Gainesville, June 20-22, 1957 166
House of Delegates, Proceedings of Called
Meeting, Jacksonville, Dec. 8, 1957 827
Medical District Meetings, 1957 738
Mediclinics of Minnesota, Fort Lauderdale,
March 2-12, 1958 732
J. Florida M.A.
June, 1958
INDEX TO VOLUME XLIV
1351
Medico-Legal Institute Held in Jacksonville,
Nov. 22-23, 1957 '
Mount Sinai Hospital Postgraduate Seminar,
Miami Beach, May 22-25
Mountaintop Medical Assembly, Waynesville,
N. C., June 19-21
Obstetric-Pediatric Seminar, Daytona Beach,
Sept. 9-11, 1957
Occupational Medicine Conference, Miami,
Aug. 18-22, 1958
Ophthalmology and Otolaryngology Midwinter
Seminar, Miami Beach, Jan. 27-Feb. 1, 1958
Postgraduate Obstetric-Pediatric Seminar,
Daytona Beach, Sept. 9-11, 1957 .....
Seminar on Internal Medicine, Gainesville,
April 3-5, 1958
Southern Medical Association Meeting, Miami
Beach, Nov. 11-14, 1957 384,
Southern Railway Surgeons Meet in Jackson-
ville, April 14-15, 1958
Twelfth Annual University of Florida Mid-
winter Seminar in Ophthalmology and
Otolaryngology, Miami Beach, Jan. 28, 1958
Mentally 111; Environment of Good Cheer and
Hope (Commentary)
Meprobamate in Treatment of Emotional Disorders
(Abst)
Midwinter Seminar in Ophthalmology and
Otolaryngology, Miami Beach, Jan. 27-Feb 1,
1958 (Commentary)
Modern Medicine Moves Ahead “AMA in Action”
(Commentary)
Mongoloids, Preliminary Report on Treatment
(Scientific)
Myocardial Infarction; Fate of Patients Surviving
Acute (Abst)
Myocardial Infarction: Hiccups as Sole Presenting
Symptom (Scientific)
National Socioeconomic Issues Confronting Medicine
New Members 90, 191, 291, 394, 510, 646,
892, 1014, 1161, 1282,
New Orleans Graduate Medical Assembly, March
3-6, 1958 (Commentary)
Newly Established Educational Council for Foreign
Medical Graduates (Commentary)
Nicotinic Acid Ester in Tuberculosis; Skin Reactions
(Scientific)
Nuclear Size and Nuclear: Cytoplasmic Ratio in
Delineation of Atypical Hyperplasia of Uterine
Cervix (Abst.)
Occupational Medicine Conference, Miami, Aug.
18-22, 1958 (Commentary)
Oligospermia (Abst)
Ophthalmologists Awarded Citations by Florida
Council for the Blind (Commentary)
Organic Phosphate Poisoning (Others Are Saying)
Papillomas of Neck, Cutaneous (Abst)
Pediatric Supervision of Children: Guiding
Principles (Scientific)
Pediatric Surgery; Optimal Timing (Scientific)
Peptic Ulcer, Management with Anticholinergic
Drugs (Scientific)
Phenylpyruvic Oligophrenia (Commentary)
Physician Celebrates Golden Anniversary of Career
(Commentary)
Physicians’ Role in Social Security (Commentary)
Polio and Polio-Like Diseases-1956 (Scientific)
Popularity of Midwinter Seminar Grows
(Commentary)
Postcoital Test, Impbaved Results with Terramycin
Vaginal Suppositories (Scientific)
Postdiphtheritic Polyneuritis and Pseudo-diphtheritic
Polyneuritis (Abst)
Presidential Address, Francis H. Langley
President’s Page:
Hopeful Procrastination
Progress Yet Antiquation 374
The Old Army Game 496
Proceedings of Called Meeting, House of Delegates,
Jacksonville, Dec. 8, 1957 827
Proceedings Eighty-Third Annual Meeting 31
Program for Eighty-Fourth Annual Meeting
(Commentary) 852
Program; Eighty-Fourth Annual Meeting, Bal
Harbour, May 11-14, 1958 1107
Pulmonary Tuberculosis Surgery, Problem of Poor-
Risk Patient (Abst) 826
Psychiatric Analysis (Edit) 497
Psychiatry, Highlights of Second International
Congress (Scientific) 820
Radiographic Findings in Certain Diseases Peculiar
to Subtropical Climate (Abst) 495
Rapport in Medicine (Scientific) 243
Relationship of Sex to Childhood Accidents
(Scientific) 1343
Removal of Urethral Calculi by Johnson Stone
Basket (Abst) 722
Renal Revascularization by Splenic Artery
Implantation (Abst) 613
Reports:
Report of the Editor 79
Annual Joint Report of Secretary-Treasurer and
Managing Editor 73
Report of Ford Foundation, 1957 (Commentary) 976
Respiratory Liver Metabolism in Surgical Patients
(Abst) 246
Roberts, William Carmel, M.D., President 81
Salk Vaccine Program, Cost of Administration
(Scientific) 150
Sarasota County Medical Society Employs
Executive Secretary (Commentary) 1362
Scientific Program Planned for Annual Meeting, Bal
Harbour, May 10-14, 1958 (Commentary) 973
Sears-Roebuck Foundation Plan (Commentary) 1359
Second Medico-Legal Institute, Jacksonville, Nov.
22-23 (Commentary) 501
Segmental Liver Revascularization (Abst) 722
Seminar on Internal Medicine (Commentary) 975
Senile and Seborrheic Keratoses (Abst) 495
Small Business Administration, New Loan Policy
(Commentary) 377
Socialized Medicine and Socialism by Way of
Veterans Administration (Abst) 493
Southern Medical Association Builds Permanent
Headquarters (Commentary) 171
Southern Medical Association Meets in Miami Beach,
Nov. 11-14, 1957 382, 502
Southern Medical Association Meeting Held at Miami
Beach (Commentary) 726
Southern Postgraduate Seminar (Commentary) 1362
Southern Railway Surgeons Meeting in Jacksonville,
April 14-15, 1958 (Commentary) 1132, 1361
Spastic Disorder; Neuromuscular Reflex Therapy
(Scientific) 1234
Spleen, Injuries of (Abst) 372
Squamous-Cell Carcinoma of Uterine Cervix; Protein
Bound Sulfhydryl and Disulfide Groups (Abst) 246
State Board of Health:
A New Strain of Influenza 172
Asiatic Influenza 274
State Science Fair, 1958 1361
Statewide Medico-Legal Institute Held in Jackson-
ville (Commentary) 730
Statewide Medico-Legal Institute Well Attended
(Commentary) 1360
Stibestrol Therapy on Hematopoiesis in Pregnant
Human (Abst) 494
Streptococcal Epidemiologic Survey (Scientific) 1341
“Stress of Life” author to Address Florida Academy
of General Practice, St. Petersburg, Nov. 1-2,
1957 (Commentary) 271
Syphilis in Polk County (Scientific) 607
Syphilis in Shakespeare’s Tragedies (Scientific) 714
730
1249
1249
171
733
619
86
975
, 728
1132
975
378
372
619
267
709
1244
960
: 24
744,
1378
620
976
152
158
733
1244
86
1362
826
1219
238
357
1358
733
501
610
975
968
28
19
160
1352
INDEX TO VOLUME XLIV
Volume XLIV
Number 12
The Art of Setting Fees (Others Are Saying) 977
The 1957 Annual Meeting in Review (Commentary) 82
The Medical Secretary (Commentary) 270
The Problem and The Forand Bill (Care of The
Aged) (Others Are Saying) 1252
The Public Wants to Know (Others Are Saying) 1147
The Voice of Reason by Frank G. Slaughter, M.D. 615
This I Believe (Others Are Saying) 502
Timely Telephone Topics (Edit) 972
To Catch a Thief (Scientific) ... 242
Toxoplasmosis, Congenital and Acquired (Scientific) 227
Tranquilizing Drugs, Allergenicity (Abst) 493
Traumatic Torsion of the Lung (Abst) 722
Tuberculosis, Pulmonary Resection (Abst) 494
University of Florida College of Medicine 254
Ureteropyelograms in Children (Abst) 373
Ureters, Transplantation into an Isolated Ileal Loop
(Scientific) 809
Urography Experiences in Intravenous Using
Hypaque (Abst) 722
Uterine Varix, Spontaneous Rupture at 28 Weeks’
Pregnancy (Abst) 373
Valvular Heart Surgery, Clinical Value of Right and
Left Catheterization in the Selection of Patients
(Scientific) 592
“What is an Ophthalmologist?” (Commentary) 727
What Price Radiation? (Edit) 1245
Whither Goest? (Edit) 1357
Will Tragedy Strike? (Others Are Saying) 1363
Whole Truths to Combat Misconceptions (Edit) 616
Woman’s Auxiliary:
Doctor’s Day Awards 770
Meet The President 1411
Program of Thirty-First Annual Meeting, Bal
Harbour, May 11-13, 1958 1118
Report of Annual Meeting of Woman’s Auxiliary
to A.M.A . 192
Report of Fall Conference of Presidents and
Presidents-EIect 668
Satisfaction Guaranteed 1038
The President Reports 542
Wounds of Colon and Rectum (Abst) 493
INDEX TO AUTHORS
Articles
Ackerman, J. H., Jacksonville 607
Allen, Marvin S., Hollywood 955
Anderson, Augustus E. Jr., Jacksonville 702
Andrews, Frederick C., Mount Dora 720
Annis, Edward R., Miami 146
Bernstein, William H., Miami Beach 592
Bistowish, Joseph M., Tallahassee 150
Bond, James ().. Jacksonville 964
Bowen, Frederick H., Jacksonville 1099
Branch, A., Miami 610
Broadaway, Rufus K., Miami 587
Broussard, Elsie R., Pensacola 1343
Carmona, Manuel G., Hollywood 955
Carter, Charles H., Gainesville 709
Chesney, John G., Miami 1091
Cook, Thomas D., New Smyrna Beach 1229
Daughtry, DeWitt C., Miami 1091
Davis, H. Clinton, Miami 238
Day, Samuel M., Jacksonville 471
Denham, Sam W., Jacksonville 1089
Dickinson, Thomas G., Sarasota 242, 815
i ' L. W., Memphis 139
Donaldson, James A., Winter Haven 607, 957
Do tei John l< Jr., Jacksonville . 592, 604
D al [ohn A. Jr.. Jacksonville . 604
Emmel, < . Leonard, Gainesville 702
Farrell, John J., Miami 587
Fay, 'I emple Philadelphia 1234
l'indley, Thomas, Augusta, Ga. 699
Fishbein, I. Leo, Miami Beach 820
Fisher, John J., Jacksonville 718
Fomon, John J., Miami 587
Foraker, Alvan G., Jacksonville 1089
Forbes, Sherman B., Tampa 227
Gair, David R., Miami 491
Gibson, William J., St. Augustine .. 1334
Gilbert, N. Stuart, Miami 960
Gittelson, George, Miami 364
Greene, Irvin M., Miami Beach 1105
Hahn, Theodore F. Jr., DeLand 714
Harrell, George T. Jr., Gainesville 254
Heller, John R., Bethesda, Md. 348
Hinton, Forrest, Immokalee 1097
Howard Ernest B., Chicago 24
Ira, Gordon H., Jacksonville 356
James, Al., Jacksonville 1241
Kurzweg, Frank T., Miami 587
Lary, Banning G., Miami 146
Leech, Clifton B., Fort Lauderdale 367
Lesser, Milton E., Miami Beach 592
Litwak. Robert S., Miami 587, 592
McLeod, James A., Orlando 480
Maley, Malcolm C., Gainesville 709
Marsh, Homer F., Miami 247
Martin, Wayne B., Coral Gables 146
Metzger, Frank C., Tampa 1231
Moewus, L., Miami 610
Moody, James D., Orlando 480
Morgan, Bernard L. N., Jacksonville 949
Nayfield, Chester L., Winter Haven 957
Newman, J. Harold, Jacksonville 809
Nickau, Robert H., Lakeland 1224
Reeves, Robert J., Durham, N. C. 1224
Rivas, Lt. Col. E. G., Washington 27
Roberts, Hyman J., West Palm Beach 357
Ross, John B., Jacksonville 484
Samet, Philip, Miami Beach 592
Saslaw, Milton, S., Miami 152, 1341
Schlaepfer, G., Miami 610
Schultz, John M., Miami 968
Sigel, M. M.. Miami 610
Silverman, Leonard, Miami Beach 592
Smith, Frank R . N. Y. 599
Spear, Harold C., Miami 1091
Stage, John T., Jacksonville 143
Streitfeld, Murray M., Miami 152
Stuart, Harold C., Boston 1219
Terry, John H., Jacksonville 471, 484
Thomas, William C. Jr., Gainesville 264
Trappolini, Alma, Miami 146
Trystad, Ethel H., Naples 489
Turken, H., Miami Beach 592
Voyles, Carl M., St. Petersburg 1337
Walls, William L., Miami 491
Weathington, Warren T., Apalachicola 150
Werch, S. C., Miami 243
Whiteside, William H., N. Y. 599
Wolf, Richard E., Cincinnati 1327
Zaydon, Thomas J., Miami 238
Abstracts
Ayre, J. Ernest, Miami 29, 158, 159
Barrett, Bernard M., Pensacola 29
Bernstein, Clarence, Orlando 493
Boucek, Robert J., N. Miami Beach 159, 1346
Carmichael, L. P., Miami 613
Carson, Russell B., Fort Lauderdale 373
Casten, Gus G., Miami 1346
Chunn, C. Frank, Tampa 493
Daughtry, DeWitt C., Miami 722
Davis, H. Clinton, Miami 246, 613, 722, 1345, 1346
Davis, James M., Jacksonville 494
Denham, Sam W. Jacksonville 1345
Eichert, Herbert, Miami 826
Finch, T. Vernon, Sarasota 373
J. Florida M.A.
June, 1958
INDEX TO VOLUME XLIV
1353
Fitzpatrick, Raymond, Gainesville 722
Foraker, Alvan G., Jacksonville 29, 158, 246,
495, 613, 1345
Futch, William D., St. Petersburg 1244
Hampton, H. Phillip, Tampa 246
Harrow, Benedict R., Miami 722, 1244
Hatt, William S., Sarasota 372
Klotz, Solomon D., Orlando 493
Knauer, William J. Jr., Jacksonville 971
Kraeft, Nelson H., Tallahassee 826
Lee, Robert M., Miami 1346
Lehman, David J. Jr., Hollywood 29
Lowenstein, B. E., Miami 494
Morse, Irwin S., Coral Gables 246, 613, 722, 1345
Mosley, R. Sam, Coral Gables 159
Nelson, Arthur R., Jacksonville 373, 495, 1106
Orr, Louis M., Orlando 493
Peck, Sidney J., Hollywood 494
Phillips, Roger E., Orlando 372
Raap, Gerard, Miami 495
Rich, Maurice, Miami 1106
Roberts, Hyman J., West Palm Beach 28, 723, 971
Rogers, Wayne S., Hialeah 159
Rowntree, Leonard G., Miami Beach 159
Sams, Wiley M., Miami 373
Schultz, John M., Miami 1244
Smith, Donald W., Miami 1346
Snyder, Clifford C., Miami 158
Terry, John H., Jacksonville 372
Turnley, William H., Ocala 28
Waisman, Morris, Tampa 826, 1345
Wells, W. Dotson, Fort Lauderdale 373
Williams, John I., Fort Lauderdale 373
1354
Volume XI.IV
Number 12
JERE WRIGHT ANNIS, M.D.
President 1958-1959
Florida Medical Association
J. Florida M.A.
June, 1958
1355
Jere Wright Annis. M.D.. President
A native of Minnesota, Dr. Jere Wright Annis
was born in Minneapolis on April 30, 1909. He
attended Phillips Academy, Andover, Mass., from
1922 to 1926, Dartmouth College from 1926 to
1928, and Cornell College in Iowa for the last
two years of his academic training, receiving the
A.B. degree from that institution in 1930. Re-
turning to Minnesota for his medical training, he
entered the University of Minnesota Medical
School, where he received the M.D. degree in
1934. After serving an internship at the Minneap-
olis General Hospital, he spent three years as a
fellow in internal medicine at the Mayo Clinic.
Since 1938, Dr. Annis has been associated
with the Watson Clinic in Lakeland, except for
five years spent in military service during World
War II. He entered the Army Medical Corps in
1941 and was discharged in 1946 with the rank
of lieutenant colonel. Locally, Dr. Annis has been
on the staff of Morrell Memorial Hospital through
the years, serving as secretary and as president,
and has held many civic posts. He has been ac-
tive in the Lakeland Chamber of Commerce,
holding several offices and serving as vice presi-
dent in 1957. A trustee of the Polk County Guid-
ance Center, he is chairman of the Health and
Safety Committee of the district Boy Scouts or-
ganization and is advisor to the Lakeland Chapter
of the American Red Cross and the Lakeland
Boys Club. He is medical director of the Polk
County unit of Florida Civil Defense. A thirty-
second degree Scottish Rite Mason, he is also a
member of the Lakeland Elks Club, Yacht Club
and American Legion. He holds membership in
the Lakeland and Winter Haven Rifle clubs and
in the National Rifle Association and the West
Coast Pistol League.
Dr. Annis is a past president of the Polk
County Medical Association, and also a former
secretary and trustee. For many years he has
served his county medical society as a delegate
to the Florida Medical Association.
Active in the Florida Medical Association for
two decades, Dr. Annis has held numerous key
positions. He is a former chairman of the Com-
mittee on Scientific Work and the Committee on
Nursing, has represented the Association on the
Advisory Board on Practical Nurse Education of
the State Board of Education, and has been a
member of the original Committee on Civilian
Medical Care for Military Dependents. He has
served on the Board of Governors, on reference
committees of the House of Delegates for several
years, and during 1957-1958 as President-Elect.
Also, he has held the post of Associate Editor of
The Journal.
A former secretary and past president of the
Florida Heart Association, Dr. Annis now serves
on its board of directors. He is a member of the
West Coast Academy of Medicine and the Flor-
ida Society of Internal Medicine, .and has served
as chairman of the membership committee of the
latter organization. He is on the Florida State
Hospital Advisory Council and a director and
member of the executive committee of Blue
Shield of Florida, Inc. In addition, he is a direc-
tor of the Tampa Regional Mental Hygiene Com-
mittee and district chairman of the Florida Medi-
cal Committee for Better Government. His mem-
bership in the Florida Historical Society bespeaks
his interest in Florida history. He is also a mem-
ber of the Sons of the American Revolution.
Among the national medical organizations
with which Dr. Annis is affiliated are the Ameri-
can Medical Association, Southern Medical Asso-
ciation, American College of Physicians, Ameri-
can College of Cardiology, American Heart Asso-
ciation, Association of American Physicians and
Surgeons. American Gastroscopic Society, Alumni
Association of the Mayo Foundation, and the
World Medical Association. He is a diplomate of
the American Board of Internal Medicine.
A contributor to medical literature. Dr. Annis
is the author of a number of professional papers
on various subjects pertaining to his specialty.
He served as a collaborating editor of “The Book
of Health.” published by the Elsevier Press in
1953.
Dr. Annis and Mrs. Annis, the former Miss
Margaret Tinkham of Iowa, have two sons and
two daughters. Jere W. Ill, Mary, Michael and
Kathryn.
1958 - 1959 Objectives
Greetings — to all 3,349 of you who are the Florida Medical Association:
We, your new officers, reaffirm our resolutions, plans and objectives for the coming year. We
hope and pray that our industry and zeal may balance our inadequacies and we pledge you our best.
The year ahead is an important one and in it we will face many problems — some old and some
new. We must change with the times, adjusting and modifying our concepts and practices to keep
abreast of a rapidly changing world — but preserving the basic ideals and principles of our profession,
and striving always to maintain its proper dignity and respect. The responsibility of our great pro-
fessional tradition is a heavy and a hallowed one.
During this year we will finish the revision of our Constitution and By-Laws and present them
for your approval at the House of Delegates next May. Furthermore, we will complete and distribute
a handbook for county officers to aid in their orientation in the Association’s affairs.
Our Legislative Committee will remain active and alert, endorsing such legislation as is sound
medically, and opposing that which is not.
Through our own Association, and through the Governor’s Advisory Committee, we intend to
study the medical care for the indigent problem in this state, and to know more about it than any-
one else. We intend to integrate this with the problem of total medical care, rather than with the
problem of indigency — for we think this is where it belongs — and we hope to propose a carefully
weighed and considered program for its solution.
We will continue our attempts to solve more adequately the Medicare problem and re-evaluate
our contract with the government.
We will follow the instructions of the House of Delegates in following through on the Blue Shield
Designated physicians will again meet with our senators and representatives in Washington to dis-
charge our obligation in voicing our views on national affairs.
All these tasks — and many more — we shall undertake on your behalf to the best of our ability,
and on their progress we shall attempt to keep you currently informed through the pages of this —
your Journal.
Please give us your criticism — your advice and your help — by attending your county Associa-
tion’s meetings, serving on its committees and helping intelligently to formulate and voice its senti-
ments and policies. Help us, too, by taking an active part in the affairs of your community — by being
a good citizen as well as a good doctor. This, more than anything else, will make our public relations
program a success.
program.
J. Florida M.A.
June, 1958
1357
The Journal of the
Florida Medical Association
OWNED AND PUBLISHED BY FLORIDA MEDICAL ASSOCIATION
P. O. Box 2411 Jacksonville, Florida
SHALER RICHARDSON, M.D., Editor
STAFF
Assistant Editors Managing Editor
Webster Merritt, M.D. Editorial Consultant Ernes i R. Gibson
Franz H. Stewart, M.D. Mrs. Edith
Committee on Publication
Shaler Richardson, M.D., Chairman. . . .Jacksonville
Chas. J. Collins, M.D Orlando
James N. Patterson, M.D Tampa
Abstract Department
Kenneth A. Morris, M.D., Chairman. . .Jacksonville
Walter C. Jones, M.D Miami
B. Hill Assistant Managing Editor
Thomas R. Jarvis
Associate Editors
Louis M. Orr, M.D Orlando
Joseph J. Lowenthal, M.D lacksonville
Herschel G. Cole, M.D Tampa
Wilson T. Sowder, M.D lacksonville
Carlos P. Lamar, M.D Miami
Walter C. Payne Sr., M.D Pensacola
George T. Harrell Jr., M.D Gainesville
Dean, College of Medicine, University of Florida
Homer F. Marsh, Ph.D Miami
Dean, School of Medicine, University of Miami
Whither Goest?
More than a dozen years ago, the writer sat
with a panel which was a part of the instructional
program for sophomore medical students. It was
not so much the purpose of the panel to resolve
problems as to present them for discussion and
reflection. Cn the particular occasion, the sub-
ject was the potential danger of the indiscriminate
use of the sulfonamides and the new antibiotic,
penicillin.
In recalling the tenor of the panel’s discus-
sions, predictions were made which now are real-
ities; and certain observations as to the role of
the public’s demands in the determination of
medical practices are, today, more disturbing
than then. Two facets of the discussions having
interrelationships are interesting to contemplate
and may, perhapsj stimulate some thought albeit
the outcome of such thought cannot be ventured
now.
The time of the discussion was not long after
penicillin had been made available to physicians
and already certain defects in the interaction be-
tween the agent and the organisms against which
it was so potently active were being noticed.
Similar observations had been noted in the use
of the sulfonamides. It was observed that some
infectious agents, and among them the staphylo-
cocci in particular, possessed capabilities of rapid-
ly developing permanent resistance to the effect
of the new antibiotics, such characteristic being
passed from generation to generation of organisms.
Although the observation held interest to the
bacteriologist as exemplifying the adaptive ability
of micro-organisms in unfavorable environments,
it carried a greater and obvious impact for the
physician and patient. Pleas were made to the
profession not to use the sulfonamides and peni-
cillin indiscriminately but to be certain of the
effectiveness of these agents on the causal agent
of infection at hand and then to use them with
a heavy hand. Warnings were made also that
subeffective doses of the antibiotics were more
dangerous than none at all, for the use of such
amounts could lead to the acclimatizing of the
causal organisms in such a manner as to bring
about the development of resistance to the anti-
biotics.
We are now witnessing the results of organisms
developing this almost complete resistance to ther-
apeutic agents. At the moment, and in several
1358
EDITORIALS AND COMMENTARIES
Volume XUV
Number 12
different areas, the problem of resistant staphy-
lococci has reached large proportions. This is a
tragic situation, but it is more tragic to look into
an aspect which, indirectly perhaps, may have
led to the predicament.
During the course of the panel discussion
mentioned previously, the physician members
agreed that care had to be observed in the use of
the new therapeutic agents, yet they had been
put in a peculiar position through the demands
of a public which was only partially informed as
to the story of the antibiotics. Writers of articles
for popular magazines and the newspapers who
were ill-informed or noninformed of the whole
picture were playing up the sensational facets of
the new “wonder drugs.” Patients who previously
had little knowledge of the therapeutic armamen-
tarium of Medicine were sensitized, and not in
the immunologic sense, to expect miracles from
the use of the “wonder drugs” in any ailment.
Indeed, patients were diagnosing their own ills
before going to the physician and woe betide the
physician who disagreed with the diagnosis. The
physician who was asked to administer one of
the antibiotics could, of course, refuse to do so
but only in the certain knowledge that the pa-
tient would seek help elsewhere until a sympathet-
ic ear were found.
This activity of popular magazines and news-
papers in keeping the public informed, but in-
completely so, on the newer developments in
Medicine has had other repercussions. Witness,
for example, the widespread and indiscriminate
use of the tranquilizing agents until now they have
become an almost necessary part of diet to many
patients with no thought as to eventual effect
of prolonged usage. A part of the practice of
Medicine has become based on patient demands
rather than patient needs, and who is to say where
such demands will lead? Medicine is undergoing
startling advancements; it also is witnessing the
application of the old adage, “Knowledge is
dangerous when only small amounts are pos-
sessed.”
It is too late to remedy the damage which has
been done, but is it too late to apply a few pre-
ventive measures?
Complete proceedings of the Annual Meeting
of the Florida Medical Association held May 10-
14 is scheduled for publication in the July issue of
The Journal, because of printing deadlines, it was
not possible to publish this material in June.
Phenylpyruvic Oligophrenia
Phenylpyruvic oligophrenia is a syndrome
which was described approximately 60 years ago
and which recently has interested many research
scientists. Recent developments have given much
hope for the future of the persons afflicted with
this disease. The condition is due to a recessive
gene; therefore, several children in the same fam-
ily may be afflicted.
It is an abnormality of the metabolism of
phenylalanine, which is as a rule broken down
into several compounds, the principal one of
which is tyrosine. This is one of the essential
amino acids for the development of nervous tissue.
If not properly metabolized, phenylpyruvic acid
and other abnormal metabolites are formed in
the blood stream and are eliminated through the
kidneys. It is thought that several of these abnor-
mal metabolites are toxic to nervous tissue and
produce nerve destruction. The syndrome, there-
fore, is characterized by a poor development of
nervous tissue and possible destruction of this
tissue.
The children are usually blond, rather low
grade mentally, hyperactive, and frequently epilep-
tic. The disease can be diagnosed by acidifying
the urine and adding ferric chloride to it. This
produces a green color immediately which fades
on standing. Many pediatricians now run this
test routinely on the wet diapers of infants as a
scanning type of detection.
Several state pediatric societies have sponsored
programs encouraging pediatricians to carry out
this test on children from one to six months of
age on routine office check-ups. The Swedish Med-
ical Society and Norwegian Medical Society have
both recommended it to their physicians.
Treatment consists of a low phenylalanine,
high tyrosine diet until the child’s urine becomes
negative for phenylpyruvic acid and then the
gradual addition of other foods, with low phenyl-
alanine content, until the child is on as normal a
diet as possible. This is maintained from one to 10
years, and as a rule the patient develops normally.
Graduate Medical Education Seminars
The Seminar in Internal Medicine held at the
College of Medicine of the University of Florida
on April 3-5, 1958 was attended by 49 physicians
from all parts of the state. The seminar was de-
voted to selected disorders of the thyroid gland.
J. Florida M.A.
June, 1958
EDITORIALS AND COMMENTARIES
1359
the kidneys, and the respiratory system, and the
speakers were out of state lecturers and members
of the faculty of the College of Medicine. Those
in attendance found the subject matter of the
talks and discussions both stimulating and of
practical import.
Two seminars will be held in the fall of 1958,
the dates to be announced later. One will be a
seminar in internal medicine devoted to gastroin-
testinal and hematologic disorders, and the other
will be a two and a half day seminar in general
surgery.
Medical Lecture Tour to Asia
The Asia-Pacific Academy of Ophthalmology
is sponsoring a good will tour to countries of the
Orient following the International Congress of
Ophthalmology in Brussels in September 1958.
The purpose of this tour, which is to last approx-
imately one month, is to hold joint meetings with
ophthalmologists in Pakistan, India, Thailand,
the Philippines, and Hong Kong. It is expected
that this good will tour will create much interest
among physicians in the countries to be visited
and contribute greatly to American-Asiatic med-
ical rapprochement.
The government has given its wholehearted
support to the plan of stimulating and facilitating
a continuing exchange of information and tech-
nics, treatments and devices for the care of the ill
and the blind. The reception of a group of physi-
cians from the West throughout Asia will certain-
ly be most cordial and will assure the success of
this enterprise. The ophthalmolgic and medical
material in all the countries is extremely interest-
ing and should be of great value to members of
the tour.
The Asia-Pacific Academy of Ophthalmology
was organized in 1957. Its principal purposes are
to extend ophthalmologic knowledge and to ad-
vance the arts and sciences of ophthalmology and
related sciences in Asia and in countries border-
ing the Pacific Ocean; ... to stimulate research
in tropical and systemic eye diseases that are
particularly prevalent in Asia and in countries
bordering the Pacific Ocean; to cultivate social
and fraternal relationship of physicians residing in
Asia; ... to offer postgraduate instruction in
ophthalmology through the medium of lectures,
round-table discussions, seminars, clinics, films
and other means.
Physicians other than ophthalmologists and
their families are also welcome to join this trip.
Those desiring to participate in the postgraduate
lectures and seminars on medical subjects per-
tinent to ophthalmology should contact William
John Holmes, M.D., Liason Secretary, Suite 280,
Alexander Young Building, Honolulu 13, Hawaii.
Inquiries regarding travel arrangements should be
sent to Compass Travel Bureau, 55 W. 42nd
Street, New York 36, New Youk.
Sears-Roebuck Foundation Plan
For Community Medical Assistance
The Sears-Roebuck Foundation, organized and
endowed by Sears, Roebuck and Co. to aid in the
economic and social improvement of the Ameri-
can community, works in cooperation with estab-
lished agencies. Its widely varied projects include
programs developed for charitable, scientific and
educational purposes. Its Community Medical
Assistance Plan, developed with the cooperation
of the American Medical Association, represents
a recent extension of the work of this nonprofit
corporation. This new project designed to assist
communities in providing medical facilities is
directed toward communities that have no physi-
cian and would like to build a facility in order to
attract a doctor.
Competent and convenient medical care is the
best insurance a community can carry. It demands
the services of a well trained physician, the sup-
port and cooperation of the community, and mod-
ern medical equipment and facilities. Many small
communities today are handicapped when com-
peting with cities for the services of doctors and
lack the necessary knowledge of how to obtain
these services. In their efforts to improve the
health of the area they may now turn to the Com-
munity Medical Assistance Plan for aid. This
educational activity is aimed entirely at providing
to the community educational services that will
furnish the “know how” and coordinate the ef-
forts of a community in its attempt to attract a
doctor. These educational services are prepared to:
1. Assist in a survey of the community to
ascertain its ability to support a doctor.
2. Provide the services of a professional eco-
nomic consultant to aid the community in
both organizational and fund-raising activi-
ties.
3. Provide architectural services in the form
of blueprints and specifications for a med-
1360
EDITORIALS AND COMMENTARIES
Volume XLIV
Number 12
ical center or advise on remodeling an ex-
isting structure.
4. Utilize the. experience and efforts of the
American Medical Association, the Medical
Advisory Board of the Foundation, and the
state medical society in obtaining the doc-
tor.
The preliminary survey provides a factual
evaluation of the medical needs of the area. If the
survey is favorable, community organization be-
gins with the selection of a committee of leading
citizens to initiate the activity and raise the nec-
essary funds. When the funds have been raised, a
permanent nonprofit corporation can be establish-
ed.
Most rural communities have no hospital and
probably could not support one. The up-to-date
medical facilities required by modern medicine are
therefore all the more important in rural areas. It
is essential that facilities there include provisions
for emergency surgery and one or two recovery
beds. The Foundation retains a professional archi-
tect who specializes in medical architecture. Flans
are now available for a one or two doctor unit
that is adaptable to local building materials, is
modern in design and contains many built-in fea-
tures. Complete blueprints and specifications will
be given the communities selected. In the event
an existing structure could be remodeled and still
provide attractive and efficient medical facilities,
advice will be given.
The community that provides modern medical
facilities increases its competitive position in ob-
taining a physician. The Foundation has a close
working relationship with the American Medical
Association and the state medical societies. A 1 7
member Medical Advisory Board has been ap-
pointed by the Trustees of the American Medical
Association to advise and cooperate with the
Foundation in this medical program. The efforts
of all can be combined to encourage competent
young physicians to practice in areas participating
in the plan.
Persons or groups in Florida who believe that
their community could qualify for this self-help
program for which the Foundation offers to as-
sist with specialized services may obtain applica-
tion blanks from the Florida Medical Association
Physicians Placement Service, Box 2411, Jack-
sonville 3, Fla. After the blanks have been com-
pleted, they are sent to the Sears Roebuck Foun-
dation, 675 Ponce de Leon Ave., Atlanta, Ga.
Statewide Medico-Legal Institute
Well Attended
The third Statewide Medico-Legal Institute,
sponsored jointly by the Florida Medical Associa-
tion and the Florida Bar, was held in Tampa on
April 11 and 12, 1958. The registration, which
totaled 143 persons, included 117 attorneys and
26 physicians.
Presiding officers for the three sessions were
the Hon. Baya M. Harrison Jr. of St. Petersburg,
President of the Florida Bar, Judge William P.
Allen of the Florida Second District Court of
Appeal and Florida Supreme Court Justice
Stephen C. O’Connell.
Dr. John E. Gottsch of Tampa and the Hon.
Jack F. Wayman of Jacksonville presented the
first topic, “Whiplash.” The subject of doctors’
professional liability was discussed by the Hon. J.
Lance Lazonby of Gainesville and the Hon. Wil-
liam A. Gillen of Tampa.
The second session opened with a discussion
of “The Doctor’s Day in Court” by a panel
which consisted of Dr. Ben J. Sheppard of Miami,
Dr. Herschel G. Cole of Tampa, the Hon. Wil-
liam M. Berson of Orlando, and the Hon. Ed-
ward B. Rood of Tampa. The topic “Post Concus-
sion Syndrome” was discussed by Dr. W. Tracy
Haverfield and the Hon. Earl Faircloth. both of
Miami. The final subject of the day, “Relation-
ship of Trauma and Strain on the Cardiovascular
System,” was presented by Dr. Herbert Eichert
and the Hon. Kenneth B. Sherouse Jr., both of
Miami.
The Saturday morning session opened with
a discussion of “Back Injury — Its Cause and
Sequelae,” presented by Dr. Frank H. Lindeman
Jr. and the Hon. T. Paine Kelly Jr., both of
Tampa. The final subject, “Disability Evalua-
tion.” was discussed by Dr. Earl D. McBride of
Oklahoma City, the Hon. C. C. Howell Jr. of
Jacksonville and the Hon. C. J. Hardee Jr. of
Tampa.
In charge of arrangements for the meeting
were Dr. Sheppard, who is chairman of the Flor-
ida Bar’s Committee on Medicolegal Law and
Procedures, and Dr. Haverfield, who is the mem-
ber of the Florida Medical Association’s Public
Relations Advisory Committee responsible for
liaison with the legal group. Concluding the Fri-
day portion of the program was a social hour and
dinner. All sessions were held in the Hillsboro
Hotel. Previous Institutes were held during 1957
in Miami and Jacksonville.
J. Florida M.A.
June, 1958
EDITORIALS AND COMMENTARIES
1361
1958 State Science Fair
“Along with other members of the Committee,
I was amazed at the high caliber of the exhibits
which we judged. It was very difficult to select
the winners because they all showed evidence of
hard work, intelligence and superior ability. We
would do well to encourage these youngsters to
become members of our profession.”
These are the words of one of the physicians
who served as a judge for the Association’s second
annual awards for medical aptitude in the 1958
State Science Fair, held April 10-12 in St. Peters-
burg at the St. Petersburg Junior College. They
typify the reaction of each of the physicians who
took part in the judging.
The Florida Medical Association Awards were
established in 1957 to recognize the scientific
achievements of junior and senior high school
students and to encourage promising students to
enter various fields of medical science. The
awards were presented for the first time in April
1957 at the State Science Fair held at the Uni-
versity of Florida in Gainesville.
In addition to the two top awards of special
hand-lettered citations and $75 and $50 in cash
for the Science Fair’s senior and junior divisions,
respectively, the 1958 awards were enhanced by
four honorable mention awards presented by the
Woman’s Auxiliary to the Association. These
awards consisted of hand-lettered citations and
$25 each in cash.
A total of 42 of the Science Fair’s approxi-
mately 200 exhibits were judged for medical
aptitude by the Association’s committee. Each
student whose exhibit was judged, whether or not
he won an award, received an attractive certificate
of recognition from the Association.
The citations which accompanied the two top
awards were issued “In commendation of an Ex-
emplary and Original Exhibit in the Field of the
Basic Medical Sciences and Health Displayed at
the 1958 State Science Fair, Saint Petersburg,
Florida.” They were signed by the President and
Secretary-Treasurer and impressed with the Seal
of the Association.
At the awards ceremony on April 12, the
Association’s senior award went to Bill Nelson of
Melbourne High School, Melbourne, for his exhibit
entitled “Injecting Genetic Material Into New-
born Mice.” Manuel L. Cepeda of Ocala Junior
High School, Ocala, won the junior award for his
exhibit entitled “Experiment with Vitamin De-
ficiency.” The awards were presented on behalf
Dr. Francis H. Langley, of St. Petersburg, Past President of the Florida Medical Association, congratulates
Manuel L. Cepeda (left) of Ocala Junior High School and Bill Nelson of Melbourne High School, junior and
senior winners of the Florida Medical Association Awards in the 1958 State Science Fair.
1362
EDITORIALS AND COMMENTARIES
Volume XI.IV
N UM BKH 12
of the Association by Immediate Past President
Francis H. Langley of St. Petersburg.
The honorable mention awards were presented
on behalf of the Woman’s Auxiliary to the Asso-
ciation by Mrs. John P. Ferrell of St. Petersburg,
a member of the Board of Directors of the Aux-
iliary. The winners of these awards in the senior
division and the titles of their exhibits were:
Suzanne Brown, Melbourne High School, Mel-
bourne, “Antigenic Reactions of the Salivary
Gland in Immunity to the Mosquito Bite;'' James
E. Kutz III. Archbishop Curley High School.
Miami, “Glands;” and Frances Kay Woodcock,
Melbourne High School, Melbourne, “Hypothal-
amic Lesions and their Effects on Body Temper-
ature.” In the junior division, Barbara Smith
of John Gorrie Junior High School, Jacksonville,
received an honorable mention award for her ex-
hibit entitled "Medicines Derived from Plants
and Animals.”
The Association’s special judging committee
was composed of Dr. John P. Ferrell, Chairman.
Dr. Douglas W. Hood, Dr. Donald E. McClana-
than. Dr. Frank L. Price and Dr. John P. Roweli.
all of St. Petersburg.
Sarasota County Medical Society
Employs Executive Secretary
Mrs. Blantk
As reported in the April Journal, four com-
ponent county medical societies of the Florida
Medical Association had a lay executive secretary
early this year. Last month another county-
society was added to the list, and this month a
sixth society reports following the popular trend.
These organizations are the Dade, Duval, Orange,
Pinellas, more recently Broward, and now Sara-
sota County societies.
Mrs. Eleanor R. Blanck has recently been em-
ployed by the Sarasota County Medical Society
as Executive Secretary. A native of Montgomery
County, Maryland. Mrs. Blanck attended George
Washington University, where she was awarded
the Bachelor of Arts degree. For several years,
she was on the editorial staff of the American
Council on Education in Washington. I). C. Prior
to filling that post, she attended the conference
of the Food and Agriculture Organization of the
LTnited Nations at Quebec, Canada, as a part of
the Chinese Delegation, and also attended the
next conference at Copenhagen, Denmark, as a
member of the staff of the Food and Agriculture
Organization.
Airs. Blanck has one son. Bobby, aged seven.
She resides in Sarasota.
Southern Postgraduate Seminar
Saluda, N. C., July 7-26
The Southern Postgraduate Seminar, formerly
the Southern Pediatric Seminar, will hold its thir-
ty-eighth annual session at Saluda, N. C., in July.
The program for the first week, July 7 through
12, includes lectures on both Pediatrics and Inter-
nal Medicine. The second week. July 14 through
19. is devoted to a series of lectures on Pediatrics,
and the program for the third week. July 21
through July 26, covers Obstetrics and Gynecol-
ogy. The course is a postgraduate seminar pre-
senting the newest methods of diagnosis, preven-
tion. and treatment in these three fields with em-
phasis on the solution of ordinary daily problems
in the most modern, scientific and satisfactory-
way. It is designed to fit the needs of the general
practitioner, and credit for attendance is accepted,
hour for hour. Category 1, 35 hours per week, by
the American Academy of General Practice.
The lecturers are among the finest medical
authorities in the South. The faculty, a happily
balanced combination of professors and practition-
ers, volunteer their services to create a unique
teaching center where the most advanced infor-
mation is presented. Most universities in the
South are represented on the faculty, and special
guest lecturers join the teaching staff to add
freshness and divergent points of view. Florida
faculty members include Dr. Warren W. Quillian,
of Coral Gables, Dean. Dr. J. Champneys Taylor,
of Jacksonville, Dean of Obstetrics. Dr. Robert
B. Lawson, of Miami, and Dr. Hugh A. Carithers,
of Jacksonville.
J. Florida M.A.
June, 1958
OTHERS ARE SAYING
1363
Southern Railway Surgeons
Annual Meeting Held
On April 14 and 15, the Association of Sur-
geons of the Southern Railway System held its
Fifty-Seventh Annual Meeting in the George
Washington Hotel in Jacksonville with 130 doctors
attending. These doctors were from all of the
Southern States east of the Mississippi River,
and from a few of the border states.
Following two days of scientific sessions at
the hotel and at the Duval Medical Center, the
meeting ended with election of officers for the
coming year. Dr. Battle Malone, Memphis, Tenn„
succeeds Dr. Cecil E. Newell of Chattanooga, re-
tiring president. Other officers named are Dr.
Sam Orr Black Jr., Spartanburg, S. C., first vice
president; Dr. Max Rogers, High Point, N. C.,
second vice president; Dr. Walter R. Brewster,
New Orleans, La., third vice president; Dr. Ken-
neth Morris, Jacksonville, fourth vice president;
Dr. J. Marsh Frere Sr., Chattanooga, Tenn., re-
cording secretary; and William J. Ashton, Wash-
ington, D. C., secretary-treasurer.
OTHERS ARE SAVING
Will Tragedy Strike?
Every day a dangerous product is being used
and sold in our midst with relatively few safe-
guards. I refer to the insecticides of the Phos-
phate group and one of this group is known to
you as Parathion. There are others of this group
with newer ones being developed.
When these poisons were first introduced they
were mainly used by the large commercial citrus
growers who have learned by hard experience to
practice safeguards in their use. They are careful
to require protective clothing, frequent blood
counts, and then limited exposure for those
engaged in the actual spraying operation. Even
with these protective measures some serious ill-
nesses still occur.
Parathion can be purchased by any individual
at a garden store. However, some stores try to
persuade you not to use the product unless you
are thoroughly familiar with it and warn you of
its danger. There are many commercial sprayers
who use this product daily throughout all resi-
dential areas of this city. They will suddenly
arrive at a home requiring spraying and turn on
a high pressure spray that pours out a heavy
fog of this lethal agent. I have personally seen
them turn the sprays up into the trees when high
winds were blowing and this causes the spray
to drift over to adjacent homes. Apparently little
attempt is made to warn the adjacent homes that
spraying is being done and that they should close
their windows and protect their children and ani-
mals until the spraying is completed.
To carry out commercial spraying, individuals
must have a landscaper’s license and they are
supposed to exercise precaution in the use of
Parathion. Apparently those engaged in spraying
are not impressed with the dangers of this agent
and seem to require no protective clothing, give
no warning to adjacent homes that spraying is
being carried out, and I am sure do not require
blood counts and limited exposure for those ac-
tually engaged in spraying. Recently, when a
controversy locally arose regarding the use of
Parathion, one commercial sprayer was so little
impressed with the dangers of this agent that
he stated that it was a little more than a good
“laxative.”
Inhalation alone is not considered important
as a cause of serious poisoning but I wonder if
this applies to the many persons in our commu-
nity with chronic pulmonary and cardiac disease.
I know of several cases of acute asthma occurring
from casual contact with the spray. I know of
another case where an individual developed severe
swelling about the eyes from contact with bed
clothing that had been contaminated by spraying
next door. When the person involved asked to
be given warning so that they could close the
windows to their house when spraying occurred
next door, the man in charge of the spraying
laughed and continued to use the spray in a very
careless manner.
These Phosphate poisons are very toxic agents
and I personally feel that they should not be used
in residential areas but should be confined to
farming and citrus operations where those using
these agents have a healthy respect for the dan-
gers involved. I am sure that those individuals
over the state who have become poisoned and
those doctors who have had to treat poisoning
cases feel that Parathion is much more than a
“good laxative” and anyone who handles this
product, and considers it in this light, has little
concept of the danger involved.
Richard L. Foster, M.D.
The Record, Broward Comity
Medical Association
November, 1957.
1364
Volume XLIV
Number 12
Organic Phosphate Poisoning
The purpose of this presentation is to call your
attention to the dreadful consequences of un-
treated insecticide organic phosphate poisoning,
and to indicate a dermatological sign that may
be helpful in suspecting the disease at a stage be-
fore serious consequences may result. All too late,
we are seeing more and more patients with signs
of cardiac arrest, acute abdomen paralysis, con-
vulsions, or coma. Such acutely ill patients may
die, often within the hour, and occasionally within
ten minutes of the onset of symptoms. To the
doctor “on guard,” such a patient is treated
easily, recovers promptly, and with no after ef-
fects. Most certainly, then, it becomes necessary
for the welfare of our community that we dis-
seminate full and complete information to all phy-
sicians and especially to the emergency room doc-
tors of hospitals.
The organic phosphates responsible for hu-
man poisoning are listed below with their common
trade names and chemical structure.
1. Parathion — diethyl-p-nitrophenol thiophos-
phate.
2. Systox — diethoxythiophosphoric ester of 2
ethyl mercaptoethynol.
3. TEPP — tetraethyl pyrophosphate.
4. HETP — hexethyl tetraphosphate.
5. EPN — ethyl-p-nitrophenol-thionobenzene-
phosphate.
6. OMPA — octamethylpyrorophosphoramide.
7. Malathion — dimethyl S-phosphorodithion-
ate.
8. Diazinone-diethyl-O-thiophosphate.
Most reported fatalities have been from the
more commonly used preparations, Parathion and
Systox. Diazinone is now on the market and
preliminary studies indicate that it is so readily-
absorbed through skin as to be more toxic to hu-
mans than its sister preparations. Malathion ex-
hibits low toxicity as compared to the others.
MICROSCOPE REPAIR
SERVICE
Microscopes, pHmeters, balances,
colorimeters, microtomes, etc.
Factory authorized repairs for
B.&L., A.O., Zeiss, Becker, etc.
PRECISION INSTRUMENTS
30 KINGS COURT, SARASOTA, FLA.
Phone: RIngling 7-2687
Write for shipping instructions
and containers.
In general, the formulation consists of 3%
sprays and 4% dusts. Aerosols are concentrated
to 10%, especially as the Parathion preparation,
when used in nurseries and greenhouses. Exposure
concerns persons engaged in synthesizing, formu-
lating. packaging, applying it, or working among
residues. Even occasional exposure may predis-
pose to poisoning. Children exposed to “empty”
containers, or open ones, have been a major source
of chemical poisoning. The organic phosphates
are readily absorbed through the skin. Inhalation
alone, is not considered important as a cause of
serious poisoning because these compounds have
a very- low vapor pressure. Ingestion, of course,
may be fatal rather promptly. The mode of action
of these poisons involves inhibition of choline-
sterase enzymes of the blood and tissues result-
ing in release and accumulation of excessive
amounts of acetylcholine. Therefore, the result-
ing signs and symptoms are those of marked
parasympathetic stimulation. The symptoms in-
clude: headache, weakness, nausea, cramps, gid-
diness, blurred vision, diarrhea, chest discomfort
and nervousness. Signs include: sweating, miosis,
or paradoxical mydriasis, salivation, tearing,
cyanosis, pulmonary edema, muscle twitches, con-
vulsions, coma, areflexia, and loss of sphincteric
control. All these changes are reversible with ade-
quate and prompt therapy. The essential labor-
atory finding for diagnosis is the reduction of the
cholinesterase level of blood or serum. The differ-
ential diagnosis runs the gamut of cardiac as well
as acute abdominal diseases. Poisonings have
been confused with heat stroke, heat exhaustion,
gastroenteritis and pneumonia. Mild poisoning
must be differentiated from asthma and simple
fright. In every case, there is need for a careful
history of exposure and a comprehensive analysis
of clinical observations. Recently, a 26-year-old
fireman was seen complaining of periodic, profuse
sweating and roughness of the skin, of three weeks
duration. He had been engaged in crop dusting
for the past three months. The chemical used was
Parathion. Two of his associates had developed
nausea and weakness at about the same time.
Examination revealed cutis anserina (gooseflesh)
of the arms and back manifested by closely set
papules surmounted by tiny hairs. Patchy areas
of hyperhidrosis were noted on the extensor arms
and back. Pupils dilated. The impression diag-
nostically, was that of Parathion poisoning. The
patient recovered when removed from contact
with the chemical. It is not known whether the
J. Florida M.A.
June, 1958
1365
the clinical results are positive when
®
restores positive nitrogen balance
The anabolic effects of Nilevar are quickly manifest both to the patient
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When loss of nitrogen delays postsurgical recovery or stalls
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Nilevar has been found to effect these responses:
• Appetite improves • The patient feels better
• Weight increases • The patient recovers faster
Similarly Nilevar helps correct the “protein catabolic state” associated
with prolonged bed rest in carcinomatosis, tuberculosis, anorexia nervosa
and other chronic wasting diseases.
Nilevar is unique among anabolic steroids in that
androgenic side action is minimal or absent in appropriate dosage.
Nilevar (brand of norethandrolone) is supplied as tablets of 10 mg. and
ampuls (1 cc.) of 25 mg. The dosage of both forms is from 10 to 50 mg. daily.
s
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A Decision of Physicians
When it comes to prescribing
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Achromycin V.
The reason for this decided preference
is simple.
For more than four years now, you and
your colleagues have had many
opportunities to observe and confirm
the clinical efficacy of Achromycin
tetracycline and, more recently,
Achromycin V tetracycline and
citric acid.
In patient after patient, in diseases
caused by many invading organisms,
Achromycin achieves prompt control
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significant side effects.
The next time your diagnosis calls for
rapid antibiotic action, rely on
Achromycin V— the choice of
physicians in every field and specialty.
1368
Volume XLI V
Number 12
foregoing case represents a pathognomonic feature
of this disease. However, it is presented with the
view in mind that it might be helpful in arriving
at a very early conclusion before continued ex-
posure to organic phosphates may lead to serious
poisoning.
In the more usual case, where the patient is
obviously ill, therapy should be instituted at once.
One to two mgm (1/60 to 1/30 grains) of atro-
pine sulfate, every hour, is given intravenously up
to 20 mgm per day. Although these doses appear
excessive, people poisoned by organic phosphates
have been noted to have increased tolerance for
atropine. The effects of intravenous atropine
begin in one to four minutes and are maximal in
eight minutes. Atropinization, to a lesser degree,
should be maintained in all cases for twenty-four
hours, and in severe cases, forty-eight hours.
Never give morphine, theophylene, thco phylline-
ethylenediamine or intravenous fluids. Do not
give atropine to a cyanotic patient. First, give
artificial respiration, then atropine. To relieve
pulmonary congestion, postural drainage and suc-
tion may be used. When signs and symptoms have
been allayed, the patient must be quickly de-con-
taminated. Wear rubber gloves to remove the
patient’s clothing. Bathe him with soap and wa-
ter using baking soda because organic phosphorus
compounds are hydrolized more rapidly in the
presence of alkalies. If ingestion of the poison is
suspected, induce vomiting and give milk or wa-
ter. Atropine does not protect against muscular
weakness. The mechanism of death is respiratory
failure. Therefore, the use of positive pressure
oxygen should be started early. This acute emer-
gency lasts twenty-four to forty-eight hours, and
the patient must be watched continuously. In
very severe cases, one must give artificial respira-
tion at once, followed by atropine, 2 mgm intra-
venously, as soon as cyanosis is overcome. This
dose is repeated at five to ten minute intervals
until signs of atropinization appear. These are
recognized by the dry, blushed skin and a tachy-
cardia near 140 per minute. The skin is then
decontaminated or the stomach is emptied, if
ingestion has occurred. Symptomatic treatment
should follow. It should be noted that quantities
of atropine, greater than 3 mgm, given within
the first five hours, are likely to revive persons
severely poisoned with Parathion.
Recently toxicity classes were established for
the various insecticide poisons. Classes 5 and 6,
HYPERTENSION?
PEC
P. O. Box 282
We specialize exclusively in
a complete line of RICE DIET
baked products for those on
salt and fat restricted diets.
All of our products are
Laboratory analyzed.
K'S
Durham, N. C.
LITERATURE AND PRICE LIST
AVAILABLE UPON REQUEST
{. Florida M.A.
une, 1958
1369
^Theominal' R.S.
(Theominal with Rauwolfia serpentina)
£
i\st
meets
WEST
ESSENTIAL HYPERTENSION
RAUWOLFIA SERPENTINA — used medicinally for centuries in India and Malaya
-
+ THEOMINAL — prescribed by American physicians for several decades.
= THEOMINAL R. S .! Each tablet contains 320 mg. theobromine, 10 mg. Luminal ,®
1.5 mg. purified Rauwolfia serpentina alkaloids (alseroxylon).
ADVANTAGES:
1. Gradual but sustained reduction of blood pressure
2. Diminution of emotional tension, anxiety and insomnia
3. Alleviation of congestive Headache, vertigo, dyspnea
4. Improvement in orientation and social behavior in the aged
Dose: 1 tablet two or three times daily.
Supplied: Bottles of 100 and 500 tablets.
LABORATORIES
NEW YORK 1». N. Y.
Theominal and Luminal (brand of phenobarbital), trademarks reg. U. S. Pat. Off.
1370
Volume X LI V
Number 12
SUITE AVAILABLE
St. Nicholas Medical Center
3127 Atlantic Blvd.
Jacksonville, Fla.
700 square feet of floor space, conveniently
located to all Jacksonville by public and private
transportation.
Pediatrician, otorhinolaryngologist and ophthal-
mologist needed. Other specialties would be desir-
able.
Balanced clinic.
Air conditioned; all utilities furnished except
telephone.
lanitor and maid service.
W. G. ALLEN JR., Manager
Colonial Properties, Inc.
3116 Atlantic Boulevard
Telephone EX 8-5500
Jacksonville
labeled as extremely toxic and super-toxic, have
been assigned to the organic phosphates. Appar-
ently, organic phosphorous derivatives are poisons
of the first magnitude and must be treated with
caution by all who are exposed to them.
In view of the foregoing, and the increasing
number of fatalities reported about the nation,
it may well be that medical societies, individually
or collectively, may express interest in seeking
legislation for the control of these highly danger-
ous poisons to which human beings, innocently
and even unknowingly, are being exposed to
daily.
Tobias R. Funt, M.D.
The Record, Broward County
Medical Association
November, 1957.
American Medical Association
Annual Meeting'
The 107th Annual Meeting of the American
Medical Association opens June 23 in San Fran-
cisco and continues through June 27. The Shera-
ton-Palace Hotel will be headquarters for the
sessions of the House of Delegates.
150,000
Physicians
use
the
Time saving, easy-to-use.
Invaluable for desiccation,
fulguration or bi-active coagulation.
Unrivalled for removal of surface
and other growths with
excellent cosmetic results.
BIRTCHER
FREE 32-PAGE BOOKLET SYMPOSIUM
ON ELECTRO-DESICCATION AND BI-
/ ctive COAGULATION and full color
booklet with color progress pho-
tographs of technics and results
sent on request without obligation.
HYFRECATOR
A HYFRECATOR in every office • Many physicians now have
hyfrecators in every examining and treatment room to save time
and inconvenience for their patients. This time-proven method for the
removal of moles, warts and other growths is used so frequently in the
average practice, it’s impractical not to have several hyfrecators!
Dermatology • General Practice
Gynecology • Urology • Proctology
Ophthalmology • E.E.N.T.
Physicians in virtually every
field, find the hyfrecator
an invaluable instrument.
THE BIRTCHER CORPORATION
Dept. FM 658
4371 Valley Blvd.. Los Angeles 32, Calif.
Send me the 2 booklets on HYFRECATION
Dr
Address
City Zone State
THE
BIRTCHER
CORPORATION
J. Florida M.A.
June, 1958
1371
’T’hese Visettc owners are
increasingly making1 the
’cardiogram a part of many
examinations in patients’ homes,
at hospitals, plant clinics —
wherever the need is indicated.
Its 18 pound weight and “brief-
case” size allow the Visette to
go along on these calls as readily
as an instrument bag. Tests are
made quickly and easily because
of such typical Visette features
as all accessories right at hand
in the cover compartments . . .
automatic grounding by push-
button control . . . lead selection
by simply turning a knob, with
automatic stylus stabilization
between leads . . . “double-
check” standardization signals
. . . instantly visible, inkless
record made by a heated stylus
. . . convenient “writing table”
surface for making test notations
on the record. And Visette per-
formance stays accurate and
reliable, as a result of rugged
mechanical construction . . . the
use of modern electronic compo-
nents including transistors and
aircraft type ruggedized tubes
. . . and a smaller, more durable
recording assembly.
If, like this growing number
of your colleagues, you feel your
practice would benefit by such
convenient ’cardiography, ask
your local Sanborn Representa-
tive for complete information
and a Visette demonstration. Or
for descriptive literature, write
Sanborn Company, attention
Inquiry Director.
Sanborn Model 300 Visette electro-
cardiograph $625 delivered, con-
tinental U.S.A.
fjfubt ette yeal afYel inticfluctioti . . .
than 2000 doctors already know
the convenience and value of "VISETTE” 'cardiography
Model 51 V iso-Car dielte, “ office standard " in thousands of
practices , remains available at $ 785 delivered , continental U.S.A
SANBORN
COM PA N Y
MEDICAL DIVISION
175 WYMAN STREET,
WALTHAM 54, MASS.
Miami Branch Office 1545 S. W. 8th St.. Franklin 3-549 3 Sc 3-5494
St. Petersburg Branch Office
1221 Arlington Ave. N., St. Petersburg 7-3229
1372
Volume XLIV
Number 12
STATE NEWS ITEMS
The American College of Gastroenterology has
announced that its annual course in postgraduate
gastroenterology will be held at the Jung Hotel
in New Orleans October 23-25. The course will
be under the direction of Dr. Owen H. Wangen-
steen, Professor of Surgery at the University of
Minnesota Medical School, and Dr. I. Snapper,
Director of Medical Education, Beth-El Hospital,
Brooklyn, N. Y. They will be assisted by a facul-
ty selected from the medical schools in and around
New Orleans. Information may be obtained from
the American College of Gastroenterology, 33
West 60th Street, New York 23, N. Y.
The American Physicians Fellowship for the
Israel Medical Association is sponsoring a tour
to Israel for the 4th World Medical Assembly of
the Israel Medical Association. The Assembly is
being held in Tel Aviv, Haifa, Jerusalem. August
12-24. Tour group will depart from New York
on August 9 and will leave Israel on August 24.
Details may be obtained from American Physi-
cians Fellowship, 1330 Beacon Street. Brookline
46, Mass.
Drs. Maurice Kovnat of Lantana, and Louis
G. Lytton of Miami Beach are members of the
Executive Committee of the American organiza-
tion.
The Seventh Annual Symposium for General
Practitioners on Tuberculosis and Other Chronic
Pulmonary' Diseases is being held in Saranac
Lake, New York, July 7-11. Dr. Henry W.
Leetch, P. O. Box 627, Saranac Lake, N. Y., is
general chairman.
The Second Oklahoma Colloquy on Advances
in Medicine has been scheduled for November
12-15 at the University of Oklahoma School of
Medicine, Oklahoma City. It will be devoted to
arthritis and related disorders and is under the
joint sponsorship of the Department of Medicine,
University of Oklahoma; the Division of Post-
graduate Education; Geigy Pharmaceuticals;
Wyeth Laboratories; the Upjohn Co.; Pfizer
Laboratories, and the Schering Corp. Information
may be obtained by contacting the Division of
Postgraduate Education. University of Oklahoma
School of Medicine, Oklahoma City.
(Continued on page 1376)
Used Routinely . . . Safe . . . Effective
CALPHOSAN
the painless intramuscular calcium
is the preferred vehicle
of choice because of its ease of administration and its
lasting effect. Complete literature on request.
Formula: A specially processed solution of Calcium Glycero-
phosphate and Calcium Lactate containing 1% of the ester and
salt in normal saline with 0.25% phenol. Patent No. 2657172.
Distributor in Florida:
L. C. Grate Biologicals
P. O. Box 341 Riverside Station
Miami, Florida HI 8-4750
THE CARLTON CORPORATION
45 East 17th St., New York 3.
J. Florida M.A.
June, 1958
NOW... A NEW TREATMENT
'Cardilate' tablets . / shaped for easy retention
in the buccal pouch
. . the degree of increase in exercise tolerance which sublingual ery-
throl tetranitrate permits, approximates that of nitroglycerin, amyl
nitrite and octyl nitrite more closely than does any other of the approxi-
mately 100 preparations tested to date in this laboratory."
"Furthermore, the duration of this beneficial action is prolonged suffi-
ciently to make this method of treatment of practical clinical value.”
Riseman, J. E. F., Altman, G. E., and Koretsky, S.:
Nitroglycerin and Other Nitrites in the Treatment of
Angina Pectoris. Circulation (Jan.) 1958.
♦‘Cardilate’ brand Erythrol Tetranitrate SUBUNGUAL TABLETS, 15 mg. scored
1373
BURROUGHS WELLCOME & CO. (U.S.A.) INC.. Tuckahoe. New York
1374
Volume XI, IV
Number 12
FIRST— clinically confirmed for better management
of psychotic patients
NOW— clinically confirmed as an improved
antiemetic agent
PROMPT, POTENT and LONG-LASTING ANTIEMETIC ACTIVITY
Clinical investigators * report that in clinical studies
Post-
operatively
After
Nitrogen
Mustard
.Therapy
In Chronic
Nausea and
Vomiting
In Infections.
Intra-abdominal
Disease, and
Carcinomatosis
In
Neurosurgical
Diagnostic
Procedures
In
Pregnancy
When Vomiting
Is Persistent
VESPRIN
■ showed potent antiemetic action
■ completely relieved nausea and vomiting in small
intravenous doses
■ showed a prolonged antiemetic effect
■ caused little or no pain at injection site
■ controlled chronic nausea and vomiting in
orally administered doses
■ produced relief in certain cases refractory to other antiemetics
■ often markedly depressed or abolished the gag reflex
■ effectively terminated the hard-to-control nausea and
vomiting common to nitrogen mustard therapy
■ provided prophylaxis against the nausea and
vomiting associated with pneumoencephalography
•Reports to the Squibb Institute for Medical Research
antiemetic dosage: Intravenous route — 8 mg. average single dose; dosage range 5 to 10 mg.
Intramuscular route — 15 mg. average single dose ; dosage range 5 to 15 mg.
Oral route — 10 to 20 mg. initially, subsequently 10 mg. t.i.d.
Squibb
supply : Parenteral Solution-1 cc. ampuls (20 mg./cc.)
Oral Tablets— 10 mg., 25 mg., 50 mg., in bottles of 50 and 500
Squibb Quality— the Priceless Ingredient
'VtSMIN- It* SQUIM T«*0tMA«C
J. Florida M.A.
June, 1958
1375
in each of these indications
for a tranquilizer. . .
SR is a cardiac patient. His doctor
put him on atarax because (+)
it is an anti-arrhythmic and non-
hypotensive tranquilizer.
Other tranquilizers added to PN’s
g. i. discomfort (he has ulcers).
But now his doctor has him on
atarax because (+)it lowers gas-
tric secretion while it tranquilizes.
Asthmatic JL used to have fre-
quent tantrums followed by acute
bronchospasm. Her family doctor
tranquilized her with atarax be-
cause (+) it is safe, even for chil-
dren.
Senile anxiety and persecution
complex dogged Mrs. K. until her
doctor prescribed atarax Syrup.
(+) It tastes good, and it’s a per-
fect vehicle for Mrs. K’s tonic.
Dosage: Children, 1-2 10 mg. tablets or
1-2 tsp. Syrup t.i.d. Adults, one 25 mg.
tablet or 1 tbsp. Syrup q.i.d.
Supplied ; 10, 25 and 100 mpr. tablets, bottles
of 100. Syrup, pint bottles. Parenteral Solu-
tion, 10 cc. multiple-dose vials.
1376
Volume XLIV
Number 12
(Continued from page 1372)
Dr. Jere W. Annis, of Lakeland, President
of the Florida Medical Association, was one of
the principal speakers on the program of the
First Annual Florida Conference for Veterin-
arians held May 17 at the University of Florida
in Gainesville. The Conference was sponsored by
the University and the Florida Veterinarian Medi-
cal Association. Dr. Annis discussed “Profession-
al Association Public Relations Program.”
The Sixth Congress of the Pan American Med-
ical Women’s Alliance was held at the McAllister
Hotel in Miami on April 13-17. Over half the
registrants were from various Latin American
countries. Dr. Tegualda Ponce, President, of
Valparaiso, Chile, presided and was succeeded in
office by Dr. Sarah D. Rosekrans of Neillsville,
Wis. The chairman of the local arrangements
committee was Dr. Alma Trappolini, and all of
the Miami women doctors acted as hostesses.
/*=*"
Dr. Samuel R. Warson of Sarasota discussed
“Community Responsibility” at the final meeting
of the season for the Mental Health Association
of Sarasota County held the middle of April at
Sarasota.
Dr. Cornelia Morse Carithers of Jacksonville
presented a paper in Miami on April 16 before
the Sixth Congress of the Pan American Medical
Women’s Alliance at the scientific session devoted
to Pediatrics. Her subject was “Children — Their
Pets and Diseases.”
The Greater Miami Pediatric Society held its
ninth annual seminar the middle of April in Jack-
son Memorial Hospital at Miami. Guest speakers
included Dr. Sydney S. Gellis, Professor of Ped-
iatrics, Boston University School of Medicine, and
Dr. Judson J. Van Wyk, Assistant Professor of
Pediatrics, University of North Carolina School
of Medicine.
Dr. Raymond J. Fitzpatrick of Gainesville was
principal speaker at a mid-April meeting of the
Rotary Club of that city.
Dr. Jean Jones Purdue of Miami served as
moderator of the scientific session on Internal
Medicine at the Sixth Congress of the Pan Amer-
ican Medical Women’s Alliance, held in Miami
April 13-17, and also presented a paper entitled
“The Stroke Patient, Diagnosis and Handling.”
Of course,
women like “Premarin”
Therapy for the menopause syndrome
should relieve not only the psychic
instability attendant the condition, but
the vasomotor instability of estrogen
decline as well. Though they would have
a hard time explaining it in such medi-
cal terms, this is the reason women
like “Premarin.”
Doctors, too, like “Premarin,” because
it really relieves the symptoms of the
menopause. It doesn’t just mask them —
it replaces what the patient lacks -
natural estrogen.
“PREMARIN;’
conjugated estrogens (equine)
Ayerst Laboratories
New York 16, New York • Montreal, Canada
5840
J. Florida M.A.
June, 1958
1377
The non-narcotic analgesic with the potency of codeine
DARVON (Dextro Propoxyphene
Hydrochloride, Lilly) is equally as
potent as codeine yet is much better
tolerated. Side-effects, such as nau-
sea or constipation, are minimal.
You will find 'Darvon’ helpful in
any condition associated with pain.
The usual adult dose is 32 mg.
every four hours or 65 mg. every
six hours as needed. Available in
32 and 65-mg. pulvules.
DARVON COMPOUND (Dextro
Propoxyphene and Acetylsalicylic
Acid Compound, Lilly) combines the
antipyretic and anti-inflammatory
benefits of 'A.S.A. Compound’* with
the analgesic properties of 'Darvon.’
Thus, it is useful in relieving pain as-
sociated with recurrent or chronic dis-
ease, such as neuralgia, neuritis, or
arthritis, as well as acute pain of trau-
matic origin. The usual aduU^dbs^ is 1
or 2 pulvules every sn^
Each Pulvule ‘Darvon Compound’ provides:
' Darvon ’ . . .
A cetophenetid in
' A.S.A.’ (Acetylsalicylic Acid, Lilly)'
Caffeine
•'A.S.A. Compound' (Acetylsalicylic Acid and Acetophenetidin Compound, Lilly)
• INDIANA
NDIANA, U. S. A.
ELI LILLY AND COMPANY
820320
1378
Volume XLIV
Number 12
Drs. Hugh E. Parsons, R. Renfro Duke and
Blackburn W. Lowry of Tampa attended the
clinical meeting of the Wilmer Residents Associa-
tion held early in April at the Wilmer Ophthalmo-
logical Institute of The Johns Hopkins Hospital
and University in Baltimore.
Drs. M. Jay Flipse and Earlsworth C. Brun-
ner of Miami have been presented 50 year medal-
lions by the Dade County Tuberculosis Associa-
tion for their service in combating tuberculosis.
Dr. Henry L. Harrell of Ocala, president of
the Florida Academy of General Practice, Dr.
Douglas W. Hood of St. Petersburg, and Dr.
George W. Karelas of Newberry were among the
group of Florida physicians attending the scien-
tific assembly of the American Academy of Gen-
eral Practice held at Dallas. Dr. Karelas is chair-
man of the Committee on Rural Health of the
American Academy.
Dr. Daniel M. Shapiro has been appointed
Associate Professor of Surgery at the University
of Miami School of Medicine. He was formerly
associated with the Columbia-Presbyterian Medi-
cal Center at New York.
Dr. Samuel E. Kaplan of Venice was guest
speaker at a recent meeting of the Venice Area
Business and Professional Women’s Club.
Dr. Mason Trupp of Tampa was one of the
principal speakers at the meeting of the Southern
Neurosurgical Society held at Jackson, Miss.
NEW MEMBERS
The following doctors have joined the State
Association through their respective county medi-
cal societies.
Brenner, Robert L. Jr., Fort Lauderdale
Cayia, Edward de R., Fort Lauderdale
Cornett, Eugene J.. Tampa
Douglas, William M., Tampa
Ersay, Emil F., Pompano Beach
Ewing. Channing L., Belleview
Goyings, Ezra Jr., Winter Park
Hahn. Theodore W.. Deerfield Beach
Hollander. Asher, Hollywood
Langley, Warren F.. Pompano Beach
Sheahan, Robert C., Fort Lauderdale
Squires. John B., Fort Lauderdale
L'pdike, Edwin H. II. Ocala
Woulfe, James C., Fort Lauderdale
and inflammation
withBUFFERIN0
IN ARTHRITIS
salicylate benefits with
minimal salicylate drawbacks
Rapid and prolonged relief — with less intoler-
ance. The analgesic and specific anti-
inflammatory action of Bufferin helps re-
duce pain and joint edema— comfortably.
Bufferin caused no gastric distress in 70
per cent of hospitalized arthritics with
proved intolerance to aspirin. (Arthritics
are at least 3 to 10 times as intolerant to
straight aspirin as the general population.1)
No sodium accumulation. Because Bufferin is
sodium free, massive dosage for prolonged
periods will not cause sodium accumula-
tion or edema, even in cardiovascular cases.
Each sodium-free Bufferin tablet contains acetyl-
salicylic acid, 5 grains, and the antacids magnesium
carbonate and aluminum glycinate.
Reference: 1. J.A.M.A. 158:386 (June4) 1955.
ANOTHER FINE PRODUCT OF BRISTOL- MYER#
Bristol-Myers Company
19 West 50 St., New York 20, N. Y
virtually ALL
DIARRHEAS
ANTIBIOTIC • ADSORBENT • DEMULCENT • ANTI SPASMODIC
Diarrheas due to neomycin-susceptible pathogens
are effectively treated by the highly efficient in-
testinal antibiotic in Donnagel with Neomycin,
whose other ingredients serve to control toxic, ir-
ritative and emotional causes. Result: Early re-
establishment of normal bowel function.
SUPPLY: Bottles of 6 fl. oz.
ALSO AVAILABLE: Donnagel, the original formula, for
use when the antibiotic component is not indicated..
Bottles of 6 fl. oz.
Each 30 cc. (1 fl. oz.) of the comprehensive formula
of DONNAGEL WITH NEOMYCIN contains:
Neomycin sulfate ...300 mg.
(Equal to neomycirr base, 210 mg.)
Kaolin (90 gr.) 6.0 Gm.
Pectin (2 gr.) .................142.8 mg.
Dihydroxyaluminum aminoacetate 0.25 Gm.
Hyoscyamine sulfate ........................0.1 037 mg.
Atropine sulfate 0.0194 mg.
Hyoscine hydrobromide 0.0065 mg.
Phenobarbital (Vi.gr.) ........16.2 mg.
. i i . j ; 1 1 i'j./ / JrpjJi Jj.
.i . .'jil. I; ..! .lit j
1 .7 J
J. Florida M.A.
June, 1958
1381
MEPROLONE is the only anti-
rheumatic-antiarthritic designed to
relieve simultaneously (a) muscle
spasm (b) joint-muscle inflammation
(c) physical distress ... and may
thereby help prevent deformity and
disability in more arthritic patients
to a greater degree than ever before.
SUPPLIED: Multiple Compressed
Tablets in bottles of 100, in three
formulas:
MEPROLONE-5— 5.0 mg. prednisolone,
400 mg. meprobamate and 200 mg.
dried aluminum hydroxide gel.
MEPR0L0NE-2— 2.0 mg. prednisolone,
200 mg. meprobamate and 200 mg.
dried aluminum hydroxide gel.
MEPR0L0NE-1 — supplies 1.0 mg.
prednisolone in the same formula as
MEPROLONE-2.
1 Comroe's Arthritis: Hollander, J. L., p. 149 (Fifth
Edition, Lea & Febiger, Philadelphia, Pa. 1953).
2. Merck Manual: Lyght, C. E., p. 1102 (Ninth
Edition, Merck & Co., Inc., Rahway, N. J. 1956).
THE FIRSTMEPRO BAMATE PREDNISO LONE THERAPY
meprobamate to relieve muscle spasm
prednisolone to suppress inflammation
relieves both
muscle spasm
and joint inflammation
MERCK SHARP & D0HME Philadelphia 1, Pa.
Division of MERCK & CO., Inc.
rheumatoid arthritis
involves both
joints and
muscles
only
1382
Volume XLIV
Number 12
COMPONENT SOCIETY NOTES
Collier
Dr. Paul Dudley White was principal speaker
and guest of honor at a special meeting of the
Collier County Medical Society held early in
March at the Naples Community Hospital. Dr.
White’s subject was “Recent Interests in the
Field of Cardiology.” Other guests at the meeting
included members of the Lee-Charlotte-Hendry
County Medical Society.
Duval
Mr. Nelson Young, of the Professional Man-
agement Corp., Detroit, was principal speaker at
the May meeting of the Duval County Medical
Society. Mr. Young discussed a number of sub-
jects including office overhead control, income tax
problems, associates and partnerships, invest-
ments and estate planning.
Lee-Charlotte-Hendry
Dr. Edward Hamblen, Professor of Endocrin-
ology at Duke University School of Medicine,
Durham, was guest speaker at the March meet-
ing of the Lee-Charlotte-Hendry County Medical
Society.
Dr. Jere W. Annis, of Lakeland, President-
Elect of the Florida Medical Association, was
principal speaker for the Society’s April meeting
held at Fort Myers. His subject was pancreatitis.
The Society has paid 100 per cent of its state
dues for 1958.
Leon-Gadsden-Liberty- Wakulla- Jefferson
Dr. Edward R. Woodward, of Gainesville,
Chairman of the Department of Surgery at the
College of Medicine, University of Florida, was
guest speaker at the regular meeting of the Leon-
Gadsden-Liberty-Wakulla-Jefferson County Med-
ical Society held the middle of April in the W. T.
Edwards Hospital at Tallahassee.
The Woman's Auxiliary to the Society met
concurrently and installed Mrs. George H. Massey,
of Quincy, as president.
Marion
Dr. Hugh B. Haston Jr., of Jacksonville, was
principal speaker on the program of the April
(Continued on page 1383)
Our Customer
Is the most important person
with whom we come in contact-
in person, by mail or by telephone.
Service Is Our Motto.
m
CALL THE MEDICAL SUPPLY MAN!
HOSPITAL, PHYSICIANS and LABORATORY SUPPLIES t EQUIPMENT
EDICAL SUPPLY COMPANY
JacksonviUe
420 W. Monroe St.
Telephone EL 4-6661
of JacksonviUe
Orlando
329 N. Orange Ave.
Telephone 5-3537
J. Florida M.A.
June, 195$
1383
meeting of the Marion County Medical Society
held at Ocala. The title of his address was “Gen-
eral Considerations of Fractures in Children.”
Pinellas
Dr. John E. Orebaugh, of St. Petersburg, was
principal scientific speaker on the program of the
May meeting of the Pinellas County Medical So-
ciety held in the Hurricane Restaurant, Pinell is
International Airport. His subject was “Advances
in Vascular Surgery.”
Polk
Dr. Morris Fishbein, of Chicago, medical
editor of Encyclopaedia Britannica, delivered an
address at the April Meeting of the Polk County
Medical Association held at Winter Haven. Dr.
Fishbein was formerly editor of The Journal of
the American Medical Association.
CLASSIFIED
Advertising rates for this column are $5.00 per
insertion for ads of 25 words or less. Add 20c for
each additional word.
BRAND NEW AIR CONDITIONED AND
HEATED MEDICAL BUILDING in fast growing
North Miami has three openings. Prefer Board-certi-
fied (or eligible) internist, ophthalmologist, otolaryn-
gologist, dermatologist, or laboratory to complement
present occupants: pediatrician, surgeon, orthopedist,
obstetrician. All independent. See it at 1S4S N.E.
123rd Street and phone PL 4-2744.
RADIOLOGIST: Aged 32. Finishing residency
June 30, 1958. Will take specialty board exam May
1958 for certification in Radiology, including isotopes.
Would like to become associated with established radi-
ologist in private practice. Florida licensed. Contact
C. R. Merrill Jr., M.D., 8956 Rutherford, Detroit 28,
Mich.
WANTED: General Practitioner with Florida lic-
ense to associate with 48 year old G. P. in S. E.
Florida city. No investment. Reply full details, mili-
tary service. Send photo. Write 69-267, P. O. Box
2411, Jacksonville, Fla.
OBSTETRICIAN-GYNECOLOGIST WANTED :
Florida group desires obstetrician-gynecologist Board
Certified or Board Eligible for permanent association.
Guaranteed salary and percentage with advancement
to full partnership. Will work with another Board
Certified obstetrician-gynecologist. Position open July
1 or before. Write 69-270, P. O. Box 2411, Jackson-
ville, Fla.
FOR SALE: X-Ray Tilt Table complete with
Buckey X-Ray tube and shock proof transformer.
A-l condition. 5 gallon developing tanks. Red light
viewing box. Complete laboratory $695.00. Send for
photograph. Write Frank Denniston, M.D., 915 N.
E. Second St., Fort Lauderdale, Fla.
INTERNIST: Age 31; with special pulmonary
training; Part I Boards completed. Three and one-
half years private practice. Florida license. Married;
four children. Desires association with group. Fall
of 1958. Write 69-271, P. O. Box 2411, Jacksonville,
Fla.
When he sees it engraved
on a Tablet of Quinidine Sulfate
he has the assurance that
the Quinidine Sulfate is produced
from Cinchona Bark, is alkaioidallv
standardized, and therefore of
unvarying activity and quality.
When the physician writes “DR”
(Davies, Rose) on his prescriptions
for Tablets Quinidine Sulfate, he is
assured that this “quality” tablet
is dispensed to his patient.
Rx Tablets Quinidine Sulfate Natural
0.2 Gram (or 3 grains)
Davies, Rose
Clinical samples sent to physicians on request
Davies, Rose &. Company, Limited
Boston 18, Mass.
Of special
significance
to the
physician
is the symbol
I
NEW published reports
of clinical studies show:
Decisive
skeletal muscle relaxation
with
f
® I i^bms
Methocarbamol Robins U.S. Pat. No. 2770649
“Excellent,”5 “marked,”1 “pronounced”2 or “Sig-
nificant”6 results in 75.3% of cases of acute skeletal
muscle spasm, and moderate results in 20.3% — or
an over-all beneficial response in 95.6%. Other
important advantages:
* Highly potent and long acting.2'3'4,6,7,8
* Relatively free of adverse side effects.1,2,3,6
* In ordinary dosage does not reduce normal
muscle strength or reflex activity.6
Summary of four published clinical s
ROBAXIN BENEFICIAL IN 95.6% OF Ci
r
PAT
STUDY V
Skeletal muscle spasm
secondary to acute trauma
STUDY 22
Herniated disc
Ligamentous strains
Torticollis
Whiplash injury
Contusions, fractures,
and muscle soreness due
to accidents
STUDY 3s
Herniated disc
Acute fibromyositis
Torticollis
STUDY 4 6
Pyramidal tract and
acute myalgic disorders
TOTALS
Comments on Robaxin by
ked
moderate
slight
none
TE SKELETAL MUSCLE SPASM1 2 5 6
l meed”
5 13
4 4
3
2 1
llent"
5 2 —
3 —
4 28 4 2
3%) (20.3%)
—
JOURNAL
A. Mrlro* Mo iU«l
I HE JOURNAL
Xmerirnm '4 »****■ intian
RESPONSE
leant"
THE
JOURN
Antrim*
M rdirml
1386
Volume XMV
Number 12
kcctcr "
Give Us Your Transportation Worries
OUR BENEFITS
TO YOU ARE
COMPLETE
RELEASE OF CAPITAL
New Automobiles
Any Make
No Worries Over
Taxes . . . Fees
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Repairs
License Fees
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Anti-Freeze
Battery Replacements
Tire Replacements
Inspection Registration
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If You Would Like to Have Our Doctor's Leasing Plan Explained to You In Detail,
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On You at Your Convenience.
Piedmont
Auto and Truck Rental, Inc.
P. O. BOX 427 212 MORGAN STREET
DURHAM, NORTH CAROLINA PHONE 2-8151
G. B. Griffith, President
J. Florida M.A.
June, 1958
O
anti-diaper ras
because
it is
DESmN
OINTMENT
desitin ointment is effectively1 impervious to urine,
excrement, perspiration and secretions — and so
it is effectively anti-irritant. One soothing,
protective, healing application acts for hours
in helping to prevent and clear up . . .
DIAPER RASH
irritation, chafing
excoriation
DESITIN ointment — rich in cod liver oil (with its un-
saturated fatty acids and natural vitamins A and D)
— is the most widely used ethical specialty for the
over-all care of the infant’s skin.
Tubes of 1 oz., 2 oz., 4 oz., and 1 lb. jars
May we send SAMPLES and literature?
DESITIN CHEMICAL COMPANY
812 Branch Ave., Providence 4, R. I.
1387
1388
Volume X LI V
Number 12
Brand
POLYMYXIN B-BACITRACIN OINTMENT
to Mm X&Majby
(A
For topical use: in Vi oz. and 1 oz. tubes.
For ophthalmic use: in '/* oz. tubes.
BURROUGHS WELLCOME & CO. (U.S.A.) INC.. Tuckahoe, N. Y.
J. Florida M.A.
J une, 1958
1389
Off 10 A SIRING START WITH
Happy Jeanette, aglow with health,
is a Baker’s Blue Ribbon Baby.
Doctor, your dietary decision can build Blue
Ribbon babies. The baby who wins the blue
ribbon is the one whose doctor — no one else —
selects its formula.
MODIFIED MILK
A complete formula in liquid and powder form
prepared exclusively from Grade A Milk
BAKER’S MODIFIED MILK BUILDS BLUE RIBBON BABIES
• A complete, balanced uniform for-
mula.
• Convenient and easy to prepare —
simply add water.
• Made from milk of outstanding
purity.
• Provides adequate amounts of all
known essential vitamins plus much-
needed iron.
• Butterfat replaced by easily digested
vegetable oils.
• Twice homogenized for better di-
gestion and absorption.
• Helps doctor control infant’s formu-
la longer. Advertised to the medical
profession only.
• Economical to use — eliminates need
for additional vitamins and iron.
FURNISHED GRATIS TO HOSPITALS FOR NURSERY USE
Available in drug slores
OTHER PRODUCTS— VARAMEI a scientifically formulated
evaporated milk product prepared exclusively from Grade A Milk
Modified miLI<
Powder Form— 1 Tbsp. powder to 2 II. oz. J f
water f. O
20 calories per ounce I
Normal Dilutions
Liquid Form-1 ll.oz.milktolll.oz. water
Laboratories, Inc. • Cleveland 3. Ohio
Milk Products Exclusively for the Medical Profession
1390
Volume X I. IV
Number 12
BIRTHS AND DEATHS
Births
Dr. and Mrs. Alvaro Vargas, of Hialeah, announce
the birth of a daughter, Marianne, on Feb. 18, 1958.
Dr. and Mrs. James G. Lverly Jr., of Jacksonville,
announce the birth of a son, William Mitchell, on March
2, 1958.
Dr. and Mrs. Robert H. Lester, of Arlington, announce
the birth of a son, Robert Clark, on Feb. 21, 1958.
Dr. and Mrs. Richard T. Shaar, of Jacksonville,
announce the birth of a son, William Mason, on Feb.
25, 1958.
Dr. and Mrs. Thomas S. Edwards, of Jacksonville,
announce the birth of a daughter, Susan Crawford, on
April 17, 1958.
Deaths-Members
Bell, John D. Pensacola January 28, 1958
Bond, Benjamin, Winter Haven February 28, 1958
Brown, Oliver C., Fort Lauderdale March 10, 1958
Freedland, Marvin S., Coral Gables March 8, 1958
Lisk, Percy F., Fort McCoy January 22, 1958
Mendel, James H. Sr., Coral Gables February 5, 1958
Moon, William B., Crystal River March 20, 1958
Nickel, Frank W., Winter Park December 22, 1957
Turnage, Johnson Lee, Crestview March 19, 1958
Deaths — Other Doctors
Arnow, Matthew, Eustis December 29, 1957
Miller, J. Preston, Miami December 21, 1957
Ranney, Earl Albert, St. Petersburg November 27. 1957
Sabshin, Zalmar Isaac, Miami Beach December 21, 1957
Medical Licenses Granted
Dr. Homer L. Pearson Jr., secretary of the
State Board of Medical Examiners, has reported
that of the 325 applicants who took the examina-
tion of the Board, held November 25 and 26, 19-
57, in Miami, 275 passed and have been issued
licenses to practice medicine in Florida. The
names and addresses of the 275 successful ap-
licants follow:
Adel, Frank Edward, Miami (U. Tenn. 1957)
Albee, Robert Dempster, Buffalo (U. Buffalo 1944)
Alfonso, Rafael, Baltimore (U. Havana 1948)
Alfred, Harry Charles, Fort Walton Beach (U. Tenn. 1946)
Allen, Arthur Charles, Miami (U. California 1936)
Alpert, Barnett Bertram, Hollywood (McGill U. 1932)
Anderson, Herbert Charles, Miami (Duke U. 1956)
Andrews, James Patten, Cleveland (Western Reserve U.
1950)
Angell, Joseph Samuel, Oak Park, 111. (Rush 1937)
Antiles, Harold Robert, Brooklyn (Georgetown U. 1938)
Barnes, Claude James, Milton (Tulane 1954)
Barry, Patrick Joseph, Miami (Cornell 1957)
Batley, Louis Le Garde, Augusta, Ga. (Georgia Medical
1946 )
Bauer, David Patton, Jacksonville (Emory 1952)
Bayer, Irving, Jamaica, N. Y. (U. Louisville 1941)
Benton, Fred Warren, Key Biscayne (Boston U. 1945)
Blechman, Wilbur Jordan, Richmond, Va. (Virginia Med.
Col. 1957)
Bloom, John Desmond, Chicago (Stritch Sch. Med. 1953)
Bodaski, Albert Alexander, Tyler, Minn. (U. Minn. 1938)
Border, Clinton Larry Jr., Miami (U. Louisville 1952)
Boyd, George Hugh Jr., Clayton, Ga. (Georgia Med. Col.
1950) (Continued on page 1394)
Qnderson Surgical Supply Co.
Established 1916
A GOOD REPUTATION
It takes years to build, but can be
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Fur mu In :
Dosage :
BONADOXIN
stops morning sickness but
relief with BONADOXIN in 1534 patients*
good or excellent 87.8%
fair or moderate 8.6%
poor or none 3.6%
* Summary of published clinical studies.
BONADOXIN*
doesn’t
stop
the
patient
“...tolerance was excellent,
with no drowsiness resulting.”1
“No side reactions
were observed. . . .”2
Each pink-and-blue tablet contains:
Pyridoxine HC1 .... 50 mg.
Meclizine HC1 25 mg.
Bottles of 25 and 100.
Now also available as
BONADOXIN DROPS
1. Weinberg, A., and Werner, W. E. F.: Am.
Pract. & Digest Treat. 6:580 (April) 1955.
2. Codling, J. W., and Lowden, R. J. : North-
west Med. 57:331 (March) 1958.
New York 17, New York
Division, Chas. Pfizer & Co., Inc.
1394
Volume XLIV
Number 12
(Continued from page 1390)
Boyett, James Edward, Lafayette, Ala. (Harvard 19S4)
Boynton, Bruce II, Grafton, N. D. (U. Minn. 1944)
Braun, Richard Allan, Fort Leonard Wood, Mo. (Western
Reserve U. 1954)
Brennan, James Edward, Lakeland (Jefferson 1953)
Brodsky, Leonard, Miami (Jefferson 1953)
Brocks, Allan, Miami (Hahnemann 1957)
Brown, Robert William, New Orleans (Tulane 1950)
Brown, Stuart Irwin, Miami (U. Illinois 1957)
Browning, Louis DeLoach, Hopkinsville, Ky. (Harvard
1949)
Bunn, Joe Plummer, Jacksonville (Duke U. 1957)
Caffey, John William Jr., Chapel Hill, N. C. (Duke U.
1953)
Callaghan, Patrick Edward, Eglin AEB (Stritch Sch. Med.
1955)
Carter, Mary Jo, Coral Gables (Bowman Gray 1957)
Carter, William Franklin, Jacksonville (Emory 1957)
Cataldo, Marne, Oak Park, 111. (U. Chicago 1945)
Celian, Charles Irving, Bay Harbor Island (U. Penn.
1955)
Cesarano, Francis Lewis, Miami (Syracuse U. 1956)
Christy, Raymond Arthur Jr., Gulf Breeze (U. Kansas
1954)
Clark, Francis Leslie Jr., Washington, D. C. (George-
town U. 1954)
Claytor, Samuel Barton, Tampa (South Carolina Med.
Col. 1956)
Cohen, Arthur Nathaniel, Miami (New York U. 1957)
Cohen, Noel Lee, Elberta, Ala. (U. Utrecht 1957)
Cole, John Harry, Orlando (Tufts 1951)
Cooper, Thomas Walker, Charlottesville, Va. (Bowman
Gray 1955)
Craig, Louis Chastain, Charlottesville, Va. (U. Virginia
1954)
Cremer, Leonard Eugene, Jacksonville (U. Cinn. 1957)
Crisler, Morris McCaleb Jr., Edwards, Miss. (Tulane
1953)
Crow, Claude Robert, Orlando (Emory 1957)
Cullen, Julia Mary, Buffalo (U. Buffalo 1949)
Damron, John Russell, Fort Lauderdale (U. Louisville
1952)
Davenport, Oliver William, Key Biscayne (U. Arkansas
1952)
Davis, Herbert Harvey, Miami (U. Tenn. 1957)
DeHaan, Quentin Conrad, Miami (Columbia U. 1955)
de la Vega, Felix, Freeport, 111. (U. Havana 1949)
Demming, James Henry, P-hiladelphia (Western Reserve
U. 1954)
DeSimone, Vincenza Theresa, Tampa (Georgetown U.
1952)
Dever, Richard Curzon, Miami (Johns Hopkins 1952)
Donnelly, Elwin William, Fort Lee, Va. (Northwestern
U. 1955)
Donovan, Daniel Lafayette, Chapel Hill, N. C. (Stritch
Sch. Med. 1947)
Douglass, William Campbell, Sarasota (U. Miami 1957)
Dozier, Richard Moore, Tallahassee (U. Tenn. 1957)
Duckwall, Vernon Eugene, Elkins, W. Va. (Columbia
1941)
Dugan, Charles Clark, Jupiter (Jefferson 1946)
Durfey, John Quincy, Jacksonville (Columbia 1954)
Earp, William Lee, St. Petersburg (U. Penn. 1957)
Ellington, William Thomas, Miami (G. Washington U.
1956)
Facundus, Bruce Elton, Monroe, La. (Louisiana St. U.
1954)
Fein, Clayton Lewis, Detroit, Mich. (U. Ottawa 1954)
Ferguson, Edward Charles, Miami (Marquette 1951)
Fernandez, Mario, Miami (U. Havana 1940)
Fial, Edward Alexander, Buffalo (U. Buffalo 1946)
Fisher, Elbert Luther Jr., Tampa (Duke U. 1957)
Flanary, Jack Ronald, St. Petersburg (Virginia Med.
Col. 1957)
Flood, Charles Crosbie, Gainesville (Georgetown U. 1938)
Fontaine, Catherine Silliman, Coral Gables (Womens
Med. Penn. 1954)
OUR
EXPERIENCE IS VALUABLE TO YOU
CONSULT US FOR INFORMATION ON---
1. DIATHERMY EQUIPMENT
2. ELECTROCARDIOGRAPHS
3. ANESTHETIC EQUIPMENT
4. HAMILTON FURNITURE
5. RITTER TABLES
6. HOSPITAL STERILIZERS AND LIGHTS
7. ANY OTHER NEEDS YOU HAVE
uratca
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COMPANY
1050 W. Adams St. P. O. Box 2580 Jacksonville, Fla.
T. B. SLADE, JR.
J. BEATTY WILLIAMS
J. Florida M.A.
June, 1958
1395
d FET1ST + (3 ATARAXfl)
(pENTAERYTHRITOL TETRANITRATE) (bRANO OF HYOROXYZINe)
why petn?
For cardiac effect: PETN is . the most effective drug
currently available for prolonged prophylactic treatment
of angina pectoris.”1 Prevents about 80% of anginal attacks.
Why ATARAX ?
For ataractic effect: One of the most effective— and probably
the safest— of tranquilizers, atarax frees the angina patient
of his constant tension and anxiety. Ideal for the on-the-job
patient. And atarax has a unique advantage in cardiac
therapy: it is anti-arrhythmic and non-hypotensive.
why combine the two?
NEW YORK 17, NEW YORK
Division, Chas Pfizer & Co., Inc.
•Trademark
For greater therapeutic success: In clinical trials, cartrax
was demonstrably superior to previous therapy, including
petn alone. Specifically, 87% of angina patients did better.
They were shown to suffer fewer attacks . . . require less
nitroglycerin . . . have increased tolerance to physical effort
. . . and be freed of cardiac fixation.
1. Russek, H. I.: Postgrad. Med. 79:562 (June) 1966.
Dosage and Supplied: Begin with 1 to 2 yellow cartrax "10”
tablets (10 mg. petn plus 10 mg. atarax) 3 to 4 times daily.
When indicated this may be increased by switching to pink cartrax
"20” tablets (20 mg. petn plus 10 mg. atarax.) For convenience,
write "cartrax 10” or "cartrax 20." In bottles of 100.
cartrax should be taken 30 to 60 minutes before meals, on a
continuous dosage schedule. Use petn preparations with caution
in glaucoma.
1396
Volume XLIV
Number 12
Provides balanced
nutritional values
® Fibre-free HYPOALLERGENIC formula.
(2) An excellent formula for regular
infant feeding.
@ An ideal food for milk allergies,
eczema and problem feeding.
SOYALAC helps solve the feeding problem of
prematures and infants requiring milk-free diet.
Strikingly similar to mother's milk in composition
and ease of assimilation, babies thrive on SOYALAC.
Clinical data furnish evidence of SOYALAC'S value
in promoting growth and development.
Protein of high biologic value is obtained from the
soybean by an exclusive process.
oKce ^(jiAleta/nd $ow|d&4
A request on your professional letterhead or prescription form
will bring to you complete information, and a supply of
samples. Please address the Loma Linda Food Company,
Arlington, California, or Mount Vernon, Ohio.
Medical Products Division
LOMA LINDA FOOD COMPANY
ARLINGTON, CALIFORNIA • MT. VERNON, OHIO
5s.-
J. Florida M.A.
June, 1958
1397
Frisch, John Warren, Chicago (U. Illinois 1953)
Furlow, Leonard Thompson Jr., Charlottesville, Va.
(Washington U. 1956)
Gabriel, Arthur N., Brooklyn (Emory 1957)
George, William Smith, Coral Gables (Washington U.
1929)
Getz, John Lewis Jr., Jacksonville (Georgetown U. 1948)
Gibson, James Wiley, Coral Gables (South Carolina Med.
Col. 1951)
Gilmore, Elizabeth Pellett, Miami (U. Penn. 1950)
Gilson, Albert Jack, Miami (Cornell 1957)
Glass, MacEllis Kopel, Biloxi, Miss. (Harvard 1955)
Glenn, William Darby III, Eglin AFB (U. Penn. 1956)
Glotfelty, John William, Staten Island, N. Y. (U. Louis-
ville 1953)
Gomez, Max Eulogio, Miami (U. Havana 1950)
Goodson, Michael Piers, Miami (Cambridge U. 1950)
Goyings, Ezra Jr.. Biloxi, Miss. (Med. Col. Virginia 1948)
Grant, Edwin Harris, Miami (Alabama Med. 1957)
Green, Quentin Lafayette, New Orleans (Baylor U. 1948)
Gregory, Ledford Gerald, Beckley. W. Ya. (Cornell 1949).
Grisell, Ted Lewis, Indianapolis (Indiana U. 1939)
Grumley, Ann, Miami (Tufts 1957)
Haddad, George Norman Jr., Miami (U. Oklahoma 1957)
Handte, Robert Earl, Miami (New York Med. 1953)
Harris, Henry William, Jacksonville (U. Tenn. 1957)
Haynes, William Ned, Coral Gables (Med. Col. Virginia
1953)
Heffner, Ralph Wesley, S. Miami (U. Penn. 1945)
Henderson, William Neavitt, Tulsa, Okla. (Duke U. 1946)
Hibbert, William Andrew Jr., Pensacola (Emory 1957)
Hill, William Farris Jr., Sebring (U. Tenn. 1956)
Hines, Kenneth Kay, Tampa (U. Buffalo 1957)
Hocker, John Thomas, Jacksonville (U. Kansas 1956)
Hopman, Bernard Cornelis, Miami (U. Amsterdam 1922)
Horwitz, Frederick, Miami (U. Michigan 1957)
Hurt, Walter Laverne, Lake Worth (Indiana U. 1953)
Hutson, Edward Douglas, Coconut Grove (Temple U.
1957)
Irish, Louise, Miami (Vanderbilt 1956)
Isley^ Joseph Keener Jr., Durham, N. C. (Bowman Gray
1948)
Jaffee, Marvin Louis, Miami (Chicago Med. 1950)
Jahnke, Edward John Jr., Pittsburg (Jefferson 1948)
Johnson, Douglas Marion, Tampa (Duke U. 1955)
Johnson, Robert Peter, Key West (Tulane 1956)
Jones, George Richard Jr., Tampa (Temble U. 1957)
Kahana, Lawrence, Tampa (Washington U. 1953)
Kane, Wilton Rodgers, Crescent City (Jefferson 1956)
Kasner, David, Chicago (Tulane 1954)
Katz, Evan, Coral Gables (Chicago Med. 1956)
Keates, Edwin Utley, Elkins Park, Pa. (Jefferson 1957)
Keates, Richard Harry, Elkins Park, Pa. (Jefferson 1957)
Kessler, Nathan, Cross City (Phy. & Surg. Boston 1949)
Kunz, Lyle Bernard, Miami (Iowa St. U. 1953)
Kurzner, Howard, Miami (U. Arkansas 1957)
Lambert, Mark Orlando, West Palm Beach (Tulane 1957)
Landau, Gerald David, Miami (Syracuse U. 1957)
Largen, Thomas Leland, Eau Gallie (Med. Col. Virginia
1950)
Lester, Charles Franklin, Miami (Yale 1952)
Levine, Morris Joseph, Chicago (U. Chicago 1952)
Levy, Martin Edward, Miami (Hahnemann 1957)
Liechty, John Demerath, Orlando (Northwestern U. 1957)
Lovitz, Beryl, New Orleans (Tulane 1956)
Lubow, Henry, New York (New York Med. 1950)
Lusskin, Bret Leon, Miami (St. U. N. Y. C. 1957)
Lynch, John Anthony, Bethesda, Md. (St. Louis U. 1955)
McCarthy, John Ayers, Pittsburgh (Jefferson 1955)
McCoy, Donald Lewis, Tampa (U. Kansas 1954)
McMahon, Donald Jr., Metairie, La. (Tulane 1952)
Mahoney, John Richard, Dumont, N. J. (Tufts 1951)
Maile, Earle Joseph, Parks AFB, Calif. (U. Wisconsin
1949)
Maniatis, William Richard, Bridgeport, Conn. (Yale 1947)
Mann, Joel Barry, Miami (Hahnemann 1957)
Mann, Richard Manning, Pittsburgh (U. Pittsburgh 1951)
Margulies, Charles, Miami Beach (New York Med. 1941)
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1398
Volume XLIV
Number 12
Marks, Bernard Henry, Miami (Washington U. 1955)
Marsh, Myrle Frederick, Speedway, Ind. (Indiana U. 1954)
Martinez-Lopez, Jorge Ignacio, Metairie, La. (Louisiana
St. U. 1950) '
Maseda, Ramon Leoncio, Coral Gables (U. Havana 1945)
Matz, Martin Henry, Miami Beach (U. Penn. 1957)
Maultsby, Maxie Clarence Jr. (Col.), Orlando (Western
Reserve U. 1957)
Mayer, Joan Weiss, Miami (Columbia 1954)
Mayer, Paul Wellman, Miami (Columbia 1954)
Maynard, Robert Ensign, Miami (U. Buffalo 1953)
Meltzer, Charles Curtis, Miami (Duke U. 1957)
Merrill, Carleton Russell Jr., Detroit (St. Louis U. 1954)
Messing, Samuel Louis, Miami (Syracuse U. 1957)
Metsch, Herbert, Surfside (U. Buffalo 1957)
Michals, Robert Anthony, Miami (Cornell 1957)
Millard, Max Solomon, Miami (U. Dublin 1944)
Miller, James Reynolds, Miami (Temple U. 1957)
Miller, Wallace Emil, Miami (Harvard 1944)
Mills, Henry Pipes Jr., Orlando (U. Miss. 1957)
Mitchell, John Potter Jr., Lantana (Tulane 1951)
Molina, Vincent Joseph Jr., Miami (Tulane 1957)
Montgomery, Brian Keys, Warrington (U. London 1950)
Moore, Rowe Price, Miami (Temple U. 1953)
Moreno, Gustavo Joseph III, Tampa (Georgetown U.
1952)
Mortimer, Raymond Edward, St. Petersburg (New York
Med. 1951)
Moss, Jack William, Miami (New York Med. 1923)
Murphv, Ray Earlvwine Jr., Dublin, Ga.(U. Louisville
1952)
Neder, Gecr^e Abraham Jr., Jacksonville (Emory 1957)
Nelson, John Robert, Chattahoochee (U. Tenn. 1956)
Newell, Bruce Jr., St. Petersburg (Duke U. 1956)
Newell, Charles Harold, Omaha (U. Nebraska 1954)
Newman, Harry, Portland, Ore. (U. Oregon 1954)
Niswonger, Joseph Kingdon, Kev West (G. Washington
U. 1947)
Nitzberg, Saul Israel, Mattapan, Mass. (Emory 1951)
Nodine, Robert Carlton, Glen Oaks, N. Y. (Yale 1955)
Norris, James Ellsworth Chiles (Col.), Kilmarnock, Va.
(Western Reserve U. 1957)
Offen, Joseph Allan, Coral Gables (U. Virginia 1949)
Ogle, Dan Clark, Washington, D. C. (U. Illinois 1929)
Olix, Melvin Leonard, Columbus, Ohio (U. Cinn. 1954)
O’Neill, James Flemister, Durham, N. C. (Duke U. 1954)
Parent, Charles-Henri, Fort Lauderdale (Laval U. 1946)
Parrish, Bruce Elliott, Cortez (U. Tenn. 1957)
Pavilack, Sidney, Tampa (Med. Col. Virginia 1957)
Piergeorge, Andrew Robert, Pittsburgh (U. Pittsburgh
1943)
Pike, Robert Edgar, Miami (U. Penn. 1955)
Polasky, Saul Hyman, Miami (U. Cinn. 1954)
Polizo, Dimitri Charles, Elizabeth, La. (U. Virginia 1955)
Potyk, David, Miami (Northwestern U. 1957)
Prout, George Russell Jr., Miami (Albany Med. 1947)
Quimby, Charles Sumner, Tampa (South Carolina Med.
Col. 1956)
Ramsay, Reginald Carlyle, Raiford (Tulane 1953)
Rauch, Robert Joseph, Valley Stream, N. Y. (St. U. N.Y.
C. 1953)
Reilly, Walter Malcolm, Tampa (Phy. & Surg. Boston
1948)
Rein. Harry, Fort Benning, Ga. (St. U. N.Y.C. 1957)
Rhea, James Wendell, Columbus, Ga. (New York Med.
1943)
Rice, Ruth Alta, Miami (U. Colorado 1956)
Rich, Joseph, Naples (Long Island Col. Med. 1934)
Rizika, Harold Paul, Miami (Syracuse U. 1953)
Robarge, Ignace James, N. Miami Beach (U. Michigan
1949)
Robinson, James Elbert, Chicago (Northwestern U. 1953)
Robinson, Robert Stith, Jacksonville (U. Tenn. 1957)
Roll, Edmond Charles, Orlando (Indiana U. 1942)
Ross, Carl, Jacksonville (Chicago Med Sch. 1943)
Ruche, Harry Charles, West Palm Beach (U. Md. 1923)
Rush, John Alfred Jr., Jacksonville (Emory 1957)
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In the presence of a functional
pancreas, Or inase effects the production
and utilization of native insulin via
normal channels.
Upjohn |
tolbutamide , UPJO
1400
Volume XI. IV
Number 12
Rush, Joseph Carl, St. Petersburg (Creighton U. 1952)
Saavedra, Diego, Miami (U. Havana 1947)
Sachs, Joseph, Brooklyn (N. Y. U. 1925)
Sakolsky, Robert Ivan, Miami (U. Geneva 1954)
Salko, Edward William, Cokeburg, Pa. (U. Pittsburgh
1943)
Salzman, Stanley H., Miami (Chicago Med. Sch. 1957)
Sanders, Norman, Miami (Syracuse U. 1957)
Sassano, Joseph Richard Jr., Rochester, Minn. (George-
town U. 1954)
Schiff, Eva Gyori, Miami (U. Zurich 1951)
Schlesinger, Danial J., Munster, Ind. (Indiana U. 1944)
Schmidt, Carl Frederick, Milwaukee (U. Wisconsin 1956)
Schultz, Robert Jordan, Hempstead, L.I., N.Y. (Chicago
Med. Sch. 1957)
Schwartz, William Lyle, Miami (U. Utah 1957)
Selph, James Anderson Jr., Richmond, Va. (Virginia
Med. Col 1957)
Sena, Dominic Richard, Coral Gables (U. Perugia 1937)
Shaw, Eugene Russell, Williamsburg, Va. (U. Geneva
1952)
Shellow, Ronald Alan, Miami (U. Illinois 1957)
Sherman, Maurice Elish, New York (U. Buffalo 1957)
Shirley, Sheridan William, New Orleans (New York Med.
1953)
Siegel, Alan Arthur, Woodmere, L. I. N. Y. (Chicago Med.
Sch. 1957)
Simon, Harold, Trenton, N. J. (Duke U; 1955)
Skigen, Jack, Miami (U. Pittsburgh 1957)
Smith, Dwight Raymond, New York (U. Chicago 1947)
Smith, Robert John, Jacksonville (U. Tenn. 1954)
Smith, Vernon Milan, Baltimore (Temple U. 1949)
Sokoloff, Martin Francis, Newport, R. I. (U. Louisville
1955)
Soshea, John William, St. Petersburg (Northwestern U.
1950)
Sperling, Adelle Bernice, Pensacola (Alabama Med. 1956)
Sporn, Irvin Norman, Richmond, Va. (Virginia Med. Col.
1957)
Starzl, Thomas Earl, Miami (Northwestern U. 1952)
Steck, Charles George, Gulf Breeze (Jefferson 1955)
Stiefel, John Raabe, Jacksonville (Emory 1957)
Strachan, James Boyd Jr., Birmingham, Ala. (Washington
U. 1952)
Strauss, Albert, Baltimore (U. Virginia 1951)
Swartzendruber, Frederick James, Dearborn, Mich. (U.
Illinois 1947)
Talmage, Edward Arthur, Miami (New York Med. 1952)
Tawfik, Harry David, Montgomery, Ala. (American U.,
Beirut 1945)
Taylor, Lawrence Carol, Rochester, Minn. (U. Nebraska
1955)
Terry, Robert Henry, Evansville, Ind. (U. Tenn. 1957)
Thomas, Henrv Duke, Birmingham, Ala. (Alabama Med.
1952)
Thompson, Chester McConnell, Orlando (Temple U. 1953)
Tirone, Antonio Pietro, Richmond, Va. (U. Padua 1946)
Tompkins, William Alexander, Elmhurst, 111. (U. Illinois
1947)
Traitz, James Joseph, Coral Gables (Temple U. 1945)
Trollinger, Robert James, Madeira Beach (Hahnemann
1957)
Trop, Jules, Miami Beach (Chicago Med Sch. 1957)
Vaughn, Betty Jean, Miami (Alabama Med. 1956)
Wagar, Anne Wilkinson, Winter Park (U. Georgia 1947)
Wahle, John Phillip Jr., Jacksonville (Emory 1957)
Walzer, Robert Steven, Miami (Columbia 1957)
Ward, Joseph Paul, Little Rock, Ark. (U. Arkansas 1953)
Wasserman, Fred, Miami (U. Virginia 1952)
Weise, Edmund Roland, Jacksonville (U. Virginia 1957)
Weiss, Edward Bernard, Great Lakes, 111. (Duke U. 1957)
White, William Penn, Atlanta, Ga. (Emory 1957)
Whitman, Leo, Fort Lauderdale (Eclectic Med. Cinn.
1939)
Williams, William Tilden, Dunedin (Virginia Med. Col.
1947)
Wilson, Charles Arthur, W. Chester, Pa. (Virginia Med.
Col. 1957)
(Continued on page 1406)
.. .to postpone
the "G" point?. .
R
For patients over 40, The G POINT (point of
declination in life) can be postponed!
Properly balanced Androgen — Estrogen —
nutritional therapy may prevent premature
aging and damage of gonadal decline and
nutritional inadequacy.
Complaints of symptoms such as muscular
pain, fatigue, irritability, and poor appetite
in the patient over 40 may be the first indi-
cations of three major stress factors in the
aging process: (1) Gonadal Hormonal Imbal-
ance, (2) Nutritional Inadequacy and (3) Emo-
tional Instability. GERITAG is especially for-
mulated to guard against premature damage
and to delay the degenerative process.
Rx GERITAG in preventive geriatrics.
‘Chappel, C.C., J.A.M.A., 162: 1414, (Dec. 8) 1956
Each Magenta Soft Gelatin Capsule contains:
Ethinyl Estradiol
0.01 mg.
Riboflavin
2 mg.
Ferrous Sulfate
50 mg.
Pyridoxine Hcl.
0.3 mg.
Rutin
.. 1 0 mg.
Niacinamide..
20 mg.
B-l 2
Vitamin A
5,000 I.U.
Choline Bitartrate
40 mg.
400 I.U.
1 I.U.
Cal. Pantothenate___
3 mg.
Also
available
as injectable.
S. J. TUTAG & COM PA N Y
Write for Latest Technical bulletins
DETROIT 34, MICHIGAN
for
vaginal
douching
that is
physiologically
sound
ethically promoted
Meta
n
ne
vaginal douche powder
Meta Cine represents a carefully designed formula which provides the
physician with a vaginal douche preparation which safely and effectively
maintains a clean healthy vagina.
Meta Cine is a combination of several ingredients clinically established as
valuable in promoting proper vaginal hygiene. Diluted for use, Meta Cine
possesses the desired pH (3.5); contains the mucus digestant, papain, which
dissolves mucus plugs and coagulum; contains lactose to promote growth of
desirable doderlein bacilli, and methyl salicylate for soothing stimulation of
circulation within the vaginal walls.
Its pleasant, deodorizing fragrance also meets the esthetic demands
of your patients.
Meta Cine is promoted exclusively to the medical profession, and recommends
itself as your preparation of choice for patients who might otherwise indulge
in unsupervised self-medication with potentially damaging nonphysiologic
douches.
Supplied in 8-oz. containers. 2 teaspoonfuls in 2 quarts of warm water,
douche as prescribed.
Printed douching instructions for patients available upon request.
BRAYTEN Pharmaceutical Company • Chattanooga 9, Tennessee
E
1402
Volume XI. IV
Number 12
why wine
in Diabetes ?
To the physician faced with the treatment of
diabetes, as well as to the diabetic sufferer on a necessarily
restricted diet, it is reassuring that palatable dry table
wines can be used safely to add a much needed
sparkle and enjoyment to meals.
Wine can serve as an excellent and regular source of
energy, which does not require the participation of insulin.
Wine has a sparing action on fats and proteins,
is not converted into glucose or fatty acids, and, therefore,
is neither ketogenic nor anti-ketogenic.
Caloric Values of California Wines — Studies
have shown that the average diabetic can oxidize from 7 to
10 cc. of alcohol per hour without producing
any toxic or other undesirable symptoms.
Typical California table wines — except for
sweet sauternes — yield from about 90 to 100 calories
per 100 cc.; champagnes and other dry sparkling
wines yield from 100 to 140 calories, while dry sherries,
dry Vermouths and other miscellaneous .wines will
yield about 160 calories and up to 250
in case sweet Vermouth is used.
A table giving the composition and energy value of wines, suitable for the
calculated diabetic diet, will be supplied on request.
You can make this request when writing for your copy of "Uses of Wine in Medical
Practice" to Wine Advisory Board, 717 Market Street,
San Francisco 3, California.
J. Florida M.A.
June, 1958
1403
New...
meprobamate
prolonged
release
capsules
Evenly sustain relaxation of mind and muscle ’round the clock
TWO MEPROSPAN CAPSULES IN THE MORNING
RELIEVE ANXIETY. TENSION ANO SKELETAL MUS>
CLE SPASM THROUGHOUT THE OAY.
TWO MEPROSPAN CAPSULES AT BEDTIME
PROVIDE UNINTERRUPTED SLEEP THROUGH-
bUT THE NIGHT.
Meprospan
MEPROBAMATE IN PROLONGED RELEASE CAPSULES
• maintains constant level of relaxation
• minimizes the possibility of side effects
■ simplifies patient’s dosage schedule
Dosage: Two Meprospan capsules q. 12 h.
Supplied : Bottles of 30 capsules.
Each capsule con tains :
Meprobamate (Wallace) 200 mg.
2-methyl -2-n-propyl* 1,3-propanediol dicarbamate
Literature and samples on request .
V?/ WALLACE LABORATORIES, New Brunswick , N . J .
1404
Volume XL1V
Number 12
J. Florida M.A.
June, 1958
1405
Gastric distress accompanying "predni-steroid"
therapy is a definite clinical problem — well
documented in a growing body of literature.
iew of the beneficial re-
observed when antacids
d diets were used concom-
ith prednisone and predni-
r'e feel that these measures
le employed prophylacti-
offset any gastrointestinal
;ts.” — Dordick, J. R. et at.:
ite J. Med. 57:2049 (June
r.
^c“It is our growing convic-
tion that all patients receiving
oral steroids should lake each
dose after food or with ade-
quate buffering with aluminum
or magnesium hydroxide prep-
arations.”— Sigler, J. W. and
Ensign. 1). C.: J. Kentucky
State M. A. 54:771 (Sept.) 1956.
4s“Tlie apparent high inci-
dence of this serious [gastric)
side effect in patients receiving
prednisone or prednisolone
suggests the advisability of
routine co-administration of an
aluminum hydroxide gel.” —
Bollet, A. J. and Bunim, J. J.:
J. A. M. A. 158:459 (June 11)
1955.
One way to make sure that patients receive
full benefits of ‘‘predni-steroid" therapy plus
positive protection against gastric distress is
by prescribing CO-DELTRA or CO-HYDElTRA.
oDeltra.
PREDNISONE BUFFERED
iple compressed tablets
provide all the benefits
of “Predni-steroid” therapy-
plus positive antacid protection
against gastric distress
2.5 mg. or 5.0 mg. of prednisone
or prednisolone, plus 300 mg. of
dried aluminum hydroxide gel
and 50 mg. magnesium trisili-
cate, in bottles of 30, 100, 500.
MERCK SHARP & D0HME Division Of MERCK & CO.. Inc.. Philadelphia 1. Pa. (MSra
1406
Volume XUV
Number 12
(Continued from page 1400)
Wolman, Irving Jacob, Philadelphia (Johns Hopkins 1929)
Wulfekuhler, Warren Vinson, Orlando (Tulane 1956)
Wyman, Edward Holbrook, Fort Lauderdale (South
Carolina Med. Col. 1931)
Yerkovich, Anthony Cyril, Buffalo (U. Chicago 1939)
Yoder, John Robert, Ann Arbor, Mich. (U. Rochester
1954)
Young, Clifton Aurelius Jr., Dunedin (U. Tenn. 1956)
Young, James Norman, La Grange, 111. (Northwestern
U. 1950)
Zimskind, Paul Donald, Trenton, N. J. (Jefferson 1957)
OBITUARIES
Walter Bailey Johnston
Dr. Walter Bailey Johnston of Winter Park
died suddenly at the Winter Park Memorial Hos-
pital on Nov. 19, 1957. He was 55 years of age.
Born at Mineral Point, Wis., in 1902. Dr.
Johnston had his premedical training in Florida at
Rollins College and at the University of Wis-
consin. He taught at Rollins College before enter-
ing medical school. He attended Western Reserve
University School of Medicine and received his
medical degree from that institution in 1931.
Dr. Johnston engaged in the practice of medi-
cine in Cleveland, Ohio, until 1941 when he
entered military service. He spent five years in
the service of his country, holding the rank of
lieutenant colonel in the medical corps of the
United States Army. He experienced his first at-
tack of coronary thrombosis after a period of con-
tinuous duty for 28 hours treating the wounded
during the establishment of the Anzio beachhead
and was never well thereafter.
Upon discharge from the sendee, Dr. Johnston
accepted the post of senior physician for the Proc-
tor and Gamble Company in Cincinnati, serving
there until he came to Florida in 1947 and located
in Winter Park. Until the time of his death he
engaged in the general practice of medicine there
with emphasis on obstetrics and gynecology. In
1955 he was named man of the year by the Win-
ter Park Rotary Club for outstanding civic work
with the Winter Park Health Clinic. Locally he
was on the staff of Winter Park Memorial Hos-
pital. Orange Memorial Hospital and the Florida
Sanitarium and was the college physician at
Rollins College. He was a member of the Con-
gregational Church and active in the choir.
Dr. Johnston was a member of the Orange
County Medical Society and for 10 years had
held membership in the Florida Medical Associa-
tion. He was also a member of the American
(Continued on page 1410)
NEW “flavor -timed” dual-action
CORONARY VASODILATOR
ORAL (tablet swallowed whole)
for dependable prophylaxis
SUBUNGUAL-ORAL
for immediate and
sustained relief
TRADEMARK
of ANGINA PECTORIS
NITROGLYCERIN -
0.4 mg. (1/150 grain) — acts quickly
CITRUS "FLAVOR-TIMER" —
signals patient when to swallow
PENTAERYTHRITOL TETRANITRATE -
15 mg. (1/4 grain) — prolongs action
For continuing prophylaxis patient swallows
the entire Dilcoron tablet.
Average prophylactic dose:
1 tablet four times daily.
Therapeutic dose:
1 tablet held under the tongue until citrus
flavor disappears, then swallowed.
Bottles of 100.
ABORATORIES NEW YORK II. N v
J. Florida M.A.
June, 1958
1407
running noses .
caused by
pollen allergies
TRIAMINIC stops rhinorrhea, congestion and
other distressing symptoms of summer allergies,
including hay fever. Running nose, watery eyes
and sneezing are best relieved by antihistamine
plus decongestant action — systemically — with
Triaminic.
This new approach frequently succeeds where
less complete therapy has failed.lt is not enough
merely to use histamine antagonists; ideally,
therapy must be aimed also at the congestion of
the nasal mucosa. Triaminic provides such ef-
fective combined therapy in a single timed-
release tablet.
Triaminic provides around-the-clock
freedom from allergic congestion with
just one tablet t.i.d. because of the
special timed-release design.
first— 3 to 4 hours of relief
from the outer layer
then— 3 to 4 more hours of relief
from the inner core
Triaminic brings relief in minutes— lasts for
hours. Running noses stop, congested noses
open— and stay open for 6 to 8 hours.
Dosage: One tablet in the morning, mid-after-
noon and at bedtime. In postnasal drip, one
tablet at bedtime is usually sufficient.
Each timed-release TRIAMINIC Tablet contains:
Phenylpropanolamine HC1 50 mg.
Pheniramine maleate 25 mg.
Pyrilamine maleate 25 mg.
TRIAMINIC FOR THE PEDIATRIC PATIENT
TRIAMINIC Juvelets*, providing easy-to-swal-
low half-dosages for the 6- to 12-year-old child,
with the timed-release construction for pro-
longed relief.
•Trademark
TRIAMINIC Syrup, for those children and
adults who prefer a liquid medication. Each
5 ml. teaspoonful is equivalent to V\ Triaminic
Tablet or /> Triaminic Juvelet.
rp • • • ®
1 riamimc
SMITH-DORSEY . a division of The Wander Company • Lincoln, Nebraska •Peterborough, Canada
BRUISES
BOYS
BURNS
BACTERIA
INDICATED:
MEO-MAGNACORT
^^^^^■TOPICAL OINTMENT
neomycin and hydrocortamate
The first water-soluble dermatologic corticoid plus neomycin, for consistently
outstanding control of contact dermatitis and other inflammatory dermatbses
complicated by or threatened by infection. *
In l/2-o z, and 1/6-oz. tubes, 0.5% neomycin sulfate and 0.5% hydrocortamate hydrochloride (hydro-
cortisone diethylaminoacetate hydrochloride) - Magnacort.
also available: Magnacort® Topical Ointment - in 1/2-oz. and 1/6-oz. tubes, 0.5% hydrocortamate
hydrochloride (hydrocortisone diethylaminoacetate hydrochloride).
*Howell. C. M„ Jr. : Am. Pracl. i Digest Treat. 8:1928, 1957.
PFIZER LABORATORIES DIVISION, CHAS. PFIZER & CO., INC., BROOKLYN 6. NEW YORK
long- clay ahead
morning sun glare — eyes irritated
can’t read — coach smoky
leave the work let’s lunch
back to work — eyes worse
take afternoon off — see doctor
pick upVISINE — home again
let’s try the drops
nice dinner — read the paper
eyes comfortable — good TV play
useVISINE — bed 11:30
newVISINE* EYE DROPS
BRAND OF TKTRAHYDROZOLINE HYDROCHLORIDE
“an excellent ophthalmic decongestant . .
almost immediate relief of hyperemia, soreness, itching, burning, tearing — no rebound
vasodilatation, mydriasis, photophobia or systemic effects./ supplied: in 1/2 oz. bottles,
0.05 % tetrahydrozoline hydrochloride in a solution containing sodium chloride, boric
acid, sodium borate; with sterile, eye dropper.
Trademark 1. Grossmann, E. E., and Lehman, R. H.. Am. J. Ophth. 42:121, 1956.
Pfizer
PFIZER LABORATORIES Division, Cltas. Pfizer & Co., Inc. Brooklyn 6, New York
1410
Volume XLIV
Number 12
(Continued from page 1406)
Medical Association and the American Academy
of General Practice.
Surviving are the widow, Mrs. Edna Wallace
Johnston, and a son, Richard Johnston, both of
Winter Park; two brothers, Willard A. Johnston
of Chicago and Albert M. Johnston of South
Dakota; and two sisters, Mrs. Katherine Fritz
of Oak Park, 111., and Mrs. Eunice Kretchman
of Lansing, 111.
Frank William Nickel
Dr. Frank William Nickel of Winter Park
died in that city on Dec. 22, 1957. He was 75
years of age.
Born in Germany in 1883. Dr. Nickel received
his premedical education in that country and at
Hildreth College in Iowa. For his medical train-
ing he attended the University of Illinois College
of Medicine in Chicago and was awarded the
degree of Doctor of Medicine by that institution
in 1910. He served an internship at the Cook
County Hospital in Chicago and a residency in
pathology at the Illinois State Hospital. He en-
gaged in postgraduate study at Allgemeine Kran-
kenhaus in Vienna and for a time was Assistant
Professor of Pathology at the University of Ill-
inois College of Medicine.
From 1912 to 1920 Dr. Nickel practiced gen-
eral medicine in Eureka, 111. He then moved to
Peoria, 111., where he continued to practice until
he retired in 1947. At that time he came to
Florida to reside at Palm Beach. After two years
in retirement, he moved to Winter Park and re-
entered active practice continuing there until the
time of his death.
Dr. Nickel was a member of the Orange Coun-
ty Medical Society, Florida Medical Association,
American Medical Association and American
Academy of General Practice.
THE DUVALL HOME
for RETARDED CHILDREN
A home offering the finest custodial care with a
happy home-like environment. We specialize in the
care of infants, bed-ridden children and Mongoloids.
For further information write to
MRS. A. H. DUVALL GLENWOOD, FLORIDA
- ^
ANESTHETIC - Pontocaine® HCI (10 mg.)
— prolongs surface analgesia
without irritation.
DECONGESTANT -
ANTI-INFECTIVE
eo-Synephrine® HCI (5 mg.)
— reduces swelling and engorgement
promptly — for extended periods.
ulfamylon® HCI (200 mg.)
— is effective against both gram-
positive and negative bacteria.
Supplied in boxes of 12 —
PNS, Pontocoine (brand of tetracaine),
Neo-Synephrinc (brand of phenylephrine)
and Sulfamylon (brand of mafenide),
trademarks reg US Pat Off.
LABORATORIES
J. Florida M.A.
June, 1958
1411
WOMAN’S AUXILIARY
Meet the President
In my recently appointed position as writer
for the Woman’s Auxiliary to the Florida Medical
Association, I am pleased to introduce in this
first article, our new President, Mrs. Lee Rogers
Jr., of Rockledge, better known to a host of
friends as Ann. We are indeed fortunate to have
such a warm and friendly personality to repre-
sent our state this year.
Our Mississippi born President comes with
a wide and varied background in medical social
work as well as county and state Auxiliary jobs.
She attended Mississippi State College for two
years, receiving her B.A. degree from Mary Bald-
win College, Staunton, Va., with a major in sociol-
ogy and a minor in psychology. She received her
master’s degree from Tulane University, New
Orleans, in medical social work. While in New
Orleans she met her husband Lee, an intern at
Touro Infirmary. He is now associated with the
Kenaston Clinic in Cocoa as a surgeon. The third
member of the family is a delightful thirteen year
old daughter, Cally, — in her more dignified mo-
ments known as Ann Calvin.
While Ann’s husband was receiving training
in surgery at Lahey Clinic in Boston, she did
medical social work at Boston Dispensary. Fol-
lowing this, she was Director of the Cooperative
Nursery School at Shanks Village, N.Y., while
husband Lee continued surgical residency at New
York Post Graduate Hospital. To hear her de-
scribe this work reflects her love for children and
the thrill she received from doing medical social
work.
She has held many, many jobs in the Aux-
iliary, both on a county as well as state level. In
Brevard county she has been Secretary-Treasurer.
Vice-President, chairman of various committees,
including Legislation this year. In state work,
she has been Corresponding Secretary, Revisions
and Resolutions Chairman, Southern Medical
Auxiliary Councilor and Second Vice-President
and Chairman of District B.
Aside from her Auxiliary work, there are
many activities in the community in which she
plays a major part. One registers no surprise at
her comment that she has no time for hobbies.
To see her tackle her many jobs, one realizes that
her work is her hobby and she gets a real thrill
from it all.
One of her most outstanding contributions is
teacher of the Young Adult Sunday School Class
of the Rockledge Presbyterian Church which she
also serves as member of the Board of Deacons
and as Secretary of the Building Committee.
Other activities include Director, American Red
Cross, various jobs in P.T.A., and many hours
contributed to one of her special interest projects,
the local hospital Auxiliary, where she dons her
“Pink Lady” costume and donates hours of
service.
The time worn statement that “if you want a
job well done, pick the busiest person” truly fits
here. I feel that we are indeed fortunate to have
this outstanding personality as our President this
year. It is my wish that each Auxiliary member
in the state may have the opportunity of meet-
ing her during her term in office.
Mrs. Albert F. Stratton Jr.
Auxiliary Officers
The names of the officers of the Woman’s Aux-
iliary to the Florida Medical Association elected
at the meeting held in May will be published as
part of the next article by Mrs. Albert F. Strat-
ton Jr., writer for the Auxiliary.
in very special cases
a very superior brandy.,
specify
MlHifESST
COGNAC BRANDY
84 Proof I Schieffeiin 4 Co., New York
1412
Volume XLIV
Number 12
COPYRIQMT 1957 THE COCA-COLA COMPANY.
The purity, the
wholesomeness,
the quality of
Coca-Cola as
refreshment has helped
make Coke the
best-loved sparkling
drink in all the world.
J. Florida M.A.
June, 1958
1413
BOOKS RECEIVED
Fear: Contagion and Conquest. By James Clark
Moloney, M.D. Pp. 140. Price, $3.75. New York,
Philosophical Library, Inc., 1957.
In this volume, the author mobilizes evidence from
his experience as a psychoanalyst and from studies of
people of various cultures to reinforce his conviction
that “emotionally stable, normally integrated, emotionally
mature adults develop by being afforded properly
measured mothering” through the first three to five
years of life. The facts assembled provide discerning and
important insights into the behavior of the Chinese, the
Japanese and the populations of such South Pacific
islands as Bali and Okinawa, as well as Americans and
Europeans.
The Neuroses and Their Treatment. Edited by
Edward Podolsky, M.D., F.A.P.A., F.A.P.M. Pp. 555.
Price, $10.00. New York, Philosophical Library, 1958.
Whatever one’s definition of the neurosis, it remains
the most common, the most widespread, and the most de-
structive of contemporary mental illnesses, making diag-
nosis, management and treatment of first importance to
every physician in active practice. In this comprehensive
survey of the field at present, Dr. Podolsky has selected
some 40 representative papers containing the latest knowl-
edge of specialists in the handling of all phases of the
neurosis, from simple allergy to severe and crippling
phobias, from psychotherapy in infancy to the handling
of senility, from the routine psychotherapy to electro-
shock, and from the new psychopharmacologic aids to the
extreme measures of lobotomy. Together, these authori-
tative clinical reports provide a valuable and illuminating
cross section of the latest diagnoses and therapies from
advance researchers in the field of mental illness. Among
these reports is one entitled “Allergy and Psychoneuroses”
by Dr. Frank C. Metzger of Tampa.
with sound advice, gentle humor, and warm understand-
ing. Reading this book may add years to one’s life.
The Relation of Psychiatry to Pharmacology.
By Abraham Wikler, M.D. Pp. 322. Price, $4.00. Pub-
lished for the American Society for Pharmacology and
Experimental Therapeutics by The Williams and Wilkins
Company, Baltimore 2, Md., U S. A., 1957.
The Editorial Board of Pharmacological Reviews
assumes editorial responsibility for the material in this
volume, which was originally intended for publication in
Pharmacological Reviews, and the Board of Publication
Trustees of the American Society for Pharmacology and
Experimental Therapeutics subsidized the printing. Sec-
tion 1, The Effects of Drugs on Human Behavior, deals
with therapeutic procedures including the production of
coma, “psychoexploration,” tranquilization, and arousal
and elevation of mood; diagnostic and prognostic testing
procedures; and the production of “model” psychoses
including rationale and syndromes. Section 2, Theories
and Mechanisms of Drug Actions, presents an operational
view of causal explanations of behavioral change; bio-
chemical aspects, including theories relating changes in
behavior to changes in cerebral metabolism and biochemi-
cal mechanisms of drug action ; neurophysiological aspects,
including theories relating changes in behavior to changes
in neural organization, and neurophysiological mechanisms
of drug action; and psychological aspects, including
theories relating changes in behavior to changes in envi-
ronmental adaption, and psychological mechanisms of
drug actions.
Viewed from the standpoint of “experimental psychia-
try,” the material included in this review affords abun-
dant evidence that investigation of the “mechanisms”
of drug actions has served on the one hand, to detect and
permit manipulation of a host of variables that may in-
fluence behavior, and on the other, to reveal the inade-
quacy of current theories which seek to relate such vari-
ables to behavior in a causal manner.
You Can Increase Your Heart-Power. By Peter
J. Steincrohn, M.D., F.A.C.P. Pp. 381. Price, $4.95.
Garden City, New York, Doubleday & Company, Inc.,
1958.
Who does not want to make the most of his heart
power? This book offers an excellent guide to that end
— not alone to those who have already had heart trou-
ble but also to those who wish to remain well and lead
a full life. The author is an eminent heart specialist
and internist and a nationally syndicated writer and
author of many popular medical books for the layman.
Dr. Steincrohn has written this book to show that “each
one of us is the appointed caretaker of our heartbeats,”
and to explain the why’s and wherefore’s and do’s and
don’ts of our most important job in life. Each person,
he estimates, has a lifetime of about three and a half
billion heartbeats, and the object of his book is to help
the reader use these heartbeats for a long, healthy, happy
life.
Every aspect of heart disease, including imaginary
heart trouble, is covered. Coronary problems, angina,
high blood pressure, hardening of the arteries, proper
diet, and overweight are thoroughly discussed in under-
standable language. The effect on the heart of exercise,
alcohol, and smoking is explained and related to age and
other factors. Caution and common sense are advised
regarding the new low cholesterol diet. Dr. Steincrohn
cautions against self-prescribed diets, and his urgent plea
is to find a good doctor and follow his advice. He be-
lieves exercise is to be taken only in moderation after
forty. Since it takes a 36 mile jaunt to walk off a pound
of fat, he suggests skipping the pie a la mode as a better
means of holding the weight line.
Part of the text is in the form of questions from
patients and correspondents. These arc fully answered
THjilftnactice
AVOIDING
CONJECTURAL CRITICISM
Sfrecc<iltfeeC Service
nuz&ea aun doefon. frozen.
THE]
Medical Prqt.ec,t.iwej (SpMPAary
Fort/Wayne; Indiana.
Professional Protection Exclusively
since 1899
h
MIAMI Office
H. Maurice McHenry
Representative
149 Northwest 106th St.
Miami Shores
Tel. PLAZA 4-2703
1414
Volume XI.IV
Number 12
I Allen j Invalid Home
i
| MILLEDGEVILLE, GA.
i Established 1890
I For the treatment of
NERVOUS AND MENTAL DISEASES
I Grounds 600 Acres
Buildings Brick Fireproof
: Comfortable Convenient
J Site High and Healthful
E. VV. Allen, M.D., Department for Men
H. D. Allen, M.D., Department for Women
J Terms Reasonable
Whatever vour first requi-
sites mav be, we always
endeavor to maintain a
standard of quality in keeping
with our reputation for fine qual-
ity work — and at the same time
provide the service desired. Let
Convention Press help solve
your printing problems by intelli-
gently assisting on all details.
< jtlAI.il v hook I’KIM l\l,
rt'Hi.K AiioNS yy iiKocimins
Convention
PRESS ✓ ^
2 18 West C h u k c ii St.
Jacksonville, Florida
BALLAST POINT MANOR
Care of Mild Mental Cases, Senile Disorders
and Invalids
Alcoholics Treated
Aged adjudged cast
will be accepted on
either permanent oi
temporary basis.
Safety against fire — by Auto-
matic Fire Sprinkling System.
Cyclone fence enclosure for
recreation facilities, seventy-
five by eighty-five feet.
ACCREDITED
HOSPITAL FOR
NEUROLOGICAL
PATIENTS by
American Medical Assn.
American Hospital Assn.
Florida Hospital Assn.
5226 Nichol St.
Telephone 61-4191
DON SAVAGE
Owner and Manager
P. O. Box 10368
Tempo 9. Florida
J. Florida M.A.
June, 1958
1415
BRAWNER’S SANITARIUM
Jas. N. Brawner, Jr., M.D.
Medical Director
Albert F. Brawner, M.D.
Associate Director
For the Treatment of
Psychiatric Illnesses and Problems of Addiction
Member
Georgia Hospital Association, American Hospital Association
National Association of Private Psychiatric Hospitals
P.O. Box 218
HEmlock 5-4486
ESTABLISHED 1910
HIGHLAND HOSPITAL, INC.
FOUNDED IN 1904
ASHEVILLE, NORTH CAROLINA
Affiliated with Duke University
A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock,
psychotherapy, occupational and recreational therapy — for nervous and mental disorders.
The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western
North Carolina, affording exceptional opportunity for physical and emotional rehabilitation.
The OUT-PATIENT CLINIC offers diagnostic services and therapeutic treatment for selected cases desiring
non-resident care.
R. Charman Carroll, M.D. Robert L. Craig, M.D. John D. Patton, M.D.
Medical Director Associate Medical Director Clinical Director
1416
Volume XLIV
Number 12
mm
Information
Brochure
Rates
Available to Doctors
and Institutions
A MODERN HOSPITAL
FOR EMOTIONAL
READJUSTMENT
0 Modern Treatment Facilities
0 Psychotherapy Emphasized
0 Large Trained Staff
0 Individual Attention
0 Capacity Limited
0 Occupational and Hobby Therapy
0 Healthful Outdoor Recreation
0 Supervised Sports
0 Religious Services
0 Ideal Location in Sunny Florida
MEDICAL DIRECTOR — SAMUEL G. HIBBS, M.D. ASSOC. MEDICAL DIRECTOR — WALTER H. WELLBORN, Jr., M.D.
PETER J. SPOTO, M.D. ZACK RUSS, Jr., M.D. ARTURO G. GONZALEZ, M.D.
Consultants In Psychiatry
SAMUEL G. WARSON, M.D. ROGER E. PHILLIPS, M.D. WALTER H. BAILEY, M.D.
TARPON SPRINGS • FLORIDA • ON THE GULF OF MEXICO • PH. VICTOR 2-1811
J
Westbrooks Sanatorium
Rl CHMO N D
CstabLished 1<)/L • ■ VIRGINIA
A private psychiatric hospital em-
ploying modern diagnostic and treat-
ment procedures — electro shock, in-
sulin. psychotherapy, occupational
and recreational therapy — for nervous
and mental disorders and problems of
addiction.
Staff
PAUL V. ANDERSON, M.D., President
REX BLANKINSHIP, M.D., Medical Director
JOHN R. SAUNDERS, M.D., Assistant
Medical Director
THOMAS F. COATES, M.D., Associate
JAMES K. HALL, JR., M.D., Associate
CHARLES A. PEACHEE, JR., M.S., Clinical
Psychologist
R. H. CRYTZER, Administrator
Brochure of Literature and l ieus Sent On Request - P. 0. Box 1514 - Phone 5-3245
J. Florida M.A.
June, 1958
INDEX TO ADVERTISERS
1417
• Allen’s Invalid Home
• Ames Co., Inc.
• Anclote Manor
• Anderson Surgical Supply Co.
• Appalachian Hall .
• Ayerst Laboratories
• Baker Laboratories .....
• Ballast Point Manor
• Birtcher Corp. ..
• Brawner’s Sanitarium
• Brayten Pharmaceutical Co. ...
• Bristol-Myers Co.
• Burroughs Wellcome & Co.
• Carlton Corp
• Colonial Properties, Inc.
• Convention Press
• Coca-Cola Co.
• Davies, Rose & Co. .
• Desitin Chemical Co.
• Duvall Home
• General Electric X-Ray Corp.
• Health-Mor, Inc
• Highland Hospital, Inc.
• Hill Crest Sanitarium
• Lakeside Laboratories
• Lederle Laboratories .....
• Eli Lilly & Co
• Loma Linda Food Co.
• Medical Protective Co.
1414
1318
1416
1390
1417
1376
1389
1414
1370
1415
1401
1378
1322, 1373
1372
1370
1414
1412
1383
1387
1410
1397
1314
1415
1418
1313
1324, 1325, 1366,
1367, 1382a
1326, 1377
1396
1413
Medical Supply Co. 1382
Merck Sharp & Dohme 1316, 1317, 1320, 1321,
1322, 1380, 1381, 1404, 1405
Miami Medical Center 1419
Parke-Davis & Co. 2nd Cover, 1311
Peck’s Rice Diet 1368
Pfizer Laboratories 1408, 1409
Piedmont Auto & Truck Rental, Inc. 1386
Precision Instruments 1364
Riker Laboratories Third Cover
A. H. Robins & Co.
Roerig & Co.
Sanborn Co.
Schieffelin & Co
G. D. Searle Company .
Schering Corp
Smith-Dorsey
Smith, Kline & French Labs.
E. R. Squibb & Sons
Surgical Supply Co.
Tucker Hospital, Inc.
S. J. Tutag
Upjohn Co.
U. S. Brewers Foundation
Wallace Laboratories
Westbrook Sanatorium
Wine Advisory
Winthrop Laboratories, Inc.
1323, 1379, 1384, 1385
1375, 1392, 1393, 1395
1371
1411
1315, 1365
1318a, 1398
1407
Back Cover
1374
1394
1418
1400
1399
1319
1390a, 1391, 1403
1416
1402
1369, 1406, 1410
APPALACHIAN HALL
ASHEVILLE Established 1916 NORTH CAROLINA
An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convales-
cence, drug and alcohol habituation.
Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complele
laboratory facilities including electroencephalography and X-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town, which justly claims an all around
climate for health and comfort. There are ample facilities for classification of patients, rooms single or en
suite.
Wm. Ray Griffin Jr. M.D. Mark A. Griffin Sr., M.D.
Robert A. Griffin, M.D. Mark A. Griffin Jr., M.D.
For rates and further information write Appalachian Hall, Asheville, N. C.
1418
Volume XUV
Number 12
TUCKER HOSPITAL, INC.
212 West Franklin Street
Richmond. Virginia
A private hospital for diagnosis and treatment of psychiatric and neuro-
logical patients. Hospital and out-patient services.
(Organic diseases of the nervous system, psychoneuroses, psychosomatic
disorders, mood disturbances, social adjustment problems, involutional
reactions and selective psychotic and alcoholic problems.)
Dr. Howard R. Masters
Dr. George S. Fultz, Jr.
Dr. James Asa Shield
Dr. Amelia G. Wood
Dr. Weir M. Tucker
Dr. Robert K. Williams
Out-Patient Clinic and Offices
HILL CREST SANITARIUM
Established in 1925
FOR NERVOUS AND MENTAL DISEASES
AND ADDICTION PROBLEMS
James A. Becton, M.D.
P. O. Box 2896, Woodlawn Station, Birmingham 6, Ala.
James K. Ward, M.D.,
Phone WOrth 1-1151
I J. Florida M.A.
I June, 1958
SCHEDULE OF MEETINGS
1419
ORGANIZATION
I Florida Medical Association
Florida Medical Districts
. A-Northwest
B-Northeast
C-Southwest
D-Southeast
I Florida Specialty Societies
I Academy of General Practice
Allergy Society
Anesthesiologists, Soc. of
Chest Phys., Am. Coll., Fla. Chap.
Dermatology, Soc. of
| Health Officers’ Society
Industrial and Railway Surgeons
Internal Medicine
I Ob. and Gynec. Society
Ophthal. & Otol., Soc. of
] Orthopedic Society
Pathologists, Society of
Pediatric Society
Plastic & Reconstructive Surgery
Proctologic Society
Psychiatric Society
Radiological Society
Surgeons, Am. Coll., Fla. Chapter
Urological Society
Florida-
Basic Science Exam. Board
Blood Banks, Association
Blue Cross of Florida, Inc
Blue Shield of Florida, Inc.
Cancer Council
Diabetes Assn
Dental Society, State
Heart Association
Hospital Association
Medical Examining Board
Medical Postgraduate Course
Nurse Anesthetists, Fla. Assn.
Nurses Association, State
Pharmaceutical Assoc., State
Public Health Association
Trudeau Society
Tuberculosis & Health Assn
Woman’s Auxiliary
American Medical Association
A.M.A. Clinical Session
Southern Medical Association
Alabama Medical Association
Georgia, Medical Assn, of
S. E. Hospital Conference
Southeastern Allergy Assn.
Southeastern, Am. Urological Assn.
Southeastern Surgical Congress
Gulf Coast Clinical Society
S.E. States Cancer Seminar
PRESIDENT
William C. Roberts, Panama City
S. Carnes Harvard, Brooksville
Alpheus T. Kennedy, Pensacola
Leo M. Wachtel, Jacksonville
Gordon H. McSwain, Arcadia
R. M. Overstreet Jr., W. Pm. Bch
Charles R. Sias, Orlando
G. Frederick Hieber, St. Petersburg
Breckinridge W. Wing, Orlando
George L. Baum, Coral Gables
Kenneth J. Weiler, St. Petersburg
Henry I. Langston, Apalachicola
Gordon H. McSwain, Arcadia
W. Dean Steward, Orlando
S. Carnes Harvard, Brooksville
Edson J. Andrews, Tallahassee
Luther C. Fisher Jr., Pensacola
Ira C. Evans, St. Petersburg
Henry G. Morton, Sarasota
Grover W. Austin, St. Petersburg
Sam N. Sulman, Orlando
James L. Anderson, Miami
C. Robert DeArmas, Daytona Bch.
Duncan T. McEwan, Orlando
Melvin M. Simmons, Sarasota
Mr. Paul A. Vestal, Winter Park
John B. Ross, Jax.
Mr. C. DeWitt Miller, Orlando
Russell li. Carson, Ft. Lauderdale
Ashbel C. Williams, Jacksonville
George H. Garmany, Tallahassee
Bryant S. Carroll, D.D.S., Jax
Simon D. Doff, Jacksonville
Ben P. Wilson, Ocala
Sidney Stillman, Jacksonville
Turner Z. Cason, Jacksonville
Miss Vivian M. Duxbury, Tal.
Martha Wolfe R.N., Coral Gables
Grover F. Ivey, Orlando
Fred B. Ragland, Jax.
Kip G. Kelso, Vero Beach
DeWitt C. Daughtry, Miami
Mrs. Perry D. Melvin, Miami
David B. Allman, Atl’tic City, N.J.
W. Kelly West, Oklahoma City
E. G. Graham Jr., Birmingham
Lee Howard Sr., Savannah
Mr. Pat Groner, Pensacola
Clarence Bernstein, Orlando
Lawrence Thackston, Or’burg S.C.
M. M. Copeland, Washington, D.C.
Lee Sharp, Pensacola
SECRETARY
Samuel M. Day, Jacksonville
Council Chairman
T. Bert Fletcher Jr., Tallahassee
Don C. Robertson, Orlando
John M. Butcher, Sarasota
Nelson Zivitz, Miami Beach
A. Mackenzie Manson, Jacksonville
I. Irving Weintraub, Gainesville
George H. Mix, Lakeland
Ivan C. Schmidt, W. Palm Beach
Jack H. Bowen, Jacksonville
Lorenzo L. Parks, Jacksonville
John H. Mitchell, Jacksonville
Charles K. Donegan, St. Pet’sburg
T. Bert Fletcher Jr., Tallahassee
Joseph W. Taylor Jr., Tampa
Wendell J. Newcomb, Pensacola
Clarence W. Ketchum, Tallahassee
Harry M. Edwards, Ocala
Bernard L. N. Morgan, Jax
Don C. Robertson, Orlando
Samuel G. Hibbs, Tampa
Russell D. D. Hoover, W. P. Bch.
C. Frank Chunn, Tampa
Henry L. Smith Jr., Tallahassee.
M. W. Emmel, D.V.M., Gainesville
Mrs. Carol Wilson, Jax
Mr. H. A. Schroder, Jacksonville
John T. Stage, Jacksonville
Lorenzo L. Parks, Jacksonville
Grover C. Collins, Palatka
G. J. Perdigon, D.D.S., Tampa
Mrs. E. D. Pearce, Miami
Robert E. Rafnel, Tallahassee
Homer L. Pearson Jr., Miami
Chairman
Mrs. Mabel Shepard, Pensacola
Agnes Anderson, R.N., Orlando
Mr. R. Q. Richards, Ft. Myers
Nathan J. Schneider, Jax.
George H McCain, Tallahassee
Mrs. R. H. McIntosh, Port St. Joe
Mrs. Wendell J. Newcomb, Pensa.
Geo. F. Lull, Chicago
Mr. V. O. Foster, Birmingham
Douglas L. Cannon, Montgomery
Chris J. McLoughlin, Atlanta
Charles W. Flynn, Jackson, Miss.
Kath. B. Maclnnis, Columbia, S.C.
S. L. Campbell, Orlando
R. T. Beasley, Atlanta
J. J. Baehr Jr., Pensacola
ANNUAL MEETING
Marianna
Cocoa
Fort Myers
Miami
Miami, June 7, ’58
June 29, 1958
W. Palm Beach, Oct 2-4, ‘1958
San Francisco, June 23-27, ’58
Minneapolis, Dec. 2-5, ’58
New Orleans, Nov. 3-6, ’58
Birmingham, Apr. 9-11, ’59
Augusta ’59
Miami Beach, Mar. 9-12, ’59
Pensacola, Oct. 23-24, ’58
Tampa, Nov. 19-21, ’58
MIAMI MEDICAL CENTER
P. L. Dodge, M.D.
Medical Director and President
1861 N.W. South River Drive
Phones 2-0243 —9-1448
A private institution for the treatment of ner-
vous and mental disorders and the problems of
drug addiction and alcoholic habituation. Modern
diagnostic and treatment procedures — Psycho-
therapy. Insulin. Electroshock, Hydrotherapy,
Diathermy and Physiotherapy when indicated.
Adequate facilities for recreation and out-door
activities. Cruising and fishing trips on hospital
yacht.
information on request
MeniDer American Hospital Association
1420
Volume XLIV
Number 12
FLORIDA MEDICAL ASSOCIATION
Officers and Committees
OFFICERS
JERE W. ANNIS, M.D., President. . .
Lakeland
RALPH W. JACK. NED.. Pres.-Elect. . .
Miami
S. CARNES HARVARD. M.D.,
1st Vice Pres
. . . Brooksville
WALTER E. MURPHREE, M.D.,
2nd Vice Pres
JOSEPH W. DOUGLAS, M.D..
3rd Vice Pres
SHALER RICHARDSON. M.D., Editor. Jacksonville
MANAGING DIRECTOR
ERNEST R. GIBSON Jacksonville
W. HAROLD PARHAM, Associate Jacksonville
BOARD OF GOVERNORS
JERE W. ANNIS, M.D., Chm. Ex Officio. . . .Lakeland
JAMES N. PATTERSON, M.D... AL-59 Tampa
CLYDE O. ANDERSON, M.D.. .059. .St. Petersburg
REUBEN B. CHRISMAN JR..
M.D...D-60 Coral Gables
MEREDITH MALLORY, M.D... B-61 Orlando
ALPHEUS T. KENNEDY, M.D.. A-62. . Pensacola
FRANCIS H. LANGLEY.
M.D. PP-59 St. Petersburg
WILLIAM C. ROBERTS. M.D.. . PP-60. Panama City
RALPH W. JACK. M.D., Ex Officio Miami
SAMUEL M. DAY, M.D., Ex Officio. . . .Jacksonville
JOHN D. MILTON, M.D. . . S.B.H.-59 Miami
EDWARD JELKS, M.D.
(Public Relations) Jacksonville
ERNEST R. GIBSON (Advisory) Jacksonville
Subcommittees
1. Veterans Care
FREDERICK H. BOWEN, M.D Jacksonville
GEORGE M. STUBBS, M.D Jacksonville
W. TRACY HAVERFIELD, M.D Miami
EDGAR WATSON, M.D Lakeland
JAMES L. BRADLEY, M.D Fort Myers
IOUIS M. ORR, M.D. (Advisory) Orlando
Committees
COUNCILOR DISTRICTS AND COUNCIL
WARREN W. QUILLIAN, M.D., Chm. AL-59 Coral Gables
First — PAUL F. BARANCO, M.D. .1-60 Pensacola
Second— T. BERT FLETCHER JR., M.D. 2-59 Tallahassee
Third — J. MAXEYF DELL JR., M.D. 3-60 Gainesville
Fourth— DON C. ROBERTSON, M.D. 4-59 Orlando
Fifth— JOHN M. BUTCHER, M.D 5-59 Sarasota
Sixth — MARION W. HESTER. M.D. 6-60 Lakeland
Seventh— ALVIN E. MURPHY, M.D 7-60 P aim Beach
Eighth— NELSON ZIVITZ, M.D 8-59 Miami
ADVISORY TO SELECTIVE SERVICE
EOR PHYSICIANS AND ALLIED SPECIALISTS
I 0')' HI R ( H \ PPI LL, M.D., ( hm. Orlando
rHOMAS H. BATES, M.D. “A” Lake ( its
FRANK L. FORT, M.D "B” Jacksonville
ALVIN L. MILLS, M.D. “C” Miami
JOHN D. MILTON, M.l). "D" Miami
BLOOD
JAMES N. PATTERSON, M.D., Chm. C-61 Tampa
MALCOLM li. BURRIS, M I). AL-59 Lakeland
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
DONALD W. SMITH, M.D. I) no Miami
( MERRIL1 WHORTON, M.D. B-62 Jacksonville
ADVISORY TO BLUE SHIELD
HENRY J. BABERS JR., M.D., Chm. AL-59 Gainesville
GRETCHEN V. SQUIRES, M.D. A 59 Pensacola
111 NRY I II Wilil I L, M.D. I! 59 Ocala
JAMES II BOLLWAItl JR., M.D. C 59 lakeland
RALPH M. OVERSTREET JR., M.D D 59 W. Palm Beach
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
ROBERT L. /I I I \ I It, M.D. I! 60 Orlando
WHITMAN C. McCONNELL, M.D. < no St. Petersburg
RALPH S. SAPPENF1ELD, M.D. D-60 Miami
HAROLD E. WAGER, M.D. A-61 Panama City
CHARLES F. McCRORY, M.D. B-61 Jacksonville
JOHN S. STEWART, M.l). C-61 I ort Myers
DONALD l MARION, M.D. D-61 Miami
HENRY I SMITH JR., M.l) V-62 Tallahassee
Mills I (lllll D1 V M.D. B-62 Daytona Beach
III III II I W. COLEMAN, M.D. C-62 At on Park
ELWIN G. NEAL, M.D D-62 Miami Shores
CANCER CONTROL
ROBERT I. DICKEY, M.D., Chm. D-62 Miami
JAMES I Sill I DIN, M.D. \l 59 lakeland
BARCLE1 I). RHEA, M.D. A-59 Pensacola
ALFONSO I. MASSARO, M.D. ( no Tampa
WILLIAM \ VAN NORTWICK, M.D. B-61 Jacksonville
CHILD HEALTH
WARREN W. QUILLIAN, M.D., Chm AL-59 Coral Gables
WILLIAM S. JOHNSON, M.D. ( 59 Lakeland
GEORGE S. PALMER, M.D A-60 I allahassee
J. K. DAVID JR., M.D. B-61 Jacksonville
ROBERT F. MIKELL, M.D D-62 South Miami
CIVIL DEFENSE AND DISASTER
W. DEAN STEWARD, M.D., Chm. B-61 Orlando
KARL B. HANSON, M.D. AL-59 Jacksonville
JOHN V. HANDWERKI R JR., M.D. D 59 Miami
WALTER C. PAYNE JR., M.D. A-60 Pensacola
THEODORE C. KERAMIDAS, M.D. C 62 Winter Haven
CONSERl'A T ION OE VISION
MARION W. HESTER, M.D., Chm. C-62 .._ Lakeland
EDSON J. ANDREWS, M.D. AL-59 Tallahassee
CHARLES C. GRACE, M.D. B-59- „ St. Augustine
ALAN E. BELL, M.D. A-60 Pensacola
LAURIE R. TEASDALE, M.D D-61 W. Palm Beach
GRIEI'ANCE COMMITTEE
FREDERICK K. HERPEL, M.D., Chm. __._W. Palm Beach
WILLIAM C. ROBERTS, M.D Panama City
FRANCIS H. LANGLEY’, M.D St. Petersburg
JOHN D. MILTON, M.D Miami
DUNCAN T. McEWAN, M.D Orlando
LEGISLATION AND PUBLIC POLICY
H. PHILLIP HAMPTON, M.D., Chm C-59 Tampa
BURNS A. DOBBINS JR., M.D. AL-59 Tort Lauderdale
CECIL M. PEEK, M.D. D 60 W. Palm Beach
GEORGE H. GARMANY, M.D A 61 Tallahassee
EDWARD JELKS, M.D B-62 Jacksonville
JERE W. ANNIS, M.D. (Ex Officio) Lakeland
MATERNAL WELFARE
E. FRANK McCALL, M.D., Chm. B-60 Jacksonville
COY L. LAY, M.D. AL-59 Lakeland
RICHARD F. STOVER, M.D D-59 Miami
S. I. WATSON, M.D. C 61 Lakeland
JOSEPH W. DOUGLAS, M.D A-62 Pensacola
J. Florida M.A.
June, 1958
1421
MEDICAL ECONOMICS
SCIENTIFIC W ORK
S. CARNES HARVARD, M.D., Chm C-59
DeWITT C. DAUGHTRY, M.D AL-59 ....
MERRITT R. CLEMENTS, M.D. A-60
FLOYD K. HURT, M l) IS 61
RALPH S. SAPPENFIF.I.D, M.D. 1)62
Brooksville
Miami
Tallahassee
Jacksonville
Miami
LAWRENCE E. GEESLIN, M.D., Chm.
RICHARD REESER JR., M.D. C-59
GEORGE T. HARRELL JR., M.D. B-60
JOHN M. PACKARD, M.D. A-61
FRANZ H. STEWART, M.D. D-62
AL-59 Jacksonville
St. Petersburg
Gainesville
Pensacola
Miami
MEDICAL EDUCATION AND HOSPITALS
JACK Q. CLEVELAND, M.D., Chm. D-62 Coral Gables
ADDISON L. MESSER, M.D. AL-59 St. Petersburg
WILLIAM G. MERIWETHER, M.D. C-59 Plant City
WALTER E. MURPHREE, M.D. B-60 Gainesville
RAYMOND R. SQUIRES, M.D. A-61 Pensacola
Subcommittee
1. Medical Schools Liaison
STATE CONTROLLED MEDICAL INSTITUTIONS
WILLIAM D. ROGERS, M.D., Chm. A-60 Chattahoochee
J. ROBERT CAMPBELL, M.D AL-59 Tampa
WHITMAN II. McCONNFLL, M.D. C-59 St. Petersburg
DONALD W. SMITH, M.D. D-61 Miami
LAWRENCE H. KINGSBURY, M.D. B-62 Orlando
WALTER E. MURPHREE, M.D., Chm B-62 Gainesville
HENRY H. GRAHAM, M.D. AL-59 Gainesville
EDWARD W. CULLIPHER, M.D D-59 Miami
MERRITT R. CLEMENTS, M.D A-60 Tallahassee
JAMES N. PATTERSON, M.D. C-61 Tampa
HOMER F. MARSH, Ph.D. Univ. of Miami
School of Medicine 1961 Miami
GEORGE T. HARRELL JR., M.D., Univ. of Florida
College of Medicine 1960 Gainesville
Special Assignment
1. Florida Medical Foundation
TUBERCULOSIS AND PUBLIC HEALTH
HAWLEY II. SEILER, M.D., Chm C-59 Tampa
HOWARD M. DuBOSE, M.D AL-59 Lakeland
HAROLD B. CANNING, M.D. A-60 Wewachitchha
LORENZO L. PARKS, M.D B-61 Jacksonville
M. EUGENE FLIPSE, M.D D-62 Miami
Special Assignment
1. Diabetes Control
MEDICAL POSTGRADUATE COURSE
TURNER Z. CASON, M.D., Chm B-59 Jacksonville
DONALD F. MARION, M.D AL-59 Miami
WILLIAM D. CAWTHON, M.D A-60 DeFuniah Springs
V. MARKLIN JOHNSON, M.I). D-61 W. Palm Reach
ALBERT G. KING JR., M.D C 62 Lakeland
MENTAL HEALTH
SULLIVAN G. BEDELL, M.D, Chm. B-61
WALTER H. WELLBORN JR., M.D. AL 59
W. TRACY HAVFRFIFI.D, M.D. I) 59
MASON TRUPP, M.D. C 60
WILLIAM M C. WILHOIT, M.D. A 62
NECROLOGY
LEO M. WACHTEL, M.D., Chm. B-59 Jacksonville
EMMETT E. MARTIN, M.D. AL 59 Haines Citv
ALVIN L. STF.BBINS, M.D A 60 Pensacola
RAYMOND II. CENTER, M.D. C-61 Clearwater
SCHEFFEL II. WRIGHT, M.D. D-62 Miami
NURSING
THOMAS C. KENASTON, M.D., Chm B-59 Cocoa
A. JUDSON GRAVES, M.D. AL-59 Jacksonville
NORVAL M. MARR SR., M.D C-60 St. Petersburg
JAMES R. SORY, M.D. D-61 W. Palm Beach
HERBERT L. BRYANS, M.D. A-62 Pensacola
POLIOMYELITIS MEDICAL ADVISORY
RICHARD G. SKINNER JR., M.D., Chm. B 59 Jacksonville
ROBERT J. PFAFF, M.D AL-59 Lakeland
EDWARD W. CULLIPHER, M.D D-60 Miami
FRANK H. LINDEMAN JR., M.D C-61 Tampa
WILLIAM J. HUTCHISON, M.D. A-62 Tallahassee
REPRESENTATIVES TO INDUSTRIAL COUNCIL
PASCAL G. BATSON JR., M.D., Chm. A-60 Pensacola
FRANCIS T. HOLLAND, M.D. AL-59 Tallahassee
THOMAS N. RYON, M.D I) 59 Miami
RAYMOND R. KILLINGEH, M.D. B-61 Jacksonville
Special Assignment
I. Industrial Health
VENEREAL DISEASE CONTROL
LORENZO L. PARKS, M.D., Chm. B-60 Jacksonville
JOHN M. KIBLER, M.D AL-59 Lakeland
LINUS W. HEWIT, M.D C-59 Tampa
C. W. SHACKELFORD, M.D A-61 Panama City
JACK A. McKENZIE, M.D D 62 Miami
WOMANS AUXILIARY ADVISORY
L. WASHINGTON DOWLEN, M.D., Chm. D-62 Miami
WILLARD E. MANRY JR., M.D. AL-59 Lake Wales
G. DEKLE TAYLOR, M.D B-59 Jacksonville
MERRITT R. CLEMENTS, M.D. A-60 Tallahassee
CHARLES McC. GRAY, M.D C-61 Tampa
A.M.A. HOUSE OE DELEGATES
IOUIS M. ORB. M.D . Delegate Orlando
REUBEN B. CHRISMAN JR., M.D., Delegate Coral Gables
RICHARD A. MILLS, M.D., Alternate Ft. Lauderdale
(Terms expire Dec. 51, 1959)
FRANK D. GRAY, M.D., Alternate Orlando
(Terms expire Dec. 31, 1960)
FRANCIS T. HOLLAND, M.D., Delegate Tallahassee
(Terms expire Dec. 31, 1960)
WALTER E. MURPHREE, M.D., Alternate. Gainesville
BOARD OF PAST PRESIDENTS
WILLIAM E. ROSS, M.D., 1919 Jacksonville
JOHN C. VINSON, M.D., 1924 Fort M vers
FREDERICK J. WAAS, M.D., 1928 Jacksonville
JULIUS C. DAVIS, M.D., 1930 Quincy
WILLIAM M. ROWLETT, M.D., 1933 Tampa
HOMER L. PEARSON JR., M.D., 1934 Miami
HERBERT L. BRYANS, M.D., 1935 ... Pensacola
ORION O. FEASTER, M.D., 1936 Maple Valley, Wash.
EDWARD I ELKS, M.D., 1937 Jacksonville
LEIGH F. ROBINSON, M.D., 1939 Fort I under dale
WALTER G. JONES, M.D., 1941 Miami
EUGENE G. PEEK SR„ M.D. 194 3 Ocala
SHALEII RICHARDSON, M.D., 1946 Jacksonville
WILLIAM C. THOMAS SR., M.D. 1947 Gainesville
IOSEPH S. STEWART, M.D., 1948 Miami
WALTER C. PAYNE SR., M.D., 1949 Pensacola
HERBERT E. WHITE, Ml)., 1950 St. Augustine
DAVID It. MUItPHEY JR., M.D., 1951 Tampa
ROBERT It. McIVER. M l)., 1952 Jacksonville
FREDERICK K. IIERPEL, M.D., 1953 W. Palm Beach
DUNCAN T. McEWAN, M.D, 1954 Orlando
IOHN I). Mil ION. M l)., 1955 Miami
FRANC Is II. LANGLEY, M.D., 1956 St. Petersburg
WILLIAM C. ROBERTS, M l)., Secy., 1957 Panama City
Jacksonville
Tampa
Miami
Tampa
Pensacola
1422
Volume X I. IV
Number 12
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Many such
hypertensives have
been on Rauwiloid
for 3 years
and more*
for Rauwiloid IS better tolerated . . .
“alseroxylon [Rauwiloid] is an anti-
hypertensive agent of equal thera-
peutic efficacy to reserpine in the
treatment of hypertension but with
significantly less toxicity.”
*Ford, R.V., and Moyer, J.H.: Rau-
wolfia Toxicity in the Treatment of
Hypertension, Postgrad. Med. 23:41
(Jan.) 1958.
Rauwiloid *
Enhances safety when more potent drugs
are needed.
Rauwiloid® + Veriloid®
alseroxylon 1 mg. and alkavervir 3 mg.
for moderate to severe hypertension.
Initial dose, 1 tablet t.i.d., p.c.
just two tablets
at bedtime
After full effect
one tablet suffices
Rauwiloid® + Hexamethonium
alseroxylon 1 mg. and hexamethonium chloride
dihydrate 250 mg.
in severe, otherwise intractable hyper-
tension. Initial dose, 34 tablet q.i.d.
Both combinations in convenient
single-tablet form.
LOS ANGELES
premenstrual tension
responds very well to Compazine*
• agitation and apprehension are promptly relieved
• emotional stability is considerably improved
• nervous tension and fatigue are greatly reduced
• appetite and sleep patterns improve
• depression often disappears
For prophylaxis: ‘Compazine’ Spansulet capsules provide all-day or
all-night relief of anxiety with a single oral dose. Also available: Tablets,
Ampuls, Multiple dose vials, Syrup and Suppositories.
Smith Kline & French Laboratories , Philadelphia
*T.M. Reg. U.S. Fat. Off. for prochlorperazine, S.K.F.
tT.M. Reg. U.S. Pat. Off. for sustained release capsules, S.K.F,
-V
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